If you visit this site regularly, you know that I try to keep you up to date on the latest in pant-shitting. And sweet Jesus, are we going to see some pant-shitting if Congress goes ahead with its current plan to mandate the purchase of health insurance – although said plan has been changing by the minute for weeks, dependent entirely on barometric pressure, the alignment of the Galilean moons, and what Harry Reid, Max Baucus, and Olympia Snowe have for lunch. My sensitive instruments may be destroyed while attempting to capture the deafening, simultaneous, and nationwide pant-shitting that will ensue. All responsible people should be stocking up on underwear to weather the coming shortages safely.
Admitting my amateur status as a game theoretician, there are three basic problems with insurance. First, people are always looking for ways to shirk. They want a best-of-all-worlds scenario in which they don't pay for it until they need it, and then they want to pay in and reap the benefits once they get sick or injured. Of course this defeats the entire purpose of insurance – paying x every month to eliminate the risk of having to pay 500x if something terrible happens. If legislation mandates that affordable coverage must be made available regardless of preexisting conditions, what stops an individual from gaming the system like this? So that's one argument for mandatory coverage.
Second, insurance is only affordable because it pools risk. If a few thousand people pay x every month, only a few hundred will incur medical expenses equal to or greater than x during that time, and only a few dozen (if that) will incur really outrageous medical expenses. Why do the healthy people pay in, then? Well, nobody knows when they'll be hit by a drunk driver or wake up with a cancerous growth on their stomach. So they pay some reasonable amount x because they are risk averse. But let's say all of the healthy people say "Eh, screw this. I'm just paying for hypochondriacs and old people" and opt out. Purging the lowest-risk individuals – "creaming" the population – means that only people with medium or larger medical expenses are left. Therefore the price quickly escalates from the somewhat reasonable x to a much more onerous figure. The price of insurance, in short, is very sensitive to sampling. If a truly random mix of healthy and sick people is taken, the costs can be bearable. If the sample is biased toward people who run up huge medical bills, it becomes unaffordable for everyone.
Third – and this is the part that will baffle the mouthbreathers – it is both justifiable and "fair" to force people to buy insurance because if they don't, the rest of us have to pay their tab anyway. FJM victim Terry Jeffery tries to be cute in this piece on Intellectual Chernobyl entitled "Can Obama and Congress Order You to Buy Broccoli?" It is the typical slippery slope combined with retarded that we have come to expect from the right. Here's the difference. If you don't buy broccoli, nobody cares. If you don't buy health insurance and get into a car accident, you run up a $300,000 ER tab that the hospital has to write off – i.e., they pass it on to the people who do pay. Oddly enough the "personal responsibility" and "freedom of choice" crowd ends up in the same ER as the rest of us when some major crisis befalls them. And lo and behold their hoards of Ron Paul silver dollars and night shift at the screen door factory aren't quite enough to cover the costs. If the hospital attempted to collect it would be a heartless evil corporation – or Jews, blaming things on Jews is still popular – trying to trample on the rights of freedom-loving individuals. But who are we kidding, they have no assets worth pursuing anyway. Personal responsibility ends when their ability to pay does.
Do I think there are constitutional questions about Congress's ability to mandate the purchase of health insurance? Yes, although the state-level precedent of mandatory auto insurance offers at least some precedent. Legal questions aside, though, from a rational perspective mandatory coverage is the only logical choice. If people are allowed to shirk, they will shirk. Many of us don't have much money to work with and many of us who do are cheap sons of bitches. Mandating one half of the equation – that coverage be made available to anyone regardless of preexisting conditions – without also mandating coverage is setting the system up for a disaster so obviously inevitable that we'd literally be better off with no reform at all.