The document summarizes the current landscape for health care reform in the United States. It discusses the prospects for reform given Democratic control of Congress and the White House as well as the economic crisis. However, it also notes challenges like a split public and the need to control costs long term. The document advocates for a blended policy approach that combines expanding access through mechanisms like subsidies, exchanges and Medicaid expansion, while also implementing reforms to curb cost growth and improve quality, such as payment reform, health IT and establishing best practices.