News that federal health premiums will rise an average 9.3 percent next year prompted several couples--without children--to ask why they must pay the same "family" premium as a family with eight or 10 youngsters? Some retirees also ask why, if Medicare pays some of their medical bills, they must pay the same premiums as younger workers and retirees without Medicare?

Their point is that group rates are discriminatory.

But pretend today's column actually went like this:

"The government has announced that beginning Jan. 1, its group health plan will be revamped. A spokesman said the new program will reward people who don't use health care often and shift the burden to individuals who, because of age, lifestyle or other factors, tend to be 'heavy users.'

" 'Maybe they are just unlucky, or old,' the spokesman said, 'but some of them have choices and are behaving irresponsibly and should no longer be rewarded for it.'

"Starting next year, the current federal group plan--which treats all 9 million covered workers, retirees and family members the same for purposes of premiums and benefits--will operate in this fashion:

"The new federal Department of Designated Risk will evaluate and place all workers, retirees and dependents into one of several new health plan risk pools. New categories of coverage--and corresponding premium adjustments--will be established for eight different tailored group plans.

Plan One will cover all sky-divers, skate-boarders, motorcyclists, rock climbers and persons with other high-risk hobbies. They are likely to have accidents and use insurance more.

Plan Two will cover heavy drinkers, smokers and people who eat red meat and/or cheese. They are more likely to have more habit-related illness.

Plan Three will cover the chronically ill, including persons who are blind or deaf or who have asthma, heart disease, sickle cell or Tay-Sachs or who suffer depression or some other designated physical or mental problems. They will pay much higher premiums because they often require more medical care and, like Plan One personnel, may be more likely to have more accidents.

Plan Four will cover individuals who do not practice safe sex. We KNOW what happens to them.

Plan Five will cover anyone older than 50 (heck, make that 45) who can't demonstrate good physical condition by running an eight-minute mile and also doing 50 military push-ups in 30 seconds. Most of these folks are over the hill and lucky to be tolerated.

Plan Six will include all designated overweight people, plus persons who spend evenings and weekends watching highly paid athletes sweat on television.

Plan Seven will be reserved for persons who don't fit into any of the other new health plan risk groups. It is expected most will be regulars at church or synagogue, who follow the teachings of their faith. They also will be required to practice safe sex. Their already low premiums will be further reduced by 10 percent if they are celibate for life.

Plan Seven will be the smallest plan--but have the best rates--in the new federal program."

Sounds great, right?

Couple of questions.

Which plan will have the highest or lowest premiums?

Which one would you qualify for?

The good news, bad news about a group health plan is the same. It treats everybody in the group the same. At some point, somebody is subsidizing somebody else. Once the group is balkanized, it ceases to be a group.

Most people who want their group redefined take it to a point where they--because of their age, sex, race, health and habits or vices--would get the best deal. That is only natural. Which prompts me to offer the following suggestion for the kind of health plan a certain big city newspaper ought to offer.

I have considered it carefully and can see no problems with this proposed perfect plan:

This perfect plan, in my humble but considered opinion, would give the lowest rates to an Irish American male, late fifties, with a few bad (but equally charming) habits. This near perfect man (with the help of his former spouse) produced four children. But because they are now grown, Mr. Perfect (for want of a better description) no longer needs maternity benefits. Or baby doctors. So why should he have to pay for coverage he doesn't need or use--anymore?

As Mr. Perfect gets older, he may need extra coverage. But why pay for it now? This excellent fellow deserves an individual policy, based on his merits and strong points.

But please give me, uh, him, the group rate!

Mike Causey's e-mail address is causeym@washpost.com

Sunday, Sept. 26, 1999