The momentum for health system reform continues to gain support and cooperation from many groups who were opposed to reform in the past. The uninsured and underinsured numbers have increased with the rising cost of health care and the worsening economy. Designing a health care delivery system that delivers quality patient-centered care will require the direct involvement of patients and medical professionals. The American College of Cardiology is recognized for its commitment to education and quality and a commitment to quality metrics that facilitate best practice. The American College of Cardiology needs to continue its leadership role to ensure that health care reform meets the expectations of our patients and members.