The United States spends a greater share of its gross domestic product on health care than other nations, yet more than 15.9% of its population lacks health insurance coverage.1 The US health measures are no better (and are often worse) than those of other nations.2 This combined inequity and inefficiency creates a moral imperative and opportunity for change. Some argue for a single-payer system, others for more reliance on the market and insurance subsidies. Apart from causing political gridlock, neither strategy would effectively both guarantee coverage and constrain costs. A hybrid approach combining universal risk pools, mandated coverage with income-based subsidies, and a restructured payment mechanism has the potential to improve both equity and efficiency.