Arthur Miller moderates a panel discussion of the need for universal health coverage in the US, pressing challenges to the US health care system, and possible solutions. Distinguished Panelists: **Charles D. Baker**, president, CEO, Harvard Pilgrim Health Care **Arthur Caplan**, professor, bioethics, UPenn **Karen Davis**, president, Commonwealth Fund **Susan Dentzer**, editor-in-chief, Health Affairs **Arnold M. Epstein**, Harvard School of Public Health, associate editor, NEJM **Bill Frist**, former US Senator; visiting professor, Princeton **Robert S. Galvin**, director, global health care, General Electric **Ruben King-Shaw Jr.**, chair, CEO, Mansa Equity Partners **Thomas H. Lee**, president, Partners HealthCare, associate editor, NEJM **Jonathan B. Oberlander**, associate professor, Social Medicine, Health Policy, UNC **Sara Rosenbaum**, professor, Health Law, Policy, George Washington University **Steven Schroeder**, professor, Health and Health Care, UCSF **Reed V. Tuckson**, executive vice president, chief, Medical Affairs, UnitedHealth Group In the New England Journal of Medicine's 2008 Shattuck Lecture, 13 distinguished panelists, including physicians, academics, and business, insurance, and political leaders, address the need for universal health coverage in the United States, pressing challenges to the US health care system and possible solutions in a discussion moderated by law professor Arthur Miller. The group addresses the dissatisfaction among physicians in general and primary care providers in particular and consider its relationship to a reimbursement system that rewards high-tech procedures rather than cognitive work and time spent with patients; various approaches to payment reform are proposed. The discussion also covers the growing need for major investments of time and money in information technology and the payoff that other countries have seen. Several participants express concern about the disproportionately high costs of new drugs and end-of-life care in the United States and broach the topics of negotiation of drug prices, cost-effectiveness analyses, and rationing. After considering the political, social, and economic obstacles to achieving universal access to care, the panel concludes with remarks on the politics of health care reform and speculation about change under a new administration. Produced by the New England Journal of Medicine and the Massachusetts Medical Society.