Argument: W/o mandates insurers focus on risk instead of costs
Linda J. Blumberg, Ph.D., and John Holahan, Ph.D. "The Individual Mandate — An Affordable and Fair Approach to Achieving Universal Coverage." The New England Journal of Medicine. July 2, 2009: "the voluntary insurance system has also distracted insurers from developing incentives and mechanisms for efficiently managing health care costs. Because total health care expenditures are so concentrated — the most expensive 5% of the population accounts for half of aggregate health care spending, whereas the bottom 50% of spenders account for only 3%1 — the gains to insurers of avoiding the sick outweigh any possible gains from managing their care. As a consequence, resources have been devoted to such avoidance at a direct cost to effective care management. National health care costs continue to grow at rates well above inflation, but there has been precious little incentive for the private sector to devote its innovative energies to controlling them. And identifying ways to provide care more effectively and efficiently to people with serious medical needs is the only path to achieving the savings we all seek, since it is on such care that the bulk of the system's dollars are spent."