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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

I read with interest the recent article in the ARCHIVES by Karen Davis, PhD, and colleagues titled "A 2020 Vision for American Health Care"¹ and the editorial by James Dalen, MD, titled "A Bold Proposal to Achieve Near-Universal Health Care Coverage in the United States."² Universal coverage has several rarely appreciated cost-saving features. It is essential to recognize that universal coverage eliminates the costs of "niche" plans (eg, medical costs for automobile coverage, workman's compensation coverage, intensive care unit coverage, dual coverage with coordination of benefits, and disease-specific coverage such as cancer coverage). Universal coverage also eliminates the costs of underwriting.

The systemic changes that allow universal coverage to become a reality include essential changes in the insurance structure:

• Community rating would eliminate the cost of experience rating, including the exorbitant administrative costs for small businesses to offer health care coverage.
  
• Research and education could be supported by a percentage . . . [Full Text of this Article]

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