While the U.S. health care system is failing to serve many of its citizens, agreeing on what is wrong as well as on how to fix the system seems impossibly optimistic. Leonard Fleck attempts to do just this—to diagnose the problems and to address these problems through dialogue. Dewey’s philosophy supports the direction of Fleck’s work, but it also highlights serious problems with this argument. And when far less rich countries are able to provide better care to all their citizens for far less, we have a system in need of a deliberative process that works.