The US health care system has reached a tipping point when there is both little doubt about the kind of change that is needed and much uncertainty about how to achieve it. This issue of JAMA, a theme issue on Critical Issues in US Health Care, includes 3 scholarly Special Communications and 11 authoritative and thought-provoking Viewpoints that map out this dilemma and highlight potential solutions. The topics all relate to fundamental aspects of how the US health care system functions, with subjects selected in an iterative process involving the editorial board of JAMA. The goal was to expand the discussion beyond just cost, quality, and value.