To the editor:

Don Conrad’s cogent Take a Stand made an important distinction between health insurance and health coverage. Let me add one more argument for noninsurance-based coverage: social demographics. Some examples:

Babies who previously wouldn’t have survived because of low birth weights are now living due to advances in prenatal and perinatal care. More people survive car crashes and other traumatic events that formerly would have been fatal, due to the availability of lifeflights and well-equipped trauma centers. Senior citizens are living longer years with better quality of life due, partly, to advances in biomedical research. The Mideast conflict has a much higher ratio of injuries to casualties than previous wars due to expedited evacuation and critical trauma care.

All of these developments are cause for celebration of both human ingenuity and the will to survive. But they are also cause for rethinking health care coverage because many who survive low birth weights, crashes, advanced age or war do so with some degree of temporary or permanent impairment.

Thus, our current insurance-based system with its emphasis on underwriting and risk reduction is becoming increasingly anachronistic in a society where more and more members are likely to be living for many years, or even entire life spans, with chronic or “pre-existing” conditions. Shouldn’t our health care efforts and funds be devoted to maintaining health for and supporting productive community participation of members with chronic health conditions, rather than spending countless hours and dollars and hours on the vagaries of an outdated insurance system?