Hillary Clinton got her groove back at the last Democratic debate by opening with a whopper against Senator Barack Obama. She pointed out Obama’s plan doesn’t mandate health coverage like that of her own or Senator Edwards. It took Obama off guard and had him playing defense. It also had him defending a point about his plan that turns off most proponents of Universal Health Care.

Paul Krugman takes on Obama’s position in his latest column saying:

Mr. Obama is claiming that his plan’s weakness is actually a strength. What’s more, he’s doing the same thing in the health care debate he did when claiming that Social Security faces a “crisis” — attacking his rivals by echoing right-wing talking points.

The central question is whether there should be a health insurance “mandate” — a requirement that everyone sign up for health insurance, even if they don’t think they need it. The Edwards and Clinton plans have mandates; the Obama plan has one for children, but not for adults.

Why have a mandate? The whole point of a universal health insurance system is that everyone pays in, even if they’re currently healthy, and in return everyone has insurance coverage if and when they need it.

And it’s not just a matter of principle. As a practical matter, letting people opt out if they don’t feel like buying insurance would make insurance substantially more expensive for everyone else.

It is also essentially a large part of the reason we have so many uninsured Americans today. Let me explain.

I take neither side in the universal health care debate. I do take issue with one of the central arguments people make when calling for it, namely that so many Americans go without, usually an estimate that has that word “millions” behind it. Which is true however many of those millions are young people. They are college students and working people who would rather not pay out of their own pocket for something they don’t feel they “need”.

Because young people are young they don’t think about the many millions of things that can happen to them. They “risk it”. Of these young people there is always a percentage who do get sick, who do go to an emergency room, who do end up racking up gigantic bills they can never pay off etc. They are also a percentage of people who will chose not to elect coverage in a universal health care system and so any plan which does not mandate coverage will have similar results to the system we have now, it will have people in America who are uninsured.

Whatever you believe about “Universal” health care there is one thing you must believe to be a supporter of it. That one thing? To be “universal” everyone has to be covered. Just as I cannot opt out of social security taxes as much as I would like to, in a Universal system everyone needs to pay and be covered equally.