UHC and pre-existing conditions

I know there are a ton of threads on UHC but I have a very specific question.

Obama wants to do away with insurance companies denying coverage because of preexisting conditions. I find out tomorrow I have pancreatic cancer and cost of care will be about $10,000 per month. I go to MegaInsCorp and under ObamaCare they have to accept me. Who pays the bill?

  1. MegaInsCorp
    OK, then who in their right mind would have insurance BEFORE getting sick and how long would insurance companies exist?

  2. Me
    Then why get insurance if my premiums will be $10,419/mo to pay a $10,000 bill?

  3. The others
    Everybody’s premium goes up (10000/number of customers) per month because I chose to not spend $ on health insurance pre-cancer. Or in other words, everyone who has insurance gets punished while the douche gets the benefit of opting out (except for the cancer)

  4. The guv’ment
    See #3 except # of customers is bigger

  5. Not an issue
    Since health insurance will be mandatory from birth to grave, it’s a non-issue. But then what about civil liberties? It’s easy to compare to mandatory car insurance but it’s really not the same thing. Mandatory liability coverage protects you from me when I plow into your car. Mandatory comprehensive/collision protects the leinholder when I plow into your car. There is no requirement (assuming the car is paid off) for me to have comprehensive/collision to protect MYSELF when I plow into your car.

  6. It’s the system we have now because you pay for the uninsured already
    Agreed. But ummmmm . . . aren’t you the people favoring changing the system? And again, why have insurance before you get sick if you know that if a tiger chews you’re leg off you merely have to stop at MegaInsCorp on your way to the ER to get covered and then just wait for your leg to grow back while you make your $7.19 premium every month.
    Oh and you may say that $7.19 is less than your current premium. I took into account that ObamaCare will lower costs.

Number 5 basically. You’re required to either buy insurance or pay extra taxes.

Don’t agree too quickly. People like to assert this, suggesting that “coverage” already exists, just provided in a costly, inefficient way, so we might as well have UHC since we’re paying for it anyway. But people are not going to the emergency room to get chemo treatments or to have tumors removed. UHC would necessarily increase costs in that regard at least (unless efficiencies miraculously offset them) because the uninsured, whether that’s a voluntary circumstance or not, ain’t getting certain treatments.

But that’s nitpicking, great OP. I have asked this question numerous times, and have yet to receive a satisfactory answer.

Mandatory health insurance protects me from you when you get sick and thereby cause money to be spent on your care. The protection effect isn’t as direct and concrete as in the car insurance case, but it’s there nonetheless.

In most chronic illness casis I’ve seen where where the patient is uninsured, they end up falling back on State or Federal programs. Either by qualifying immedietly, or going broke due to their illness and the cost of treatment and qualifying for Medicaid and the like. So the public ends up paying eventually.

The answer I gave is pretty much it. Honestly it isn’t even great debates worthy, there’s an actual UHC bill, and it solves the problem using the mechanism I just stated. You can argue whether that’s a good way to do it or not, but its the factual answer to how the patient in the OP’s example would be treated.

To me, the more apt comparison would be to social security. You’re never required to use it; you’re required to pay in if you have income because it’s a public service. Whether it should be considered a public service is an entirely different argument.

As far as I’m concerned, it’s no different than paying for the military or for public transportation. All of these are perks that I believe that well-off countries should provide to their citizens.

Well, there are two cases here. One, he gets coverage, can’t pay for it and goes bankrupt, and the hospital will have to make up for it by charging other patients more, or he doesn’t get the treatment and dies. Assuming our OP is a productive member of society, and not 99, society actually loses out this way.

The actual answer is 5. Though it sucks for him to have this problem, statistically it is no big deal, so long as his payments are partially made up by people who are healthy - at the moment - and therefore do not take out of the system. The dilemma is paying nothing and then expecting a jackpot, as it were. If he had had to pay, no one thinks you are gaming the system by making use of insurance you had paid for, even if you get far more out of it than you paid in. That is what insurance is all about.

Is it fair? Well, the reason for car insurance is to prevent people who have accidents from dumping the costs they create onto society without paying for them. Since we don’t choose to let people die on the street, someone who doesn’t buy insurance and then expects society to pay for treatment is doing exactly that.

It is nothing new. Company plans don’t exclude those with pre-existing conditions, but they also require that every employee participates unless they can prove they are covered under another plan.

