Weighing in (at great length) on the debate between the Edwards and Obama campaigns over whether health insurance should be mandatory, Maggie Mahar makes a nice clear case for why if you want affordable health insurance to be available to everybody then you have to require that everybody buys it:
If we want community rating, Edwards and Clinton realize that we also must mandate that everyone sign up. Otherwise, no one would buy insurance until they were sick or elderly; then they would enroll, secure in the knowledge that insurers had to cover them, and couldn’t charge them more. Meanwhile, the insurance pool would be comprised mainly of people who are expensive to insure, and premiums would skyrocket.
Put simply, mandates are the flip side of community rating. If you want to say insurance must cover everyone—even if they are suffering from a slow, progressive disease like Parkinson’s—then you have to insist that everyone gets into the pool. This is the only way we can afford universal coverage. If you think about it, this is precisely what Medicare does: no one over 65 is excluded, but everyone—even the young and healthy—must pay the same percentage of their paycheck in Medicare taxes.
Now I get that mandates might be hard to enforce, and unpopular with voters. But I don’t really see any logical flaw in her argument.