Health care justice, especially in a global context, we are told, must be based in outcomes and efficiency yields, and using the arguments of the modern marketplace have been the basis for health care reform. This has taken us some of the way towards a health care system in America that is more just, yet it is still a matter of contention for some and for nearly everyone, only a beginning. What difficult questions need to be asked and answered before we can really make American health care a fair system? And what is the meaning of local or national justice when we newly understand the world and its health care needs as a global problem? This talk will raise some of the unsolved puzzles of health care reform and argue that for the hardest questions— sacrifice, duty, death and greed— we need reasons for action that go beyond the language of the marketplace, and use the traditions and languages found in Americans faith communities about obligations to the stranger in need.