Universal access to health care means many things in many nations. Taxes support a single-payer system in the United Kingdom, and health care providers are reimbursed directly by the government; patients pay nothing at the point of service. In the Netherlands, the government defines a basic benefit package and regulates private insurers; everyone is required to buy coverage, and generally to pay premiums and deductibles. The Affordable Care Act was a step toward broader coverage, but if the United States truly wants access for all, these and many other models along a continuum that balances public and private sector involvement can inform the upgrade. What is the best recipe for the American environment?