Your health as a market commodity

Re “Healthy? Insurers don’t buy it,” Dec. 31

Uninsurability is hardly a “hidden” problem, as The Times describes it. Insurers are getting ever more brazen in their efforts to exclude the people who might at some point actually need healthcare. There are only two ways to resolve this problem and stop the cost-shifting that continues to drive up healthcare costs for everyone. One is a single-payer system. The alternative involves mandating coverage for all, whether through employers, other organizations, purchasing pools or individually. For this to work, there would have to be subsidies for the poor and comprehensive changes in the private health insurance market, including an end to refusing coverage or increasing premiums based on health status. Unless and until such changes are made, the number of uninsured -- and underinsured -- people will continue to grow.

LAURA REMSON

MITCHELL

Winnetka

The writer is legislative coordinator and executive committee member of the California Disability Alliance.

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Without health insurance, you cannot run your own business. Insurance is unattainable except through larger-company employer coverage. You don’t seek normal healthcare for fear of being denied in the future. You select jobs based on health coverage rather than your talents and interests. The uninformed public gets irritated by the uninsured without understanding that for many it is not their choice. We have allowed insurance gatekeepers to manipulate our lives in ways the public does not even comprehend, until it happens to them. Until our government can move the discussion away from spending billions in Iraq, American citizens will be slaves to the healthcare industry and continue to suffer.

BETTY JO ATNIP

Coto de Caza

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I had open-heart surgery 13 years ago. Today I run two miles a day plus ride a stationary bike seven miles. I am by all accounts healthy with a normal blood pressure. I am an insurance professional who owns a small business, but still I am unable to buy medical insurance except for the state-mandated plan costing me about $800 a month. The medical insurance companies, as a result of many mergers and lack of government oversight, have been allowed to cherry pick only those applicants with perfect health. The rest of us are out of luck.

ARNOLD LIPSCHULTZ

West Los Angeles

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The article on problems with individual underwriting of health insurance highlights a very real problem with our healthcare system. It only provides minimal discussion, however, of the obvious solution -- legislation that guarantees every Californian has health insurance regardless of medical status or ability to pay. Blue Shield of California has long advocated government policies to provide universal coverage, and we see many hopeful signs that the 2007 legislative session will provide a significant expansion in coverage.

Absent universal coverage, the economics of the insurance market require health plans to exclude individuals based on their medical history. No health plan could unilaterally stop underwriting and remain solvent because the most costly patients would flock to that plan, overwhelming its ability to pay claims. Insurance is designed to share risk. Until everyone is insured, those with the highest risk will have difficulty finding coverage.

TOM EPSTEIN

San Francisco

The writer is vice president for public affairs of Blue Shield of California.