Many Democrats are arguing that an insurance mandate is necessary so that everyone will be forced to get health insurance. This is for the sake of cost sharing; nowadays, for instance, many consumers are looking to tighten their belts and find savings everywhere they can. One bet many poor healthy people have made is to not get health insurance because they won't need it enough to justify the cost. Insurance companies lose many of their healthy subscribers, so they lose profit; as a result, those who are too sick remain on the plan, but for the company to offset its losses, it has to increase premiums. This is probably what caused the recent 39% premium increase Anthem imposed in California (statehealthfacts.org/profileind.jsp?ind=346&cat=6&rgn=6). A mandate will prevent the possibility of this happening in the future; people will have to get insurance even if it would not be economically rational, and insurance companies get more profit. I have two main disagreements with this: Healthy people should not have to pay for sick people directly because sickness is often caused by poor lifestyle behaviors. If some people make poor decisions about their health, others (the healthy who would be forced to get insurance for cost-sharing) should not be forced to pay for it. Call me heartless, but I think if you eat so much that you're 300 pounds and need coronary bypass surgery or something, you should be the one to pay for it. It's basic personal responsibility. The government has no imperative to force citizens to buy something simply so that an industry can make more profit. Without the mandate, the people in need will disproportionately desire health insurance more - but that's how it is for every single other good and service the market provides. It's not unfair to the companies, they're voluntarily providing a service (hopefully) and others are voluntarily choosing to purchase that service or not. Firstly, the healthy should not have to pay for those who make bad decisions and make themselves sick or require expensive surgery or drugs. Of course, there are many ailments which are not caused by negligence, but many are. For instance, eating at McDonalds every other day, or taking the elevator up to the 2nd floor, or using a motorized lawn mower you ride on, or not exercising, etc. Recent advances in technology and manufacturing have increased our ability to stay inactive or to buy cheap, unhealthy goods. You can see the effects of thsese things today: Obesity: upload.wikimedia.org/wikipedia/commons/c/c1/USObesityRate1960-2004.gif 2/3 of all Americans are overweight. 1/3 of all Americans are obese. ($1425 per person * ~300 million people = $427,500 million, or $427.5 billion) Diabetes: Alcoholism: The bottom line is that poor lifestyle choices are a significant cause of much of our extravagant health care spending. These poor choices should not be subsidized by unrelated third-parties (the healthy) - it creates a moral hazard. People are more likely to make bad decisions if they know others would pay for potential consequences. Secondly, even if the lack of a mandate gives a company greater cost pressures, that's no reason to interfere with the market simply for the sake of providing the company more profit. We don't force corporations to operate at a loss; why should we force some consumers to operate at a loss (be forced to buy insurance)? This would simply be a giveaway to the insurance companies. They're already making billions of dollars in profits; why should the government interfere simply to give them more, hurting healthy citizens in the process? Of course, there is one caveat applicable to both of these, which is that some sicknesses are not caused by risky behaviors. It would be quite difficult to fairly and consistently separate those responsible, and given that reducing costs is one of the main reasons for health reform, I don't see a solution, other than the following: There is also the idea that, whether or not one is responsible for one's ailment, the state nevertheless has a duty to help out financially. While this may have philosophical merit, I don't think it's workable here, given that personal freedom is supposed to be one of the main principles of the country, and that cost control is absolutely necessary. One last argument for the mandate is that some will buy health insurance only when they get sick, decreasing the insurance industry's profits if they decide to carry you. A possible counter is that the firms may be free to deny your insurance application, which would incentivise getting insurance before you need it, for the sake of cost-sharing among the healthy. What do you think?