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As this note is being written, a proposal to provide health insurance to retired workers under Social Security—the Forand bill—is being vigorously debated. Although health care for such workers involves some special considerations, the arguments of the proponents of this bill and the massive support being marshalled for its passage are symptomatic of general concern over voluntary health insurance. The dilemma threatening the survival of many of these voluntary programs is that costs tend to outstrip their ability to provide the quantity and quality of health care demanded by the groups they serve. In this discussion, the authors attempt to identify the major problems currently at issue in voluntary health insurance and to describe and appraise some administrative innovations that have been made in a few instances to control costs and improve the quality of medical and hospital care. [ABSTRACT FROM AUTHOR]