Health care has already emerged as a major 2020 campaign topic for the Democrats, with some candidates advancing the concept of “Medicare for all.” As an aspiration, the initiative is intended to offer affordable health insurance as an essential right for all individuals in the United States. With health care costs at 18% of the gross domestic product and the number of uninsured persons once again increasing, finding a policy approach that insures more individuals while attenuating projected increases in health care spending remains a goal that has been elusive for more than 5 decades of US policy making.1