Labeling health reform proposals comprehensive or incremental erects unnecessary barriers to constructive debate. This article explains why these labels fail to adequately describe the key issues in the debate. It offers insight into the fundamental issues of infrastructure that must be addressed in order to craft enduring reform. To accomplish infrastructure reform, a new definition of health, a return to the principles of federalism, a design for private-public partnerships, and a redesign of the federal health bureaucracy are needed. Many of these issues are relevant to mental health as well.