The Wall Street Journal has an editorial out Wednesday purporting to tell the truth about health insurance reform -- an admittedly hard thing to find these days.

Not surprisingly, the conservative editorial board opposes proposals for guaranteed issue and community rating. Such reforms, where implemented, have raised costs, the Journal says.

Ironically, in attacking these reforms, which are designed to make the individual insurance market more affordable and fair for all Americans, the Journal is really making the case for an individual mandate.

Yes, "if insurers are forced to sell coverage to everyone at any time, many people will buy insurance only when they need medical care," which is precisely why every comprehensive health reform proposal being discussed, requires all Americans to purchase health insurance. Yes, community rating could lead to adverse selection, unless all individuals, healthy and sick, old and young, are required to purchase health insurance.

A requirement to purchase health insurance is the lynchpin that makes other insurance market reforms work. Insurance companies can afford to sell to all comers only if they know everyone is coming. When you have everyone in a system, community rating allows the risks and costs of health insurance to be shared evenly, with premiums that are affordable for all. Finally, with everyone in the market paying their fair share, insurance companies will have to make profit not by selecting risk, but by providing value.

That's what insurance market reform is about, and that's why requirement to purchase health insurance is necessary to make these other reforms works. Why the Journal fails to see this, or chooses to ignore it, is unclear. We'd suggest they read their own op-ed pages, and in particular, a piece in 2006 from then-Governor of Massachusetts, Mitt Romney:

With private insurance finally affordable, I proposed that everyone must either purchase a product of their choice or demonstrate that they can pay for their own health care. It's a personal responsibility principle.

Some of my libertarian friends balk at what looks like an individual mandate. But remember, someone has to pay for the health care that must, by law, be provided: Either the individual pays or the taxpayers pay. A free ride on government is not libertarian.