Why is the individual mandate essential? Current law requires hospital emergency rooms to treat all comers. Without the mandate, uninsured people could wait to buy coverage until they're in the ambulance. In 2008, doctors and hospitals delivered $43 billion in so-called free care. (Of course, it was not free. Taxpayers and anyone with private coverage picked up those bills.)
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If the mandate goes, so go the parts of the law that stop insurers from rejecting those with pre-existing conditions or canceling policies once the policyholder becomes seriously ill. In an efficient insurance pool, as we've seen in Massachusetts, healthy people must subsidize the sick.
This concept is not foreign to Republicans and has been part of their own past health care proposals. But the new law's inclusion of an individual mandate has suddenly become a big, big problem for them.
Actually, Republicans do not object to expanding government health care as much as they mind paying for it. They did not set aside a single penny for their 2003 Medicare drug benefit, tacking it all onto the national debt. (A giveaway to insurers and drug companies, the Medicare drug benefit is costing about the same as the Democrats' reform of the entire system.)
