But here’s the rub: You can’t force health plans to offer coverage to everyone, regardless of medical condition, if you don’t make sure everyone is in the insurance pool. Without such a mandate, people have an incentive to wait until they get sick to buy coverage. Insurance can’t work that way. The result is a classic insurance “death spiral” in which, on average, sicker people are in the pool, which makes premiums rise, which in turn forces healthier people out of coverage they can’t afford, which then leaves the pool filled with even sicker people on average, which sends premiums higher again, and so on. This is why states that have forced insurers to accept all comers without also having a coverage mandate (such as New York and New Jersey) have seen rates soar and coverage shrink — hardly what officials intended. This is Health Insurance 101. (The other piece is that you need subsidies for low-income folks if you’re going to have the mandate, which is why Obamacare is expensive.)…

So, conservatives, be careful what you wish for. By fighting the mandate needed to make private insurance solutions work, and doing nothing to ease the health cost burden on everyday Americans, you’ll hasten the day when the public throws up its hands and says, “Just give us single-payer and price controls.” Don’t think the anti-government wave this fall won’t reverse itself on health care if the most private sector-oriented health care system on earth keeps delivering the world’s costliest, most inefficient care.