Choices and Costs in Health Care

Your article on health insurance touched briefly on a few important issues dealing with the health insurance industry. I would briefly like to address one of the concepts discussed. Health insurance shoppers should acquire the most reasonably priced plan that yields the coverage that an individual or family requires, yet these people should always expect to pay more in premiums than they receive in benefits.

The idea of all insurance is not to get your money’s worth. Insurance is designed to protect us from rare and unusual circumstances which could financially ruin an individual or a family. I believe most people purchasing life, automobile, home, fire, liability, and earthquake insurance hope they never have to collect on their policies. It is generally accepted that we will pay large sums of money to corporations for protection that we will hopefully never use.

For some strange reason, our society feels health insurance is different. The whole concept of the insurance industry is based on the idea that many people will pay premiums for the benefit of the few who will collect. Why then do many people over-utilize their health insurance plans if significant roadblocks (deductibles, co-payments, long waits for appointments) are not put in their way? Without these barriers, many people feel it is their right to utilize their policies for many self-limited and simple problems such as colds, flu, minor strains and sprains, etc.

The individual’s decision in choosing a health care plan depends on his/her needs and expectations, but we must remember that the system is designed so that we will not get what we pay for! For an individual, I can only recommend trying to choose the health care coverage which is best suited to his/her personality and needs in the event of a significant illness. Remember that if a plan looks “too good to be true,” like most things in life, it probably is.

KENNETH A. SCHILD, M.D.

La Jolla