America's health insurance system has few defenders, many critics, and no shortage of proposals for reform. Business and labor, the nation's governors, religious leaders, advocates for children and the elderly, and the public at large share a sense that major changes are necessary and inevitable. Political leaders such as Senate Majority Leader George Mitchell and House Majority Leader Richard Gephardt rank health care reform high among domestic priorities. Even the House Minority Leader, Newt Gingrich, has begun to focus on the shortcomings of our health insurance system. The challenge now is to develop a plan for comprehensive reform that has broad enough support to prevail over well-financed, deeply entrenched groups with an interest in the present system.