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The health care debate in the national media (thanks to sniping on the presidential campaign trail) has boiled down to one question: should we require Americans to purchase insurance in order to get everyone insured? One side says yes, otherwise only the sick will sign up, and a mandate will make it affordable. One side says no, we can't require insurance until it's affordable, and people won't sign up, mandate or no, if it's not. So who does a mandate really help?

A colleague forwarded me these two quotes from mandate proponents in the National Journal (sorry, no link, it's sub. only):

    In California, which has been considering a system of universal coverage, "the big reason for mandates is, they couldn't get the insurance companies to sign on without it," Gruber said.

    (Jon Gruber is the architect of the Massachusetts mandatory health insurance plan, and consulted on the issue in California too.)

    Ronald A. Williams, chairman of the insurer Aetna, noted in a July 10 Washington Post op-ed that his company is open to discussing rules prohibiting insurers from cherry-picking. "But without an enforceable mandate for individuals who can afford to purchase health insurance -- which we have advocated for four years -- the individual market is prone to [attracting higher-cost individuals] and the policies quickly become unaffordable."

The insurance industry has been peddling this mandate myth for years, and they're the big winners if everyone is forced to buy their product. The private health insurance system is slowly imploding as coverage gets more and more expensive. But, if the government requires everyone to buy health insurers' overpriced product, they've got a guaranteed customer base for a long time to come.