The speaker emphasizes the importance of academic medical centers in providing the foundation upon which the excellence of the American health care system is built. The challenge of health care reform is to preserve what is best about that system and to fix what needs to be changed. The most important aspect of the president's health care reform initiative (the Health Security Act)--and one that the president insists upon--is universal coverage with comprehensive benefits. But many areas of the reform package are negotiable. The speaker then discusses health care reform issues that are of concern to academic medicine: the proposed new source and magnitude of future federal funding for academic medical centers; the need to resist efforts to cap the rate of growth of Medicare and Medicaid rather than to reduce the rate in the context of overall health care reform; and the dangers of the balanced budget amendment to health care reform and academic medical centers. Next, the principles of the president's plan are explained: security (i.e., universal coverage with comprehensive benefits); savings (i.e., a more efficient health care system); simplicity (i.e., moving toward a single claim system and other ways to eliminate unnecessary paperwork); choice (for patients and for physicians regarding insurance plans); quality of care; and responsibility (of individuals for their own health care, of professionals for various decisions about health care; and for the financing of health care, a proposed employer-employee system). The speaker closes by reviewing the history of past administrations' efforts to reform U.S. health care: all these failed because of the efforts of the defenders of the status quo.(ABSTRACT TRUNCATED AT 250 WORDS)