Regardless of your employment setting (public or private institution), there is a very high probability that you are concerned about the rising cost of medical insurance. And more likely than not, you are also increasingly dissatisfied with the type of coverage you are getting for your money.

At Western Kentucky University, the increases for 1990 are bad enough. Compared to what is projected over the next five years, however, they are merely a momentary inconvenience. In short, we are heading for a crisis of unprecedented proportions.

It should be noted that the phenomenon is not limited to those working in institutions of higher education; rather, it tends to be a common complaint of public servants everywhere. School teachers, for example, are also very concerned about what is happening with the insurance situation.

Sadly, many employees are having to opt out of their group medical plans altogether because the cost of family coverage has grown beyond their reach.

There was a time when institutions purchased group insurance policies as a way to keep the cost down and the quality up. The idea was simple enough. Everyone benefitted from the arrangement and, for all practical intents and purposes, it worked fairly well.

The subject of insurance didn't even make a very interesting conversation topic.

This is no longer true. Depending on individual circumstances, many employees are being asked to pay substantially more for group coverage than would be the case if they contracted for an individual policy.

After hearing the various explanations offered for this anomaly, most folks have apparently come to the conclusion that there's really nothing that can be done about the situation. Well, maybe. But then again, maybe not.

It is no secret that our health care system in general is in dire straits. On that we all agree. Medical costs are skyrocketing at an astronomical pace and no one seems to know when, where, or indeed if it will stop.

Blame it on society. Blame it on inflation. Blame it on greed. Blame it on the legal profession. Blame it on who or whatever you want. The reality of the situation remains the same regardless of whether or not we are able to get a fix on precisely what its causes are.

A more meaningful question might be to ask exactly what is currently being done in order to help employees better cope with this devastating problem. Whenever the issue is raised by those who are having to shoulder the financial burden incurred by rising costs, it is usually pointed out that everything that can be done is being done.

Assuming such a posture is not very reassuring to those hardest hit by escalating premiums. Drastic situations call for drastic measures. And only a scarce handful of the most ardent optimists would assert that the insurance problem has not reached drastic proportions.

Please note that I do appreciate the efforts of those who are trying to deal with the insurance problem. I realize that the issues are complex and there are no easy answers. But if those of us in higher education cannot resolve the problem, who can society turn to? We should be leading the way instead of tagging along behind waiting to see what will happen.

In reflecting over the entire dilemma, there are a number of options that should receive much more serious scrutiny in the coming years. As was mentioned earlier, being a member of a group should be a help, not a hindrance, with respect to the acquisition of medical insurance.

The purpose of a group policy should not be to provide only one segment of its constituency with reasonable rates. It should be beneficial for everyone.

With that in mind, why not give greater consideration to the following suggestions:

(1) Provide differential rates for at-risk subgroups within the insured population. For example, it is widely known that smokers are much more likely to need medical care than are nonsmokers. Logically, they should be expected to pay a higher premium than others within the group. If you are consciously working toward your own demise, you should be expected to share a greater portion of the insurance cost.

(2) Offer a wider range of deductible options. Several insurance companies offer comprehensive medical policies with an assortment of deductibles ranging from $100 to $2500 or more. Obviously, the premiums vary significantly according to the amount of the deductible. The employee should be as free as possible to choose the kind of plan which will best suit their needs at a particular point in time.

(3) Provide differential rates based on the number of dependents covered by the "family" option. Employees who only wish to cover themselves and their spouses should not be expected to pay the same premium as other employees who wish to cover themselves, their spouse, and five or six children. Employees who decide not to have large families shouldn't be penalized by those who do.

(4) Take age into consideration. Let's face it, older individuals are much more likely to incur medical costs than are their younger counterparts. That's neither good nor bad. It's simply a fact. The problem arises when older employees become the only subgroup which truly benefits from group insurance rates. In essence, those who can least afford to pay are asked to assume the burden of subsidizing those who should be able to pay the most toward their insurance needs.

(5) Have the premium amount correlated with the salary level of the employee. Instead of being an across-the-board rate for all employees, have the required premium be a standard percentage of each employee's base salary. As it stands now, for some the premium constitutes a relatively large percentage of their gross monthly salary. For others, it is proportionately quite small. This is an inequity we can do without.

(6) Provide a better selection of coverage options. Realistically, many employees would be satisfied with an option that would entail only hospitalization insurance. If your primary concern is protection against the financial drain of an extended hospital stay, then you should be able to acquire such protection comparatively inexpensively.

(7) Increase the amount of the institution/agency's contribution. In a very fundamental sense, insurance is a basic human right of all employees -- not a privilege. Each annual budget request should always include a cost-of-living adjustment designed specifically to defray a substantial part of the cost of medical insurance. This would be a highly tangible way of letting employees know that they are needed and appreciated.

(8) Allow employees greater flexibility in deciding where they want to be insured. This could be accomplished by providing employees with the option of taking the amount the agency normally applies toward their insurance and using it to contract with an outside company if they so desire. This would also serve as an incentive for those charged with negotiating policies for the group. If you don't like what is offered, you could always go elsewhere.

An indirect way for some institutions to deal with the rising costs of medical insurance would be to stop mandatory employee contributions to both Social Security and state- and systemwide retirement funds. By allowing employees to choose one or the other, more income would be available to apply toward the cost of medical insurance.

When push comes to shove, there appear to be a number of steps which could be taken in a serious and conscientious effort to keep the cost of medical insurance to a minimum. At some point, we must acquire a system that is more sympathetic the needs of all the employees who are asked to contribute to its maintenance.

Ultimately, the only viable solution to the insurance crisis will be a general policy shift toward some form of national healthcare coverage. Unless reforms of a somewhat radical nature are undertaken soon, this will become, by default, our only recourse. Things simply cannot continue as they have in the past.

Yes, the insurance situation is critical, especially for state employees with group policies. The percentage of employees without any coverage at all is already too high and it will only continue to creep upward with the passage of time. Unless arrested, there may come a time when only the affluent can afford proper health care. This cannot be allowed to happen.