The US healthcare debate is an old one and has long defied easy solutions. But it continues to entertain, and to stimulate. President Obama's ongoing attempts to persuade the nation to give up a degree of perceived freedom of choice in healthcare, so that basic healthcare could become available to all, has injected more energy and at least a temporary sense of urgency into the debate. A series of essays in the November-December 2009 issue of the Hastings Center Report highlights some of the current struggles of that society to provide itself an acceptable system of determining who has access to what kind of healthcare. It is easy to dismiss some of these struggles as self-imposed, but they are instructive for the rest of the world, particularly for more chaotic democracies such as ours, and especially in the context of rapidly increasing options in diagnostic and therapeutic technologies.