After a brief review of previous attempts at healthcare reform in the United States and the voting conditions surrounding Obama?s law, the author, in this lecture given on April 1, 2010, lists the main challenges that confront reform and to a greater extent determine its success or failure, i.e., maintaining the consensus, keeping lobbyists in check, ensuring complex and sensitive implementation, addressing issue of cost and considering the global economic context in which health is deeply imbedded. Lastly, in a postscript written in January, 2011, the author looks back on the first year of implementing health reform.