The health insurance system only works right if everyone buys in. If you just have old, sick people buying insurance, every account pays out. Insurers can't earn any money. You could theoretically solve this by just socializing the entire health care industry, and making it a not-for-profit wing of the US Government. But Americans don't really care for that idea. To be honest, though this is probably the version of health care reform I'd prefer, I share some of their concerns.If, instead, you want to base the system on the continued existence of private, for-profit health insurance companies, the only way to make the system solvent and universally applied is to guarantee young, healthy people - who won't actually cost serious money to insure - pay in. I kept hoping that someone would propose a third option - a way to guarantee basic, affordable health coverage to every American through private insurers but without a legal mandate for all who were able to pay in to the system - but I've never heard one. If you have, please suggest it in the comments below. These systems don't exist in a vacuum. Public policy has to work in the real world, not in the hypothetical world of ideological purity. I feel like that's where most Americans, at least the outspoken ones I've been speaking with and reading on Facebook, Twitter and blogs, lose the thread. They begin the discussion based on what's "right," the abstract way in which they would prefer America to function. They speak in moral terms and absolutes. They harken back to particular interpretations of Constitutional law. And, sure, they make compelling points now and again. But unless you're willing to sacrifice living, breathing human beings, suffering from a lack of health coverage or crippling medical debts, to ideology and argumentation, you have to think about how these things actually play out day-to-day.