European countries, but for infants born at 37 or more weeks, the U.S. infant mortality rate is the highest. (Behind International Rankings of Infant Mortality: How the United States Compares with Europe, Marian MacDorman and T.J. Mathews, IJHS, Vol 40, No 4, 2010). US infant mortality is not high compared to other countries.  It just appears that way because of the way we classify life births In 2005, the U.S. ranked 30th in the world in infant mortality. The most rigorous investigation of infant mortality in the U.S. and Europe found that even excluding infants &lt; 22 weeks, the U.S. has appallingly high infant mortality (5.8 per 1,000 births versus 3.0 in Norway and Sweden).  Much of the excess mortality is related to the much higher proportion of premature births in the U.S, the period when infant mortality is greatest.  If the U.S. had the same distribution of births by gestational age as Sweden, nearly 8,000 infant deaths would be averted each year, and the U.S. infant mortality rate would be 1/3 lower.  The Infant mortality rate in the U.S. for preterm (&lt; 37 weeks) births is comparable to that of European countries, but for infants born at 37 or more weeks, the U.S. infant mortality rate is the highest. (Behind International Rankings of Infant Mortality: How the United States Compares with Europe, Marian MacDorman and T.J. Mathews, IJHS, Vol 40, No 4, 2010). Can the ACA exchanges serve as a stepping stone to single-payer reform? A properly structured single