Skip to comments.The Better Solution for 'Pre-Existing Conditions' (No need to turn the entire system upside down)
Posted on 10/17/2012 9:11:09 AM PDT by SeekAndFindEdited on 10/17/2012 9:13:36 AM PDT by Admin Moderator. [history]
Do you remember the debates over the Affordable Care Act, aka ObamaCare? Now that repeal of the law has become a major campaign issue, it may be helpful to remember why Congress passed it in the first place.
Early in 2010, as the climactic votes neared, a parade of the legislation's defenders—from the House, Senate and Obama administration—appeared across the media. All had the same message: pre-existing conditions. They named the names of families "victimized" by companies that had refused to sell them insurance, had canceled their coverage or had refused to pay their medical bills.
(Excerpt) Read more at online.wsj.com ...
The entire idea of insurance is that you can assess the risk of an event in a pool of people who are paying premiums.
As soon as you say that somebody gets to wait until AFTER they have an event to join the pool, you are no longer talking about something rational.
(Irrationality is the sole province of government.)
Pre-existing conditions” is a straw-man argument any way because current law forbids insurance companies from denying coverage after one year of the condition treatment...see Health Insurance Portability and Accountability Act of 1996 (HIPAA)
There are two basic types of preexisting conditions and neither is insurable: the condition where a person was never insured and wishes to become insured on the way to the hospital, and the condition where a person has a chronic illness requiring expensive, ongoing treatment.
Few (hopefully) would argue that the first problem is worth anyones sympathy or tax dollars, but the second problem engenders sympathy from many and has caused us to give up our liberty to solve. Chronic illnesses costing perhaps thousands of dollars per month through no fault of the patient is a situation none of us would wish to find ourselves.
But consider: if a chronic illness costs, say, $10,000 per month to treat (perhaps for life), what would the premium have to be in order to cover it?
Obviously, anything less than $10,000 per month is a loss, yet that's just the start. An insurance company must cover it's overhead and a profit as well if it hopes to stay in business.
So what's being discussed here is not “insurance” at all, but a welfare benefit - and that's the key. We're allowing this problem to be defined as something it's not.
***As soon as you say that somebody gets to wait until AFTER they have an event to join the pool, you are no longer talking about something rational.***
And you are no longer talking about INSURANCE.
People understand auto insurance, home owners’ insurance and life insurance. You don’t wait for an auto accident, a house fire or death before paying premiums. Why is that so hard to apply to ‘medical care insurance’?
Because people gamble with their health and don’t prepare for catastrophes - they expect the nanny state to kiss their boo-boos.
But the idea was that you could wait until you were sick and then demand coverage and the insurance co’s would have to provide it. This would be especially true if young people forwent [is that a word?]coverage and ended up pregnant or breaking a bone.
Another way to handle it is that if you have been covered for a condition, that coverage should not be subject to refusal or waiting periods with a new insurer, such as if you change jobs.
I am not sure this is true. Why couldn’t you purchase a 30 year level term medical insurance policy, the same as is available for life insurance? As this article proposes, portability would trigger a whole range of new offerings. This is done to some extent now under COBRA legislation. Why can’t this be extended.
On the other hand, I would certainly strip out all those coverages which are essentially pass through costs. For example, most dental insurance is not strictly speaking insurance and amounts to forced savings.
But again: What would the premium have to be to cover a guaranteed $10,000 per month cost for 30 years?
Because of the overhead and profit costs, it might actually be cheaper to pay cash each month!
My point is, we're allowing the left to redefine the language, as usual. We're lumping together medicine, insurance and welfare benefits under the "heathcare" umbrella and the resulting distortions gives us results like Obamacare.
80,000 people nationwide need a welfare benefit. Let's talk about that and free the rest of us from all these government mandates!
Well, what you say is true, IF, you're able to obtain health insurance in the first place. So if you take a job, and health insurance is offered, and you have a pre-existing condition, after one year, they have to cover the pre-existing condition.
However, if you're seeking private insurance, no one will sell you a policy in the first place if you have a pre-existing condition. I have MS and if we did not have group, there would be no way I would be able to purchase private insurance...I would be denied a policy for health insurance, if it were not for the fact that I get it through an employer. The same holds true for life insurance.
If there was a job change, as long as I kept continuous coverage through COBRA, when I or my husband change to the new job, the new policy would not list my MS as pre-existing...because of the continuous coverage.
But if there was a job loss, and COBRA limitations were exhausted, there is no way (except for the high risk pools, PCIP...Pre-existing Condition Insurance Plan) that I could purchase a private policy.
And as to affording the disease without insurance...not possible. I don't take a disease modifying med at this point because of disease progression but I did for many years, and most MS patients do hoping to slow down exacerbations...and the cost, well anywhere from $3000 to $6000 per month. So the average Joe could not afford the meds that the doctors suggest.
You can go on SS disability, which after 2 years allows you to be on Medicare. I'm still able to work, albeit from home, so as long as I can work, I will.
It's a thorny issue and there are no easy answers.
You can purchase insurance, get treatment for whatever ails you (except your pre-existing condition) and then after one year, they are REQUIRED to treat that condition as well!
You will pay more, but hey, why should a 24 year old man be required to pay the same amount for his insurance as an 84 year old man? From the insurance point of view, their cost to treat is going to be MORE for the older customer, so their RATES will be higher for that patient - DUH!!
