Although there is consensus regarding the existence of a healthcare crisis, that point is where the consensus stops, even within defined professional and demographic groups. Clearly there is evidence that we must address a growing societal expenditure for healthcare, an aging and more complex patient population, a shortage of physicians and other health care providers, and health outcomes disparities amongst population groups. This article emphasizes how these factors impact healthcare nationally and in Hawai'i. The second part of this series outlines approaches that can enhance health in the United States without creating economic collapse.