Health Insurance

President Eisenhower's health message to Congress last week highlighted a remarkable fact: more than 100 million Americans are now enrolled in voluntary health-insurance plans. Less than 25 years ago most Americans had virtually no financial protection against illness. Today they have a large part of their hospital and surgical bills paid for them.

The most popular plans, Blue Cross and shield, provide about 45% of the coverage. General insurance companies account for 49%, and independent plans e.g. in business firms, colleges, take care of the rest. Last year Blue Cross and Blue Shield alone paid out more than '$1.25 billion in benefits; all other companies combined paid about the same amount.

Although rates have increased with medical costs, Americans still get a bargainin health insurance. Some plans appear to cover much more than they do often pay as little as one-fifth of illness costs. But most reputable health-insurance p ans provide reasonable coverage. Sample allowances: full cost of a semiprivate room for 21 days, half cost for up to 180 days; $125 for having appendix removed' $175 for a broken leg. Today more and more plans foot the hospital bill for 70 or 120 days, pay for nonsurgical care such as radiation therapy, and cover many illnesses, e.g., incurable cancer, alcoholism hat were once exempted.

As the President noted, there are some glaring gaps in the system:

P:Few plans have regular coverage for long-term "catastrophic illnesses" like tuberculosis.

P:Farmers and other people in rural areas are neglected because they are hard to reach.

P: The aged are left out of most insurance plans because their high sickness and injury rates make them a poor risk.

P: Most insurance groups-do not make provision for treatment of the mentally ill.

P: Most plans do not include peripheral but necessary medical benefits, e.g., dental care, nursing, ambulance service.

One solution to the problem: the President's suggestion that health-insurance groups join together and share or pool their risks. This would allow them to offer broader benefits and expanded coverage at cheaper terms.

The Administration is considering legislation that would exempt such a merger from the antitrust laws.

This file is automatically generated by a robot program, so reader's discretion is required.