Heck, although I was an insurance underwriter for thirty years (albeit in tort liability, not health insurance), I happy to find that I'm not the only American who understands the basic principle of insurance, the spread of risk among a group of insureds.

To the Editor:

Re "The Forgotten Domestic Crisis," by Marcia Angell (Op-Ed, Oct. 13): In addition to placing health care increasingly out of the economic reach of individuals and businesses, our commodity approach guarantees that the pool of insurable individuals will continue to shrink, thereby undermining the very essence of affordable insurance.

Insurance works because a lot of people pay premiums and not everyone uses services. The more healthy people insured, the stronger the system. A single-payer, broadly financed health insurance system is hardly socialism; it is the only way health care can become universally accessible and even remotely cost-effective.

SUSAN POOR
San Francisco, Oct. 15, 2002