There is broad agreement across the political spectrum on the need for universal access to healthcare. Conservatives and progressives use almost the same language in describing their goal. Congressional Republicans call for “coverage protections and peace of mind for all Americans—regardless of age, income, medical conditions, or circumstances.” The Center for American Progress wants to “ensure that all Americans have coverage they can rely on at all times.” We at the Niskanen Center see our task as helping to develop specific policies that can make this widely shared goal a reality.

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.