The United States appears headed toward another national debate about health system reform. Worry about access and health system deficiencies has reached critical mass, and polls indicate that health care leads the domestic agenda for the 2008 elections. This debate, like previous debates, will succeed or fail in Congress. We highlight key elements of recent sagas in health legislation and offer advice to the next president and Congress for improving the likelihood of a successful outcome in 2009-10: (1) make health reform a top legislative priority; (2) be leaders, not partisans; and (3) develop broad policy consensus but leave the policy details to Congress. [ABSTRACT FROM AUTHOR]