Catastrophic Health Insurance

To the Editor: The interpretation of the meticulous studies reported in “Impact of Nationwide Catastrophic Health Insurance,” in the editorial by Harris and Wissmann (N Engl J Med 293:721–722, 1975), is based on an untenable assumption. It assumes that if Congress enacts legislation that is restricted to catastrophic health insurance, the definition of a medical catastrophe will not change. Past experience with hospital insurance that does not cover ambulatory care — e.g., many Blue Cross-Blue Shield contracts — has clearly demonstrated that the insurance coverage has unnecessarily shifted many vertical ambulatory-care patients into the more expensive horizontal treatment in.