If he can’t afford the premiums, then number 4 kicks in also, as government helps.
Really not all that complicated.

I’m still having a hard time wrapping my head around #5. I’m not trolling just trying to understand where everyone is coming from.

To me insurance protects me. I have fire insurance in case my house burns down. I have comprehensive coverage on my paid off car in case a tree falls on it. Etc.
There is mandated insurance to protect others directly affected by my actions. I hit you with my car, it’s paid by liability insurance. Leinholders (car or house) require me to carry insurance to protect their monetary interest in the collateral.

What I don’t get is requiring people to insure society’s interest against my actions which interestingly enough, involves me insuring myself against my own actions. Can I ride around on my motorcycle with no helmet? Nope because when I do my Gary Busey impersonation, it “costs society”.

And to some extent I get that (although I don’t agree with it), but what about mandatory fetal alcohol syndrome insurance? FAS babies cost society money. What about stupidity insurance to protect society when you fall off a cliff because of texting? Where does mandatory insurance “to protect society” stop?

Forget insurance, just think of it as a service. We all pay for the fire dept, even though we may never use it. The same goes for school taxes when you don’t have kids in school, the Coast Guard when you don’t own a boat, etc.

Insurance is a bad term and it comes from the time when we had “major medical” insurance to pay for large medical costs like operations. Other costs were just paid directly to the doctor and pharmacist. Why don’t we do that now?

[li]Under that system poor people and old people died sooner and suffered more than people with more money. Society thought this was a bad thing.[/li][li]Health care is relatively more expensive these days because we have so many expensive drugs, tests, and treatments.[/li][li]Treating health care as an employer supplied insurance benefit has tax benefits.[/li][li]Over time we just got used to “insurance” paying for routine care.[/li][/ul]
The question for society is whether health care is a service like fire fighting that should be paid for out of taxes, or something like clothes that each person is responsible for themselves. Every other industrialized country in the world takes the first view and they pay less for, and get better results from, their health care system.

Right now we have a fucked up system where most people buy health insurance privately, but we have a safety net for people too poor to afford medical care. In many cases we provide the safety net in the most expensive, and least effective way possible through Emergency rooms. We all pay for that. We could just let people die in the street, but it may damage your alignment when we run over them.

Fire insurance is not mandatory - unless you have a mortgage. Also, if your house burns down with no insurance, your neighbors don’t rebuild it for you. But, since you mentioned fire insurance, lets try this alternate world fire insurance example - to me, it is more like the current health insurance scenario:

You MUST keep a house for 25 years, the odds of a fire get worse as the house ages. From 1-5 years it is 1 in a million, 6-10 1 in ten thousand, 11-15 1 in a thousand, 16-20 1 in a hundred. From 21-25 years - every remaining house is guaranteed to burn.

Now, what does the fire insurance market look like? When would you buy it? How do you think it would be priced? Would anyone offer insurance on a 19 year old house? Could you buy insurance after the fire started? Would you be willing to help rebuild your neighbors house when it burned (and they had no insurance)?

If fire insurance were automatic as long as you paid your real estate taxes, would you like that?

It’s a very fair question, and I think you did a great job laying out the alternatives.

If your house burns down, no one is out but you, so there is no law requiring it. Your mortgage company requires it for the reason you said. If the only one you could hurt in your car is you (and you are guaranteed to either walk away unscratched or die) probably we wouldn’t require auto insurance either.

I’m against motorcycle helmet laws, because we need more organ donors. :slight_smile: But take seatbelt laws. Society has saved whole bunches of money from people not dying or being injured less severely thanks to seat belts. I don’t know if you are old enough to remember when the news media tracked auto deaths during the Memorial Day and Labor Day holidays - in the hundreds, if I remember. MAD had an article with the Memorial Day telethon, with Jerry Lewis encouraging drivers to go out there and die to make the numbers. I think the death rate is so low now no one in the media tracks it.

That, and seat belts, are preventable. You don’t want to insure things you can prevent - ask Twoflower. But for the most part you can’t prevent getting sick - and insurance premiums are higher for people doing dangerous things like smoking.

What’s your take? If you think society should pay for your treatment, don’t you think it is reasonable for you to pay something upfront, just in case? (And cancer is not the only way you get something back.) Or should you be expected to go bankrupt paying for the treatment - same issue. Or should you just be expected to die for your poor decision of not buying insurance?

