As is true of automobile insurance, a strong case can be made for a mandate that requires
individuals to purchase health insurance rather than shifting costs to others. A mandate by itself,
however, is likely to be regressive. By dealing with individual needs through the back door, an
employer mandate generally keeps costs hidden and raises employment problems, while an employer
subsidy will be poorly targeted. An individual mandate, in turn, raises other difficult administrative
issues of collection and enforcement. No employer mandate is sufficient without an individual
mandate, and millions of Americans will fall outside of any mandated system.