Krugman acknowledges that critics-from-the-left of the current Democratic consensus in favor of the "regulate, mandate, subsidize" approach to universal health care have a point, but says that given the political undoability of the single-payer approach that this is the best available alternative.

Maybe so, but I'm not sure people have given enough thought to alternatives. One possibility involves the default rule. What if instead of "mandating" that the uninsured go get themselves some insurance (community rated and, for the poor, subsidized insurance, to be sure) and creating a public sector option that they might sign up for you instead automatically signed the uninsured up for the public sector option and allowed them to opt-out of it in favor a private plan if they so desired. That would solve the enforcement problem facing mandate schemes which, as best I can tell, mandate advocates haven't seriously grappled with.

Now, a plan like this would probably be harder to pass since it would more deeply damage the interests of insurance companies. At a minimum, though, I'd like to see a progressive president ask for this default rule in his or her proposal. That would put the onus for constructing an alternative enforcement mechanism for the mandate on the insurance industry lobbyists whose job it will be to eliminate this provision.

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