To contribute to the dialogue about how best to achieve equitable, fair, rational, and transparent decisions, this report addresses the social and ethical basis of long-term care, identifying the key issues in caring for persons with chronic illnesses and disabilities. It provides a framework of analysis that specifies the issues and stakeholders intrinsic to redesigning long-term health care systems. The report includes a commissioned paper by the distinguished philosopher Martha Nussbaum, which illuminates the need to expand theories of justice and social contract to encompass social responsibility for care. Together with the responses of Norman Daniels and Eva Kittay, they collectively provide a theoretical lens for rethinking issues of fairness in allocating social resources of all kinds.