The United States is the only country in the industrialized world that does not assure insurance to cover the catastrophic medical care costs of all its citizens. But Republicans and Democrats differ widely on how to address this problem. Here is a proposed compromise that offers universal coverage but with a change in the tax code, more personal responsibility for behaviors, and reduced insurance costs through lessened mandates. It also returns to true insurance, not prepaid medical care. Use high deductibles and HSAs but offer primary care and preventive care to those who truly cannot afford it.