| The recently revived idea of creating a government-run health plan to compete with private insurers may reinforce the impression that President Obama and his allies in Congress are standing tall against those corporate fat cats who delight in denying lifesaving care to children and old ladies. But Obama and the insurers still see eye to eye on a central element of his health care agenda: the requirement that every American obtain medical coverage.
It's obvious why the insurers like this idea. What industry wouldn't welcome a law that forces everyone to buy its product? But the insurers also argue that a mandate will help control costs, and the president agrees. Judging from the experience in Massachusetts, which imposed its own insurance requirement in 2006, they're both wrong.
 Because he wants to show that an insurance mandate is fair as well as fiscally wise, Obama focuses on uninsured Americans who skip out on their medical bills, leaving policyholders and taxpayers with the tab. "Such irresponsible behavior costs all the rest of us money," he said in a speech last month.
Perhaps so, but it's not very much money. In a 2008 Health Affairs article, George Mason University economist Jack Hadley and three co-authors calculate that "uncompensated care represents 2.2 percent of health spending in 2008."
Obama came closer to explaining the real motivation for the insurance mandate when he said that "unless everybody does their part, many of the insurance reforms we seek -- especially requiring insurance companies to cover pre-existing conditions -- just can't be achieved." He worries that insuring older, sicker people will be prohibitively expensive unless the young and healthy are forced to subsidize them.
The insurers are more forthright on this point, warning that insufficient penalties for failing to buy insurance will result in "adverse selection," fueling the rise in premiums. Yet the penalties in Massachusetts are faster and heftier than the ones proposed in the bills Congress is considering, and the state continues to experience rapid health care inflation.
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