As of this early June writing, our welcomed spring season has turned into something far less celebratory in regard to prospects for a smooth and unfettered transition to health reform. Harsh economic and political realities concerning the financing and structure of a viable reform package have emerged. These pressure points threaten to unravel the fragile coalition of consumers, business leaders, providers, insurers, and organized labor that has been touted as the driving force for today's reform and the missing ingredient in prior reform efforts. Despite President Obama's admonition in his February 24 address to the nation that "health reform cannot wait, it must not wait, and it will not wait another year" and the administration's optimism that a bipartisan health reform package will be in place by summer's end, the process of developing a final reform proposal may be a painful and frustrating exercise for all interest groups involved. In anticipation of what may be a contentious reform debate, the events of May provide a useful context for understanding the competing forces that over subsequent months are likely to shape the development of reform legislation or frustrate such efforts. These events have brought into sharp relief the fiscal reality of financing health care reform; the reality that a consolidated effort to impose cost containment discipline will be necessary to alleviate reform's financing pressures; the reality that creation of a new public health insurance plan will be a key point of contention in a bipartisan reform effort; and the reality that a newly minted media campaign will be waged to win the public's "hearts and minds" regarding alternative visions of health reform.