Sara J. Singer, Alan M. Garber and Alain C. Enthoven, in consultation with Mark B. McClellan, have developed a plan for near-universal coverage that they believe would make private health care plans more affordable for low- and middle-income people while promoting competition to increase the value of insurance offerings. The authors say that their plan preserves the best features of the existing health insurance system while closing gaps in coverage and providing more choices for consumers. Tax credits and the creation of new mechanisms for purchasing private health insurance are the key features. Viable reform, the authors contend, must include incentives for health plans to control medical costs and to offer "high-value" coverage to all who seek it, regardless of income or medical history. The authors believe that an approach that combines new "insurance exchanges" with targeted subsidies will achieve this end while giving consumers a wide choice of plans at a reasonable cost.