Even if Congress and President Obama agree on health care reform legislation, much of the actual reform will require the work of academic medicine, said Darrell G. Kirch, president of the Association of American Medical Colleges, in a speech Sunday opening the association's annual meeting. Kirch reviewed the developments in the last year, from the excitement of many in medicine about the possibility for meaningful reform to the disappointments over town hall meetings this summer. "The nation may be on the verge of finally addressing a longstanding issue of social justice by legislating greater health insurance coverage," he said. "On the other, this news must be tempered with the realization that meaningful change and comprehensive reform of our nation’s health care will not occur until we transform how we actually deliver it. The hardest work is still ahead. And so, while we should celebrate the passage of legislation to improve health insurance coverage, we should not think that our larger health system problems have been solved." Kirch said that medical schools and academic medical centers will now need to take the lead in finding ways to promote better health care delivery, and to study all of the ramifications of reforms (including economic ramifications). Said Kirch: "As we finally appear ready as a nation to give more Americans that protection, as a profession we are holding fast to our basic ethical commitment to social justice. Now we need to turn that same courage to tackling our cumbersome and costly ‘non-system’ of fragmented health care."