There are pros and cons of using an individual mandate for health insurance as a policy lever to promote universal health care. From a pure policy standpoint, the argument for is simple. To get rid of "free riders" in the medical system and improve the efficiencies of the health insurance marketplace, something is necessary to compel everyone to purchase an insurance plan. An individual insurance mandate, while imperfect, is one such tool. Conceived by conservative thinkers Mark Pauly and Stuart Butler in the late 1980s and early 1990s, the individual mandate now faces attack from many who formerly supported it.