I do not understand why almost everyone supports forcing insurers to cover people with pre-existing conditions. Insurance is about the transfer of risk. If a person has a pre-existing condition that is a known cost, not a risk.
I recently saw a show on the health care debate. (The show was old and was produced during the health care debate.) One of the people profiled was young man that had developed some medical condition that required him to take expense medication. His parents tried to find a health insurance plan for him. They were angry that the only plans they could find an extremely limited selection of plans and that they were all more expense than their son’s current medication costs. But what did the parents expect? Did the parents really want the insurance companies to automatically pay out more in benefits (and cover other risks) than the insurance company got in premium?
Why is it a good idea to force insurers to take on customers who have known costs that are beyond the customer’s premium? How does this not lead to massive adverse selection? Even if we force everyone to buy insurance, won’t the people with known medical costs (especially if their costs are high) flock to high benefit plans while other people will select lower benefit plans or choose to pay the fine for not having insurance. This selection will drive up the costs of higher benefit plans for everyone.
Explain why it is a good idea to ignore that insurance is a method to transfer risk? Wouldn’t it be better to make the people who have known costs continue to pay those costs and that the only thing that insurance companies should be forced to do for people with pre-existing condition is to cover those people for expenses beyond their known costs at premium levels that are reasonable considering the person’s risk levels. Basically, stop insurance companies from refusing any coverage to people with pre-existing conditions, and make the insurance companies offer people with pre-existing limited coverage that covers things beyond the people’s known costs.
It’s because we have this weird set up where health insurance is really only purchased through one’s employer, a status that is likely to change. Insurance doesn’t really insure you in a meaningful way if it means that once you develop a condition you have to stay with a given employer forever, if you can, and you will be financially ruined if you don’t. Disallowing denial of coverage for pre-existing conditions providing that the person had continuous coverage is a kludge of a solution to a kludge of a situation.
I think that’s a good summary, even if it doesn’t cover the entire problem. Instead of fixing a bad system (encouraging people to get insurance through work by preserving its tax exempt status), we made it worse by requiring insurers to pay for known expenses. As the OP says, that isn’t insurance.
We’re trying to create UHC without actually having UHC, and so we get this weird “insurance” system that isn’t insurance. People say that the whole package in the HCRB is supposed to be better than what we have now, and I guess we’ll see.
The idea is that the insurers can afford this since we now require lots of healthy people to buy insurance who wouldn’t have otherwise bought into the system.
Suppose a person has medical insurance continuously for 35 years through his employers. During that time they go to the doctors for various minor conditions. They are then unemployed and need to get individual insurance. The insurance companies look at the medical history and decide that pre-existing conditions disqualify the person for new insurance. This is despite the fact that the person paid premiums for 35 years that were far in excess of what he got out in services.
IIRC, the main horror of the “preexisting condition” was the unfortunate habit of insurers to ferret out some unrevealed “preexisting condition” as a means to evade payout. So what you had was not so much insurance but the solid assurance that, should you become ill, you will be afforded an irrevocable opportunity to play “Wheel of Misfortune”.
This might be a problem if our insurance institutions were not humane and compassionate, but driven by a ruthless reverence for the Bottom Line. I am assured that this is not the case, I just saw the ad on TV, full of compassionate and concerned actuaries. I might be worried, I suppose, if America’s insurance industry was so well-profited that they could afford to fling my premium money into political action to their selfish benefit. Or if their CEO’s were making grossly excessive salaries and bonuses. That might concern me.
Like I said, I would have no problem with forcing the insurance company to provide coverage to this person at a premium level that is reasonable for the person’s risk.
Most people are going to pay premiums in excess of the paid-out services. That is the nature of insurance.
Often you can be sick and not show symptoms until later. Then if you go to the doc he can say you had it coming on for a long time. So insurance companies should not have to pay for care?
Change jobs and your wife is pregnant, it is a pre -existing condition. Do they have to cover?
It gets to the health companies declaring whatever you have is pre-existing and you have to fight against a huge corporation to get the insurance you are paying for.
To me, this is why the term ‘medical insurance’ is a misnomer and why the ‘free market’ simply fails when it comes to medical care.
I had employer coverage for almost 40 years, am now paying my own ‘insurance’, in good health - but could still face bankruptcy from medical care. I can think of few other life necessities that work this way.
If my home or car were to be accidentally destroyed, insurance would replace them - but I would not be denied continued insurance coverage. Not so with health care.
Some preexisting conditions are unlikely to cost the insurer much money, if anything at all. For example, a friend of mine has mild intermittent asthma. What this means in reality is that once every few years, she buys a $50 inhaler. But it also meant that she was completely unable to find an individual policy before she was eligible for employer group coverage; everyone just flat-out denied her.
Let’s note too that every insurer has a different definition of what constitutes a “pre-existing condition.” I’ve seen policies where, for example, having a heart attack is the trigger for a pre-existing condition - and others where merely high blood pressure is the trigger. And who defines “high blood pressure” - where is that cutoff line? Come to think of it, I’ve seen a policy once where the line was at “heart surgery”, not heart attacks.
I know I received direct personal attacks and insults the last time I posted it in this forum, but “tough” internet thugs never scared me, and never will, so I’ll say it again. Something Obama and the Democrats did right with health care reform was eventually eliminating the pre-existing conditions from consideration. Where they fucked up was applying it to children first instead of including parents and adults at the same time. Everyone should have been included.
I would have no problem with requiring insurance companies to offer her coverage.
But, for what I understand, starting in 2014, insurance companies with be required to offer their plans, other than grandfathered plans, to anyone regardless of pre-existing conditions at the same premium.
It has to do with the unfortunately common human preference for solutions that are simple, straightforward, and involve punishing the unjust and protecting the innocent.
A solution that simply identifies insurance companies as greedy and evil, and “solves” the problem by passing a law saying they have to act against their own best interest, is attractive. Not effective, attractive. The good guys win, the evil are punished, everyone lives happily ever after. Then either [list=a][li]the insurance companies go out of business in that particular area, or [*]they figure out how to pass the increased costs along to the rest of their customers. [/list]The bill still has to be paid, one way or another. The attractive “solution” of blaming the insurance company for the high cost of health care doesn’t change that. [/li]
Actually multiple solutions, but the point remains.
This is exactly right. We need true UHC, but pragmatically I have no problem with forcing coverage of pre-existing conditions if it means people who need treatment get it.
“UHC” = Universal Health Care. The new law requires universal coverage. Its not “fake UHC” its just UHC. People seem to have a weird idea that any UHC without single payer isn’t “real”, but plenty of other countries have Universal Health Care without single payer. The US is now one of them.
They can take a shot at cancelling your coverage even without a claim of preexisting condition. I had an uncle who retired as a cop. He had coverage through the city he was employed in and it rolled over to retirement coverage. Different account, maybe, but the same insurance company.
Then he developed leukemia. His insurance didn’t like that. They kept trying to shift him into a high risk group, with a higher premium that he would have to cover. It was plainly illeagal, and he knew how to fight it, but it took a lot of time and energy that he really needed for staying well. Then they cancelled his coverage outright. Coincidentally, it was right when he got sick enough that he had to be hospitalized. He was hospitalized twice - they cancelled twice while he was hospitalized. Also plainly illeagal. Also time and energy consuming.
The new law does not require universal coverage. It has incentives and penalties, but there is no requirement. The CBO estimates that there will be roughly 23 million uninsured after all of the law has taken effect. Though about six million undocumented immigrants won’t be eligible by design, the rest of those millions will certainly include people that want health care but still can’t afford it. It will also include some that may want health care but still don’t think it is worth the cost.