The voluntary nature of the US health system has led to an insurance market centered on segmenting health care risk as opposed to one focused on providing affordable access to necessary and efficiently provided high-quality medical services. This can be corrected through comprehensive health care reform that includes a requirement that all individuals have at least a minimum level of health insurance coverage, a so-called individual mandate. While significant government subsidies would be required to fairly implement an individual mandate, we contend that it is the most politically feasible route to universal coverage in the United States today. Published by The New England Journal of Medicine