When you buy into an insurance plan, you are buying into a risk pool.  Take fire insurance.  You believe you are taking reasonable precautions not to let your house catch fire.  But accidents happen.  Perhaps a faulty space heater catches fire in the middle of the night, and by the time the fire alarm goes off and the fire department arrives, half of your house is gone and the rest is smoke- and water-damaged.  So you believe it is prudent to take out fire insurance.  You join a risk pool of other like-minded home owners.  Maybe only one in fifty has a serious fire in his home.  But if it is you, then you are covered. 

If your neighbor decides to take his chances and does not join the risk pool, that is his choice.  But if he has a fire that razes his house, well, that is his tough luck.

Now, health insurance doesn't work that way.  We don't turn our backs on people who don't have health insurance.  A young girl is bitten by a raccoon.  She is going to get medical attention whether her parents have insurance or not.  Emergency rooms cannot turn away anyone on the basis of their inability to pay. 

Now, there is the rub.

I live in Appalachia.  In visits to the emergency room, I see young mothers with children who are sick with the flu or even just a severe cold and fever.  My guess is that in many cases, they have no insurance (Okay.  I'm profiling).  But like good mothers, they bring in their children for proper medical care.  People with and without insurance have to wait their turn.  It may be hours unless you have an obvious life-threatening, time-critical condition.  People without medical insurance and without ability to pay still get treated.

Let me take a specific case.  A man in his fifties who works for a company which cleans and services septic tanks told me about what happened to him when he had a sudden heart attack.  He was rushed to the local hospital and then flown in a helicopter to a facility in a major city.  He ended up owing 120K.  His company, for which he had worked for 20 years, had no insurance plan.  Let's assume that his income was about 40K.  Even though he checked with Health and Human Services, he said he will have to make token minimum payments from his salary as long as he has a salary -- even though he will never pay off the debt.

The risk pool concept has severe challenges when dealing with health care -- challenges not faced with fire, theft, liability and other insurance-risk pool strategies.

It seems reasonable, since everyone, one way or another, is going to get at least a modicum of health care, that everyone has to pay into the system.  And they can't pay into the system just when they think they might be getting sick or have a condition.  They have to pay in from the get-go.

Arguing against that seems to me to be futile.  The "mandate" business chafes conservatives like me more than somewhat.  The government in general should not in the business of mandating choices.  But medical care is a horse of a different color.  Unlike a house or a car or a job, you can get medical attention no matter what you do.

Now, the question is where do you go from there.  And one obvious sort of non-answer answer is: to a system with the least administrative overhead.  And one thing for sure: it ain't ObamaCare.  Take a look at this chart. 

Moreover, the Congressional Budget Office in March predicted that ObamaCare will cost $1.76 trillion over 10 years -- double what it was sold as costing.  The Heritage Foundation calculated that under ObamaCare, the average cost of insurance for a full-time worker will go up by $5.51 an hour.

It is typical of government agencies to grow and overlap each other in addressing perceived government-mandated solutions.  There is no efficiency feedback loop for government agencies, and the result is an unchecked tendency to grow, encroach, and overlap.  The following is (believe it or not) from the Washington Post:

The report offers the first comprehensive analysis of the duplication and overlap across the federal budget I have ever seen.  It's all been anecdotal up to this point, but GAO has the data: 80 programs for economic development; 100 programs for surface transportation; 7 departments and agencies working on U.S.-Mexican border water quality and 20 involved in managing federal cars, trucks and airplanes; two dozen presidential appointees running programs to prevent bioterrorism; the FBI and Bureau of Alcohol, Tobacco, Firearms and Explosives still working in separate silos on controlling explosives; 15 agencies assigned to food safety; 44 programs for employment and training programs; 54 programs for financial literacy; 82 programs for teacher quality; and 18 for food assistance.  The list goes on and on. 

"This report will make us look like jackasses," Sen. Tom Coburn (R-Okla) said in advance of the release.  He was right.

The problem is that government is a monopoly.  Administrative growth is its business.  Fairness is its banner, and regulations and regulators are its product.  There are non-government-centric plans out there that minimize administrative overhead and thereby make the doctor-patient relationship much closer than the patient-government-medical-rationing-fairness-system-doctor relationship institutionalized by ObamaCare.

Here is a sampling of free-market based systems:

Docs4PatientCare, "Physician's Prescription for Health Care Reform," proposals from the American Association of Physicians and Surgeon (AAPS), and "The Pipes Plan: The Top Ten Ways to Dismantle and Replace ObamaCare" by Sally Pipes (Pacific Research).  Likewise, Dr. Milton Wolf, John Mackey (CEO of Whole Foods), and Andrew Bernstein (author of Capitalist Solutions) have also published free-market health care solutions.

Conservatives need to swallow the mandate business and get on with fashioning a "universal" health care system with minimal administrative overhead -- a system that is controlled by competition and which is thereby non-government centric.