I still haven’t quite gotten to a thorough fisking of “Exhibit B,” yet, and will have to be satisfied with arguing the following thesis in the meantime:

It is impossible to increase insurance coverage in America without increasing medical spending.

We cannot save enough on bureaucratic reform and government-induced petition” to offset the new costs associated with an influx of 40+ million new participants. Certainly the newly mandated premiums, paid by those who have determined for themselves that it is not worth it to pay in to health insurance, will also offset some of the new costs. But how many of those 40+ million uninsured have voluntarily opted out?

If even a large minority, say 1/3 of the uninsured, is made up of those that have been denied coverage outright or cannot afford it because of various health factors (many estimates place that number far higher), then guaranteeing coverage to 15 million new patients will certainly surpass any of the potential gains seen in those other revenue sources. The very reason that so many of these folks do not have insurance coverage is because private firms have determined them to be too risky (that is, too expensive) to cover.

How can we mandate coverage of this group and not increase health care spending? It seems like an impossible promise.

The contention really cannot be that we can spend just as much as we are right now and extend the same qualitative and accessible health coverage to everyone. The honest situation is that we would have to spend more to guarantee coverage, and as a nation we need to decide whether that public good requires governmental mandates, regulations, and administration or if it doesn’t.

There will be new costs. We need to determine whether and how they ought to be borne.