In the fog of political campaigns, sometimes logic is lost. It can often be regained, however, by stepping back from the political and just asking what the real/true objective(s) may be. If the main objective is universal healthcare coverage with everyone in the pool to spread costs over the largest risk pool, then that is the objective!
The Washington Post had a good healthcare reform article in it about the objectives of health reform and Democratic differences over the candidates current reform plans. The critical objective section of this article for me is blockquoted below:
Of the 47 million people in the United States who lack coverage, they argue, some are uninsured by choice and would remain so unless required to join. Many of those most likely to stay uninsured are young, healthy people who probably would not need to go to the doctor -- and whose premiums would help cover the cost of care for those who do.
If only the sick and those most likely to need care buy in, insurers would need to charge higher premiums. That, in turn, would make policies harder to afford and increase pressure on the government to further subsidize the plans, driving up the overall cost.
Also, if large numbers choose to remain uninsured, more than a few would still seek emergency-room care, which some would not be able to pay for. Hospitals that now get billions of dollars from the government to partially offset those costs would fight to hang on to the money, rather than see it redirected toward subsidizing coverage.
Finally, if the government were to prohibit insurance companies from refusing to sell policies to all comers, and if coverage were truly affordable, then many people -- not just the young and healthy -- would have an incentive to hold off buying insurance until they needed it.
"You can't . . . make it voluntary and let people wait until they're really sick, and then come in and insurers can't turn them down," Holahan said.
In this diary, I am not advocating AGAINST single payer, and if it can be politically feasibly created, it is the best answer! However, we do not seem to be going that way, so if private insurers and new social regulation of that industry is the interim (??) reform path we are going to follow, then again, let us step back from the political fray and ask what are the objectives. If the objectives are to get everyone covered which will also keep the cost lower because EVERYONE IS in the pool, well I think you must logically make that happen! Don't overlook or minimize the critical meaning of getting everyone in the risk pool. Some candidates talks about cost control but then allow the biggest (IMO) cost control potential feature to go astray, namely requiring everyone in the pool. That may be putting the cart in front of the horse and makes no sense at this stage!