USA, Presidenciais 2008

(...) The Democratic plans all rely on a "play-or-pay" link employer mandate to move toward universal coverage, requiring businesses to either offer workers insurance or pay a tax. Play or pay was the reform plan of choice for many Democrats in the early 1990s, before President Bill Clinton switched gears to pursue the more ambitious model of managed competition within a budget (which sought to promote competition among private insurance plans while also establishing government-determined limits on national health spending). The reemergence of play or pay is a testament to the enduring political appeal of building on the status quo: employer-sponsored insurance has been a cornerstone of the U.S. health care system since the 1940s and now covers about 160 million nonelderly Americans. Play-or-pay models enable reformers to finance universal coverage mainly through employer payments rather than creating a publicly funded system that would require new broad-based taxes.

However, any employer mandate is likely to ignite substantial controversy over expanding governmental authority and opposition from businesses that don't currently insure their workers. The current Clinton and Obama plans seek to temper that opposition by exempting small businesses from the mandate; the Clinton plan also grants a tax credit to small businesses that choose to offer insurance.

NEJM, J. Oberlander, " Election 2008: Presidential Politics and the Resurgence of Health Care Reform"