In this edition of Healthcare Papers, Sutherland and colleagues reflect on their experiences developing a pan-Canadian picture of quality measurement (Sutherland and Leatherman 2010). Their review points out shortcomings, gaps and variations in how we measure and report on the performance of our healthcare system. The picture is not good. It is no better when we consider what the actual data say about the health system performance in Canada. On the basis of this chartbook – which is a useful compendium of quality data from multiple sources – one of us (T.S.) made this case clearly at the Canadian Health Services Research Foundation (CHSRF) CEO Forum in 2010: Canada gets a B grade. In the commentaries that follow, several authors raise – and seem to accept – this B grade.