News of Anthem Blue Cross raising premiums in their individual purchase market by nearly 40% for the coming year. Very few people nationally have such polices (about 14 Million), but the companies claim of why the rise when their medical expenses rose by just 9% last year is instructive. They say that in a bad economy, some decide they can't afford the insurance and go without. Those doing so are more likely to be young and well....and conversely, those keeping cover in bad times are more likely to be sick.
This is the beginnings of a death spiral, whereby higher premiums drive out better risks and the individual purchase market could eventually implode. The answer to death spiral is risk pooling. Many of the incremental policies that are suggested in response to saying the Democratic bills are too grand segment risk, and attempt to make smaller and smaller pools work. The simplest answer if you think everyone should have insurance of some sort is to force risk pooling into larger and larger groups. If forced risk pooling is not the answer, then at some point what you are really saying that everyone shouldn't have health insurance if they can't afford or don't choose to afford it (whichever language makes you happy).
If we aren't willing to come up with a way to cover everyone, then at some point the logical answer is to say the uninsured don't get care. We are now stuck in no mans land, turning in horror at the plight of the uninsured, and turning in horror from any plausible policy to move toward covering everyone.