Barack Obama’s health care policy has come under a lot of blogworld attacks for not including “mandates”, i.e. fines for people who don’t buy health insurance. Here’s a typical passage from Ezra Klein.
A central tenet of his proposal is that ” No insurance companies will be allowed to discriminate because of a previous bout with cancer or some other pre-existing illness.” You literally cannot have that rule without some mechanism forcing everyone to buy in, as the healthy will stay out. … A mandate is not how you cover everyone, it’s how you force insurers to cover everyone, and discriminate against no one.
I don’t know what the force of that ‘cannot’ is supposed to be, but I know it isn’t historical impossibility. Australia for several decades did just the thing Ezra thinks that you can’t do. It had community rating of health insurance, and it didn’t have health insurance mandates. This was true of the periods 1953-1975, and again from 1981-1984. At other times it had compulsory universal basic health insurance. The system wasn’t perfect, bringing in compulsory public health insurance was a very good thing, but it wasn’t as bad as anything I’ve seen in America, and nor was it somehow an impossibility.
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