During the past 20 years, the great human service systems of the United States have suffered a spectacular decline in efficiency and effectiveness along with a spectacular increase in costs. The deficiencies threaten all of us. This work offers an original and penetrating explanation of how the problems in these systems developed, how they are interconnected, and how they might be remedied. The book does not confine itself to identifying perverse incentives, but assesses in detail the feasibility of removing or alleviating them in each of the systems considered.