While we are open to a variety of ideas, we recognize that the fear of medical costs that are catastrophic relative to income dominates healthcare concerns for the poor and the middle class. With that in mind, we see some form of universal catastrophic insurance as a logical first step toward comprehensive reform. Such coverage could be provided as an extension of Medicare, through private insurance (subsidized as needed), or through some other mechanism. We see universal catastrophic coverage as fully consistent with market-based efforts to increase the efficiency of healthcare delivery, promote innovation, and encourage informed consumer choice.