Magnifisyncopathological

Yes, I agree, mandates are at best questionable--both plans are flawed, and the only possible solution is single-payer.

-nyceve on Daily Kos

What does single-payer mean in terms of health care? Wikipedia's entry quotes the National Library of Medicine's Medical Subject Headings thesaurus as saying "An approach to health care financing with only one source of money for paying health care providers." The MeSH goes on to state that the single source of funding can be a government, an insurance company, or some other organization.

So what's the problem and how does it fit into nyceve's comment?

The problem is, in any sufficiently diverse population of individual humans possessing free will (i.e., in reality), it is impossible to have a single-payer health care system without resorting to mandates, a dressed-up term for legal requirement, itself a dressed-up term for mildly veiled threat of police violence. The threat can be aimed at two populations: the consumer of health care services and the provider of health care services.

This threat is necessary because there is no one single health care solution that fits all existing and future patients. Some people, like me, are relatively healthy and don't want to budget substantial portions of their income towards health care. Others may engage in risky behavior or have a family history of disease and might want to devote more of their wealth towards health care in order to be safe. Still others are sick right now and are willing to spend considerably more than others because, quite literally, their lives are on the line.

Furthermore, health care is not just about quantities of dollars and cents. It is also about quantities of time. How long do you want to wait for an allergy diagnosis? For a CAT scan? For a liver transplant? For an experimental drug therapy? These are not questions that have one answer. People have different needs at different times.

Then there are other aspects of health care that matter just as much as the above. How much do you value a clean hospital? Friendly staff? Decent food and ease of parking? Variety of services, allowing you to "one-stop-shop" at a single facility? This list is long indeed.

Combine those preferences and inclinations together along with the infinite other possibilities that sum up any single human's life at any given moment and tell me a system can be designed to meet every one of those needs all the time. I say it's impossible. Now, try and do it with an additional constraint: the funding for such a system must come from one source and be subject to political control, as any single-payer national health care program must.

Ain't. Gonna. Happen. It won't take long at all for holdouts to start popping up who disagree with the choices being made for them. These people don't have to be radical free market cranks like me; they will simply object to the limitations imposed on them by the system, both from the perspective of the consumer and the provider. These limitations are necessitated by the straight economics of the situation: once you remove the discipline of being responsible for one's own health care expenses, people will tend to consume health care resources at the highest rate they can since they'll see them as "free." Rationing will occur because everyone's needs cannot be met at all times; the only decision is who makes the rationing choices. State rationing under the socialism of single-payer health care guarantees consumers will feel the hands of Mandate on their backs.

If you don't think single-payer health care involves mandates, read what nyceve says about cancer treatment:

Mr. McFourMoreYears [McCain] is also a cancer survivor who, if elected, would seek to deny the American people the healthare that's kept him alive.

[...]

But the nonsense "plan" he is proposing if God forbid he were elected, allows insurers to continue to deny any of us with pre-exisiting conditions the healthcare which has kept him alive.

That's a mandate, asshole.

But ignore screaming reality of all that if you wish. No matter how well that system is designed, no matter how it attempts to accommodate the millions of individual choices that occur each day, it will still suffer from a mandate that cannot be wished away. That is the mandate of taxation. Taxes will be required to fund this monster and taxes are nothing but mandates to pay the state.

Again, nyceve:

Mr. McSame [McCain] has government healthcare, his recurring melanoma is covered and treated thanks to the generosity of the taxpayers.

Single payer equals mandates and nyceve doesn't know what the fuck he or she is talking about.