Can this health care reform work without mandating health insurance?

[GOPBasher]

I'm genuinely asking here. It doesn't seem to me like it could work, but I hope I'm wrong and I want to hear other arguments. What I'm thinking is that, short of a single-payer or otherwise socialist system, this health care reform won't work without mandating insurance coverage.

You cannot tell insurance companies that they must cover people with pre-existing conditions if we don't bring everyone into the system to spread the risk. This way, people can remain uninsured until they have a problem, and then they can sign up for insurance. To cover this, insurance companies will have to raise the premiums tremendously on everyone who is covered.

Furthermore, what do we do with people who have no insurance and end up in the emergency room? They must be treated by law (which is good). But the hospital can't get any money from them, so to recoup the money they must raise their prices on everyone who is insured. This is one of the major reasons our health care costs have sky-rocketed so much in recent years.

Even if we had a public option, I don't see how that would work either, because people would still have to pay something to get it.

In short, I think we would either need a single-payer or fully socialist system (neither of which is not happening, unfortunately), OR we must have the insurance mandate. I'm no expert on any of this, however, and I want to hear what anyone else has to say.