Posted on 11/05/2018 8:09:28 AM PST by SeekAndFind
What is a pre-existing condition? This is strictly an insurance term that was created to characterize a particular health condition a person applying for insurance may have. The vast majority of people have pre-existing conditions. They may range from migraine headaches or chronic acne to multiple sclerosis or breast cancer.
Historically, insurance companies went through a process known as underwriting, which meant they assessed the health conditions, current and past, that the applicant experienced. The cost of the insurance policy was based on the perceived risk and exposure of the insurance company. In some cases, the risk was so great that the company declined to insure the applicant. This was a business decision on the part of the insurance company, which felt that it was more likely that it would pay out more money for medical expenditures than it could collect from the applicant in premiums.
As the cost of medical care in the U.S. began to rise, in large part because of the unchecked and opaque pricing of care by hospitals, and because of the high cost of prescription drugs, more patients found themselves being denied coverage because of their medical conditions.
This so-called “denial of coverage” for most medical conditions was not really denial of coverage. It was simply a company’s choice not to offer a product it would probably lose money on. Most people with chronic medical conditions could find medical insurance, but their particular chronic condition might be excluded from coverage for the price the patient might be willing to pay. Covering the chronic condition might have meant a premium that was much too high for the patient to pay. This rendered the patient’s condition essentially uninsurable, because the patient could not afford what the insurance company quoted to the individual.
Obamacare was supposed (by many) to be the solution to the rising cost of insurance premiums and the denials of coverage. The problem, however, is that you cannot cover everything and lower premiums. They are mutually exclusive objectives—unless the government subsidizes this process.
This is exactly what happened. However, because health care prices continued to climb, the government subsidies proved untenable. They could not pay the insurance companies enough to continue to cover all medical care, so premiums began to soar. Eventually, people could no longer afford their health insurance, so they dropped out. The only people who continued to remain on health insurance exchanges were those who continued to receive large federal subsidies or those who had serious chronic health conditions and feared that the risk of getting sick justified their continued participation in the exchange.
The irony of the Obamacare debacle was that many states had set up high-risk pools for those individuals with serous chronic health conditions, but they were wiped out after this law was passed. Today these people are left with little or no choice but to stay on the exchange and the high-priced insurance until high-risk pools can once again be re-established. But the sad truth is that Obamacare ultimately was responsible for leaving people with chronic health conditions no alternatives.
So, when Democrats are trying to score political points by saying that Republicans are about denying insurance coverage to people with pre-existing conditions, remember that such conditions are commonplace and usually are insurable. Almost everyone has one or more of these conditions. Doctors refer to them as medical problems. Most such conditions do not register a concern with an insurance company.
What the GOP is trying to do now is unwind the mess that former President Barack Obama created with health care and insurance. Republicans are giving insurance companies an opportunity to offer insurance policies that differ in price according to health status, just as it once was and should be.
Now it is up to states to work with the federal government to create the safety net for the small portion of our population who have expensive medical conditions that might cause financial harm to individuals and families.
-- Hal Scherz, M.D. (info@d4pcfoundation.org), is chief of urology at Scottish Rite Children’s Hospital in Atlanta, vice president of finance at Georgia Urology, and board secretary at Docs 4 Patient Care Foundation.
Bump!
great explanations!
Obama and the Marxists destroyed the US medical system and we’re still reaping the horrors of that reality. I had a conversation with friends yesterday and we were discussing how awful medical care has become. Most physicians seem to only want to do is hand out prescriptions for medications made in some hell hole out of the USA.
This won’t make your day!! Patient beware!!
https://www.kansas.com/news/nation-world/national/article221081740.html
A patient went in for a standard back surgery. She awoke one kidney short.
Insurance company agrees to accept 90% of applicants, the generally healthy ones; can't shift off if they get sick.
Insurance company accepts your choice of doctors at market prices
Insurance companies can sell in any state
Government offers safety net insurance for people, those 10% with pre-existing conditions.
Let the free market work.
Democrats always claim they want to help people.. All they ever do is entrap them.
Said by a real doc in the field
My new rule
You have to have 10 years in real job before you can be in Congress
Rule 2. No attorneys allowed !
Thanks for the ping!
Right now, you cannot buy a policy which does NOT cover substance abuse in the Commonwealth of Pennsylvania, even if you refuse to put that $#*+ into your body. Even if you get it through an employer who has you pass a drug test as a condition of hiring you.
Nor can you buy a policy in the State of Delaware which is NOT larded up with mandates to cover conditions exclusive or nearly exclusive to the homosexual lifestyle.
Agree!
A sensible explanation. Boy, I’ll be he’s going to get a lot of hate mail.
The cost of medicine for pre-existing conditions should be revisited. It is a crime how drug companies soak those who are dependent upon monthly prescriptions to live.
When your house is on fire, call an insurance agent, tell him the current condition of your house, and try to purchase an insurance policy.
The house fire is a pre-existing condition, and he will not sell you a policy.
The same should be true for health insurance.
Think about it ...
Insurance claims don't adhere to typical economic principles of supply and demand because there are three parties to every transaction, not two. This is not a serious problem with something like life insurance because there a finality about death that makes the claims process and the aftermath much more clear, but for health insurance it introduces a flaw that always rears its ugly head. If I need medical care, we have three parties to the transaction who operate under conditions that do not apply to a "pure" economic transaction . . . (A) I have already paid for the insurance, so I really don't care how much the treatment costs -- I want the best care, best service, etc.; (B) the insurance company doesn't have to live with the consequences of poor medical treatment, so it doesn't really care about the quality of the doctor, the procedures, etc.; and (C) the doctor and medical facility is dealing with two "customers" who have two different goals in mind in the transaction. The end result is that the insurance keeps getting more expensive because there is no way for prices to be regulated by "the market" through normal supply and demand considerations.
There should be a one time, six-months amnesty, during which people w preexisting conditions can get insurance. That is it.
It is not fair to everyone else that people don’t get insurance while healthy, just wait until they get some terrible illness, then want to get insurance.
Really? How much do you charge for the medication YOU have developed?
bookmark
A better approach is to clearly define what exactly a "pre-existing condition" means ... so it reflects the way other types of insurance work.
If you have no insurance today and then you have a medical condition that requires expensive care, then yes -- you have a "pre-existing condition" (by any definition) if you go out and try to buy medical coverage.
On the other hand ... if you are already insured today and you have a medical condition that requires ongoing treatment, your condition should NOT be considered "pre-existing" if you change insurance carriers. Your continuity of insurance should protect you in all cases. In the example I cited here, there should be a transparent, regulated process for the two insurance companies (the one covering you when treatment began and the one covering you when you change insurers) to work out the details of who pays for the medical care for that particular illness or injury.
If you are currently ill, any financial contract that has someone else paying the bills is not “insurance,” and no business would willingly enter into a contract that obligated them to pay the bill rather than you.
One could hypothesize a contract that “insured” a person with, say, diabetes: the annual premium would be equal to the expected annual cost of treatment for the diabetes, plus an additional sum towards actual insurance for injuries or further illnesses. It would cost a lot, probably more than paying cash for treatment of diabetes while buying an insurance policy for other stuff.
“pre-existing” conditions is probably too loose a term to be of practical use. It implies conditions that someone has never seen a doctor about.
Should be “conditions that had to be previously paid for, either out-of-pocket or a prior insurance company”.
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