This commentary addresses three chief issues. First, it suggests that value in health is an inadequate goal in the absence of other important criteria for assessing healthcare systems, such as responsiveness and fairness. Second, it observes that the measurement of health outcomes necessary for obtaining value in health creates a danger of unintended consequences, as the healthcare providers being measured may try to avoid treating "difficult" patients. Third, it suggests that new mechanisms need to be employed to better align the interests of providers with those of patients.