It has been anything but a year of wellness for health care providers. The iShares Dow Jones U.S. Healthcare Provider Fund ( IHF) has fallen 47% so far this year, more than the S&P 500's 32% decline. The ETF returned 18.3% in 2007 vs. 5.5% for the S&P 500. The underperformance was unexpected in 2008, in light of the fact that many investors sought out less-risky asset classes as the year unfolded. Historically, an investment in health care would have sounded like a good place to be, given its defensive nature. This notion has proven to be anything but the case. IHF, whose top holdings include UnitedHealth Group ( UNH), WellPoint ( WLP), Medco Health Solutions ( MHS), Aetna ( AET) and Humana ( HUM), ran into trouble early on in 2008. In March, WellPoint slashed its full-year forecast due to higher-than-expected medical costs. Humana followed the lead two days later while blaming revised projections on the performance of its Medicare Part D plan. In April, UnitedHealth continued the trend when it reported its first-quarter results. Unusually high influenza costs and a decline in membership for its risk-based commercial markets products were cited as contributing factors to a downward revision in its full-year outlook. IHF's slide raises the issue as to whether the ETF is a bargain or value trap. It's now trading at $39, down from its 2008 high of $64. "We put a 'sell' rating on it when it broke below $59 in January," said Philip Yockey, president and chief investment officer of Tactical Analytics, an independent private research company. "Right now you are at a price that you only see 5% of the time. Either it's cheap or something has fundamentally changed."