My health-insurance company just crept into my purse and took out a few more dollars.

It will continue to do so for at least the next 12 months, until it's time to re-enroll or choose another health plan, which will then take more of my dollars.

Despite it all, my coverage and options are shrinking.

No wonder this annual rite called "open enrollment" doesn't feel very open to me.

I feel like I'm being held hostage, but the ransom demands just get bigger and bigger with each year.

Unfortunately, I'm not the only one choking on spiking insurance premiums. My employer also pays its share of the higher premiums.

In the past month or so, large numbers of workers in the Tristate have been told by their employers that insurance rates are going up, many by 20 to 30 percent.

Bitter medicine

And yet, we're paying more for less.

Deductibles on hospital stays and other big-ticket health charges are rising. Co-payments on day-to-day doctors' visits have blipped up.

I'd stress out about all of this, but I can't afford to be sick.

In many cases, including my own, health insurers aren't expanding coverage, they're retracting it. Cutting corners where they can.

They're cracking down on people who choose to stick with brand-name prescription drugs instead of going with generics.

They're whittling away at people's ability to pick doctors, specialists and hospitals - even if people are willing to pay more for that choice. And they're finding more and more ways to tell doctors and other caregivers how to do their jobs.

For instance, insurers urge doctors to write prescriptions using drug formularies - lists of preferred prescription drugs. Increasingly, those formularies exclude the newest, most expensive, and often the most effective, drugs.

Doctors can stray from the formulary, but it'll cost consumers a lot more at the pharmacy counter.

Add this to insurers' habit of delaying and second-guessing when it comes to paying medical bills, and you have a situation that sends my blood pressure soaring.

Healthy profits

I'd appreciate all this thriftiness and craftiness if I saw that it saved me money somewhere. Instead, I get to sign away several hundred more dollars in premiums for 2003.

Health insurers ably defend themselves, pointing to a host of probable culprits. Hospital and doctors' costs are rising faster than premiums, they say. Some prescription-drug prices climbed by 25 percent last year.

It's true. Drug companies are spending more on advertising, driving up demand and costs. I knew those slick, bright commercials and pages upon pages of magazine inserts for the newest herpes drug would hit my pocketbook somehow.

The drug companies' ads jack up the price of drugs until their patents wear out. Then the price magically declines.

But at least drug companies make something with all the billions they rake in.

Insurance companies make nothing and provide no tangible service. They're like bookies, taking and placing bets on health, hoping to make more in premiums than they pay in claims.

So far, they're ahead. Anthem Inc. just reported a 54 percent jump in third-quarter profits to $171 million; UnitedHealth Group, a 53 percent increase to $353 million; and Humana Inc., a 20 percent gain to $52.3 million.

Insurance execs say increased profits don't necessarily translate into strong profit margins, which they say are in single digits.

Maybe, but the insurers are healthy. It's nice to know that someone's thriving off my health-care dollars.

E-mail damos@enquirer.com or phone 768-8395.

Wallets take hit for health care