Librarians and scholars who seek to counter the rampant commercialism and consolidation that endanger equal and affordable access to knowledge can learn from the recent successful effort to pass health-care reform. Organizations with a commanding presence in an industry naturally seek to institutionalize their indispensability. They finance strategies that strengthen their position and challenge efforts to contain their power and influence. The insurance and pharmaceutical industries had great success in marshalling opposition to the Clinton health initiative. The authors see the same situation today in academic publishing, with nonprofit publishers and distributors yielding leverage to commercial entities. If it is to reverse trends of rising costs and limited access to journal content, academia would benefit from studying health-care reform in a quest to fulfill its purpose of advancing knowledge by making scholarship widely available. They posit that there are five questions central to the health-care debate that could be adapted to the scholarly periodical industry: (1) Should health care be available to all?; (2) How might stakeholders work more collaboratively and serve common interests?; (3) What is the influence of technology?; (4) What regulatory controls could ensure a fair system?; and (5) Should reform be approached comprehensively?. In this article, the authors attempt to answer these questions and offer some lessons to be learned out of each question. (Contains 3 figures.)