Without a mandate, a “nondiscrimination” rule would lead to a situation in which no one would buy health insurance until it became clear that they needed it, thus destroying the viability of the industry as we know it. One could argue that a mandate would create powerful political pressures to restrain growth in insurance premiums. But would the end of health insurance as know create powerful market pressures to restrain growth in the cost of various medical procedures, and create a market for true insurance policies that cover unforeseen, catastrophic expenditures?
This is not a politically attractive scenario for the obvious reason that no one likes change. But it’s not obvious to me that it wouldn’t, after an awkward and difficult transition, represent a marked improvement.
Now, alas, I have to leave the fantasyland in which things actually make sense.