About 2 years ago, I reviewed various options proposed for reforming the health care system.1 These options included further patches for the current problematic system or more sweeping change resulting in a universal program. Assessment of progress during the interval yields an evident conclusion: very little has happened. The buzzword in Washington, DC, this year is gridlock and that term certainly applies to health care reform. Nothing of substance has changed. Most of the proposals have stagnated. Some have been "shot down," eg, the Oregon plan that proposes rationing health care on the basis of cost benefit for various services. (Although down, it may not yet be out.) In part, the lack of action relates to the election year. Both presidential candidates gave high priority and much lip service to health care reform in their campaigns and both described health care plans in fairly general terms.2,3 In addition,