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these extraordinarily difficult choices. They took their chal-lenge seriously, they learned a great deal from each other, and they came to terms with the choices in ways that would astonish many political leaders and technical experts in health care. Citizens were quick to grasp the budgetary and technological pressures we face, and yet they were able to articulate a set of values-based choices about a system that is immensely important to them. They were remarkably pragmatic and clear about the choices. This dialogue was commissioned by the Commission on the Future of Health Care in Canada, led by Roy Ro-manow. The dialogue involved 12 groups of 40 citizens, se-lected to represent the Canadian population. Over the course of a full day, they constructed a consensus view of what an ideal health care system would look like in 10 years ’ time, and then worked through the trade-offs and choices that would make that system financially sustainable. The Commission will publish the report on this dialogue this month. Mr. Romanow is also engaged in an intensive dialogue with the stakeholders — providers, managers and governments. In his final report in November, he will therefore have a unique opportunity to create the synthesis of the values base of Canadians with the best technical ad-vice available from the people who govern, manage and de-liver health care in Canada. Mr. Romanow will have all the right materials to reno-vate the medicare edifice. In November, we shall see what architecture he recommends