Healthcare reform: high deductibles and the low road

THE COMMONWEALTH Health Insurance Connector Board is considering high-deductible minimal coverage plans ("High deductibles a healthcare worry," Page A1, March 5). If it adopts them, Massachusetts may become the first state in which everyone has health insurance. The problem is that many won't be able to use it.

They will have catastrophic coverage, the type usually favored by the wealthy who have no trouble paying the cost of ordinary care . But the people most likely to be affected by the Connector Board's plan will be no more able than they are now to get routine care . Instead, they will do nothing, which is what they do now, and hope illnesses will go away without treatment.

The fundamental problem is that the healthcare system is dysfunctional. Ours is not only the most expensive in the world, but it produces big quality and safety problems, mediocre health results, and higher rates of dissatisfaction than others in the developed world. Financial issues are important, but until the factors that produce these results are overcome, the Health Connector Board has an impossible task: provide coverage that people can actually use without breaking the bank.

STEPHEN M. DAVIDSON
Boston
The writer is a professor at Boston University School of Management.

ECONOMIC REALITY and actuarial science always trump political legerdemain. Why would we expect state-mandated programs run by private organizations to magically provide additional health services?

There are some very simple principles here. Policy revenue (premiums) must exceed outlays (claims). Deductibles affect the outlays. Low deductibles mean greater outlays because the cost of services would be cheaper to use for the customers .

Insurance companies aren't in this to lose money and won't be in it if they do. Politicians need to keep the insurance companies in the game so that they can declare victory. So, instead of poorer citizens having money in their pocket to pay for a family doctor visit, it'll go to premiums that: 1) cover catastrophic medical conditions unlikely to occur (but offload some of the state's current Medicaid expenses) and 2) pay for that video clip of politicians backslapping each other showing how they stood up for the little guy.

So, what else is new?

MARK IERARDO
Easton