I’ve seen some discussion (e.g., InsureBlog, DiabetesMine, and Contingencies) on comparing the “mandatory-ness” of many of the quasi-universal health care proposals floating around in American political circles to the requirement in most states that drivers carry auto insurance as part of the conditions of driving a car.
Mandatory auto insurance is, after all, is either believed in, or is at least tolerated by, many (most?) Americans, so why shouldn’t a mandate to buy health coverage be accepted as well?
Like most of the commenters I’ve read, I agree that the analogy of health insurance being like auto insurance is flawed. Health insurance as we know it today is more analogous to a blend of both routine auto maintenance and auto insurance.
However, I prefer to approach the idea from a different direction:
- Every consumer of health care services should have the means to either pay for services received, or have the bills paid for them by a third party.
- If a would-be health care consumer is not able to pay for such services (or have the bill paid on his/her behalf), services shouldn’t be rendered.
- However, as a society, we are unwilling to be quite so…harsh. As a society, we believe that some level of medical care should be available to all.
This is reflected in laws which generally prohibit ER’s from turning away anyone, and the availability of funds (via federal/state grants, and inflation of other patients’ bills) to foot the bills for indigent patients.
- Therefore, some mandate for citizens to have health insurance should exist…and in a sense, already does exist.
Q.E.D. 
I’ve previously discussed why I’m on the fence as to whether auto insurance should be mandatory. For health insurance, the question is a heckuva lot easier in my mind—it already is mandatory, albeit in a rather inefficient, unexplicit manner.
The more interesting, and difficult-to-answer, questions in my mind are:
- What level of basic health care should be available to everyone?
- What is the most efficient way to fund that level of care?
- How can consumers be incented, and the system be operated, so that preventive or maintenance services are encouraged, but abuse of those services is discouraged?
- How can the cost for all this be kept from spiraling out of control?
The answers to those questions are, I think, rather interrelated…and, quite frankly, give me quite a headache when I seriously contemplate their magnitude.