What ends do we expect health insurance to serve in our society? This unresolved question, which one scholar aptly terms "the struggle for the soul of health insurance" 1 arises today in many settings. This struggle pits a "social solidarity" vision of health coverage (by which insurance permits the risk of medical costs to be spread broadly across society, so that healthy persons subsidize the care received by unhealthy persons) against an individualistic vision of health coverage (by which insurance enables each person to pay an amount that reflects as closely as possible his own anticipated cost of care). 2 The tension between these two views may emerge, for example, in debates over proposals to require community rating of insurance premiums or to mandate that insurers cover particular services. 3 Laws that prohibit discrimination in health insurance also highlight this tension. These laws-whether they apply directly to insurance issuers or to employers providing health insurance coverage as an employment benefit-seem to embody the social solidarity view that persons with particular traits should neither be denied a place in the insurance pool nor be subjected to inferior coverage. The application of these antidiscrimination laws to health insurance occupies center stage in controversies over whether employers are required to provide prescription contraceptive coverage for their employees 4 and whether *
Mary Crossley (Sat,) studied this question.