WAIVERS COULD SAVE OUR HEALTH CARE, NOT SINK IT.

Byline: Pamela Logan

IT'S well past time for the leaders of our state to overturn a law that has denied health insurance to me and uncounted thousands of others.

Since 1993, California law forbids health-insurance companies from offering partial coverage - that is, it forbids the companies to allow waivers or exclusions for care of pre-existing conditions. Someone who has, say, acid-reflux disease, cannot say to their provider: ``You don't have to cover my acid-reflux disease so long as you cover everything else.'' California law insists that, with health care, it's all or nothing.

The law obviously stems from a well-intentioned desire to protect health care consumers from being denied coverage for serious illnesses that need attention. Without such legislation, many people would have to carry around insurance cards that, like driver's licenses, set limits on the privileges they bestow. A known cardiac patient who has a heart attack may find the hospital doors closed to him. This is hardly a scenario we want to see in California.

And that might make the law seem compassionate - but wait! What if your ``pre-existing condition'' is not life-threatening?

In my case, my ``condition'' is infertility. Two years ago, at the age of 44 (when infertility is hardly an abnormal condition) I sought care. Inability to bear a child, though a tragedy for many, is not a life-threatening disease - especially if you don't want children, which is the case for me now. Nevertheless, after a job change and a period of being uninsured, I was denied coverage by Blue Cross, HealthNet and Kaiser because they fear I might again get the urge to reproduce.

These days, with in-vitro fertilization, there are almost no limits on who can have a baby so long as a deep-pocketed health care company is there to foot the bill. Naturally, the health care industry wants to reduce infertility claims. And I would be more than happy to oblige them by signing away my right to such coverage. However, California law forbids such waivers or exclusions. No amount of swearing up and down, saying that at 46, I'm too old to go through pregnancy and childbirth, has helped my cause. Even if I were to divorce my husband and take vows as a celibate nun, I would still be a health care pariah.

Does this make sense?

If someone as healthy as I cannot get insurance, then what of the hundreds of thousands of others whose ailments are more serious?

The law that forbids waivers or exclusions means that many Californians cannot receive care for acute health emergencies. If I fall off a ladder and break my arm, I will either pay the exorbitant fees charged to the uninsured, or else I will go to County/USC Medical Center, where my care will be at government expense.

Which option do you think most uninsured Californians choose? Obviously, they choose the second, thus adding an unnecessary burden to facilities that should only need to care for the genuinely destitute.

In the health care market these days there is a great deal of choice. There are plans that prefer generic drugs over brand-name drugs. There are plans that allow patients to see a chiropractor instead of an orthopedist. Why isn't there a policy that allows the customer to refuse care for certain conditions?

The law forbidding waivers and exclusions is tantamount to a forced sale of services. It wouldn't be a problem if we had a single-provider system, but the multiple-provider system that we do have cannot meet the needs of the market because of this meddling by short-sighted legislators in Sacramento.

It is no secret that America's health care system is collapsing and wholesale fixes are not in the offing anytime soon. Yet it should be politically possible to make incremental changes - changes that will make care available to more Californians.

Sacramento should start by getting rid of this ill-conceived law. Let the health care companies provide services that the market demands, not those that meddling regulators think we need.