The Dems don’t want this! They want the 24 year old to pay the same amount as the 84 and they suggest that it all evens out in the long run - BS! There are many, MANY more 84 year old receiving medical treatment than 24 year olds - PERIOD!
I'm sorry you have personal problems. BUT, INSURANCE IS A BUSINESS. If you go to Vegas, they will not give you the money to lose.
Our social system is broken enough. BUT, there are ways to get the MEDICAL HELP without paying an insurance company.
Would you sell a car to someone knowing you had to buy him gas for the rest of his life? I doubt it, yet the insurance companies are told they must pay a million dollar claim when they only get $300 a month. That is not a good bizness policy, though it sounds good from a socialist point of view.
Why should I be forced to pay for what others use. Insurance is supposed to be based on actuarial tables. That means some get sick, and others don't. The insurance companies make charts and tables to show what the ANTICIPATED costs will be, THEN set prices accordingly.I'm neither, but I buy the drugs that are prescribed to keep me going.
Insurance is a profitable business. That is what bizness does, if done properly. The companies pay out a lot of money for things that should never be covered. AIDS is a classic example, since it is usually the result of homosexual sex. (Of course, they are a "protected class" that can freely move around the world spreading their "joy". Then, they expect to be provided with remediation in order to continue their perversion.
When my first child was born, I paid the doctor in cash. He delivered our son for $400, when insurance companies paid a lot more. He understood our situation.
I think all medical care would be cheaper if the insurance companies went away! It's one of those "personal responsibility" things. With insurance, everybody overuses the system for little things, and then wonder why their premiums continue to rise.
I think perhaps there is another kind of pre-existing condition: a congenital one.
While I am certainly not a proponent or supporter of ANY kind of government healthcare, I do have to admit that I am terribly worried about what will happen to my son when he turns 18.
Johnny is 14 right now, and was born with a serious heart defect. The defect was repaired with one very involved, very expensive surgery when he was a mere 6 months old. Tragically, before the surgery was performed, he suffered a stroke that caused some brain damage with attendant learning difficulties.
Since that time, he has had NO health issues — in fact, the only times he’s ever been to the doctor are for regular, yearly checkups — one with his pediatrician, and one with his cardiologist. He has NEVER been sick enough even for a call to the doctor.
He will never go to college. He will probably be able to get a job somewhere, but it is doubtful that that job would ever be able to support him or a family. I also doubt he would be offered any employer-based healthcare insurance, so when he reaches 18...I don’t know what we’ll do.
And I’m extremely worried about the Obamacare Death Panels. What will they say about our John when something goes wrong? Will they say, “Look at this one: he’s got a bum ticker and he’s mentally retarded. He’s never going to be a contributing member of society (or at least his contribution won’t amount to enough $$$ to cover his expenses). Why should we pay to treat him?”
It’s too bad we couldn’t just keep paying for him to stay on our insurance. WHY can’t we? Unless something really miraculous happens in the neurological sciences, he will most likely always be dependant upon his father and me, no matter how old he gets.
There has to be a way to get kids like Johnny, as they enter adulthood, covered by some kind of family plan. As others have suggested over the years, I wish we could divorce healthcare coverage from employment, and be able to purchase a plan just like a life insurance plan, that goes with you no matter WHERE you work (or even if you work at all).
Very true. There are people, such as my brother who could not get coverage for over 4 years.
Exactly! People act as if the "stay on you parents plan til 26" was some kind of gift. But why was it 21 (or whatever) before? Because of the law! Why should an insurance company care as long as someone is willing to pay the premiums?
Exactly and the way insurance works is on the basis of shared risks. I paid health care premiums for many years and never collected anything because I wasn't ill. No one chooses illness, if you get sick and have to use it, then you're bet that having it instead of not having it paid off. If you paid for years and never have to use it, then your "bet" didn't pay off, but you have good health.
Same with auto insurance...shared risks. Say you may get hit by a drunk uninsured driver, through no fault of your own...should your insurance company drop you or raise your rates when you didn't cause the accident, yet you sustained injuries, they had to pay out and they had to replace your car. Of course not.
Well illness, unfortunately, is getting hit by a drunk driver...you didn't see it coming, you didn't want it to happen, but now you have to file insurance claims. Shared risks is how they make their money, they're hedging their bets that you won't get hit, or with health insurance that you won't get sick.
I totally disagree with Obamacare that lets you get insurance after you've become sick, that just bad policy. But to have it, then have to use it, and then be expected to pay more because you had to use it, just isn't how insurance works unless say in the case of auto insurance, if the accident was your fault. Or in the case of house insurance, if you choose to live in an area that is more likely to incur damages, then your rates should be higher. I know about that, live near the Florida coast :)
My husband lost his job right after he got cancer. We also have a daughter with a brain injury and another daughter with a movement disorder called dystonia.
My husband is working for a small start up that doesn’t have insurance.
I’m a stay at home mom, and I’m getting nervous about the whole insurance situation.
Sorry to hear about all the illness in your family.
I can understand why you’re nervous. Are you able to afford COBRA coverage?
If you’re continually covered and your husband gets another job with benefits, then all the health problems won’t be considered pre-existing.
We can afford Cobra. It’s the job I’m worried about. If he can’t work because of the cancer, then we are screwed. There’s no way I could work full-time and take care of my daughters and him.
I’m just praying the surgery worked.