Revising the Rules Of Health Insurance

Published in The New York Times -- September 9, 2001

To the Editor:

"Hidden Barriers to Health Coverage" (Money & Medicine, Aug. 19) pointed out some of the many shortcomings of employer-sponsored health coverage, including long waiting periods for eligibility.

Indeed, employees should demand more of their employers and their union representatives and should push for the elimination of such obstacles to care.

But even more disturbing were findings of a Commonwealth Fund study, noted in the column, that a $10 increase in monthly insurance premium could sharply increase the likelihood that an employee would switch to a cheaper health plan. What does it say about how we value health care services when for $120 a year -- just 33 cents a day -- many of us would switch out of a plan with which we were otherwise presumably satisfied?

Even for low-wage earners, that amount is a tiny fraction of 1 percent of annual income; most people wouldn't cross the street to save that much on a muffin and coffee.

Do workers really believe that the providers of their care are that interchangeable?

If so, the workers are behaving no differently than the employers who are looking for the cheapest coverage instead of for the best value. And an increasing choice of health plans may mean nothing more than a race to the bottom.

We must drop the notion that when it comes to health care, we can have everything for nothing.

Thomas Campell Jackson
White Plains, Aug. 21

The writer is a senior fellow at the Institute for SocioEconomic Studies.