Since 1900, life expectancy at birth has increased by an unprecedented 30 years in the United States and other developed countries. Before World War II, most of the gains resulted from improvements in nonmedical factors: nutrition, sanitation, housing, and public health measures. Since World War II, however, biomedical innovations (new drugs, devices, and procedures) have been the primary source of increases in longevity. These innovations have also been the most important reason why health care expenditures have grown 2.8% per year more rapidly than the rest of the economy over the past 30 years.1 Will the future simply be a rerun of recent decades? Probably not. Current demographic, social, and economic forces will create new priorities for future biomedical innovations: more emphasis on improving quality of life and less on extending life, and more attention to value-enhancing innovations instead of pursuit of any medical advance regardless of its cost relative to its benefit.