Michael H. Brown, a freelance writer and former reporter for the Louisville Courier-Journal, offers an in-depth examination of a single program, the National Health Care Purchasing Institute. A great deal went wrong in the planning, oversight, and execution of the initiative. Ultimately, the Foundation terminated its support ahead of schedule and transferred the remaining funds from one grantee to another. As Brown recounts it, this is a story of confusion of purpose, disagreement both internally and among the various participants, poor communications, and precipitous program termination. All told, not a particularly pretty tale, and the editors (and others at the Robert Wood Johnson Foundation) debated whether to make it public. In the final analysis, the value of the piece to the field persuaded us to publish the chapter.