Most people would agree that in the ideal system, everyone would be covered by a good health insurance plan that provided high-value care at an affordable premium, but the interpretation of almost every word in that statement is subject to serious disagreement. Despite these disagreements, there are forces at work that might foster compromise. A compromise model that drew on past reform experiences would both expand coverage and focus spending on high-value care, ensuring that everyone had access to affordable basic care before subsidizing care of more questionable benefit and using choice and competition to promote cost-effective innovation.