The typical American family of four under age 65 spends about 40% of its household income on health care. It prompts disbelief. How can that possibly be? But the Milliman Medical Index estimated that a family of four spent on average $20,030 on health care, including the cost of health benefits and out-of-pocket spending, in 2013. At the same time, median household income has been estimated at $52,100. While Uwe Reinhardt, a health economist at Princeton University, has contrasted the two figures and noted they are not necessarily comparable, the contrast shows the real challenge in health care reform.