My take? I find the “cost to society” very disinginuous. I think that is the liberal version of the morality argument the Right uses. Gays can’t marry because of the sanctity of marriage makes about as much sense as making me wear a seat belt because of what it costs society. In Arizona, we have an idiot driver law where you get charged if you diregard danger signs and get stuck. Knowing the dangers involved, I have no sympathy for people who are bankrupted because they chose not to wear a seatbelt or smoke for 20 years just like if they went bankrupt because they invested in sea-monkey farms.

Here’s an idea. If you don’t have insurance and need emergency medical care, the government gets to garnish your wages and has a lein on all of your assets until it is paid off. Here’s the beauty of CadCare. If you are so poorly off that you have no job or assets, then you should be getting social welfare which would include low (or no) cost emergency and primary care coverage. We can argue the finer points of CadCare about abortions on demand and illegal immigrants but to my mind you either pay for insurance, pay for your health care or be TRULY in need of taxpayer support.

Also, I would offer (not mandate) state emergency and primary care insurance at cost-only prices (i think i used the term right) to ensure that everyone has an opportunity to be insurable their entire life. A doctor wants student loan forgiveness or wear a snazzy navy-like uniform in the PHS? Then they must provide pro bono or low cost primary care for low income families within reason.

So bottom line: I don’t believe in the social cost argument because it is the cost of doing business for a government and there are ways to recoup those costs.

In a true, single-payer, government-run UHC, perhaps, but then there’d be no need to eliminate exclusions for pre-existing conditions. There would be no health insurers to command thusly; only benevolent Uncle Sam remains, and he wouldn’t exclude you from coverage if you were a leprous, stage IV cancer victim. Not in the Obamacare Utopia. That term, as it’s bandied about in the real world, typically doesn’t rely on UHC. In fact, it’s a pillar of every Democratic bill, even without a public option or UHC.

Of course, eliminating exclusions for pre-existing conditions collapses of its own weight without the requirement for everyone to purchase insurance, as Saint Cad points out. Small constitutional problem, though, in requiring people to purchase something they’d rather not. It’s not analogous to car insurance, which is a requirement for the privilege of driving. You want to drive? You have to buy insurance. You don’t want insurance? Then don’t drive on public roads. There’s no analogous privilege to withhold for health insurance. Well, one. The problem with health insurance is that the true, legal consequence for not purchasing health insurance when you’re able to would be to withhold medical care. And we don’t, as a society, have the stomach for such a policy.

So, if I don’t want to purchase insurance, what gives the Federal government the power to compel me? I don’t believe the constitution permits such a law. Having said that, I’m sure that if it’s challenged, the Supreme Court will find some way to detect a vibration in the ether that will lead them to conclude it’s A-OK. So, it’s moot, I suppose.

Saint Cad,

You seem to think that the insurance problem is only a problem for poor people. I am someone who before the latest economic downturn had a nice cushy industry job. Then I was unemployed for several months…and now I am an adjunct lecturer at a university and (besides only making a small fraction of my former salary) not getting health benefits. I am currently on COBRA from my cushy job and still have about 9 months or so to go, but I am wondering what will happen once I am thrown out into the general insurance market since, while I generally consider myself healthy, I do have a few pre-existing conditions and I know that one of them was already enough to completely deny me a supplemental health insurance policy back in graduate school when I was a really healthy young buck. (I was told by the insurance guy that I was in the category “NCA” which stood for “no coverage available”…although he said he could write me an “accidents-only” health insurance policy.) At the very least, I suspect that the insurance that I could find would be difficult to afford, at least over the long term, on the much reduced income that I have now.

I find that one of the largest components of my employment decisions are revolving around health care. Without that concern, I could entertain all sorts of possibilities…consulting, continuing in an adjunct teaching status, etc., etc. I can only imagine how sucky it is to really be unhealthy rather than just being someone who is basically healthy but does not have a completely unblemished record of needing medical care…or to not have savings that I could dip into to pay inflated medical insurance premiums at least for some period of time. I mean, I am really someone who is, by all objective accounts, very fortunate in terms of both health and financial situation and even I find myself worrying a lot about these health care issues.

Basic story: The current health care system sucks! It is just stupid to try to have the free market take care of things when the interests of the parties involved aren’t even close to be aligned. And, it actually significantly hampers the free market in other sectors of the economy because many of us who could be doing more consulting or even entrepreneurial stuff (although that probably isn’t my cup-of-tea) find our opportunities restricted because we don’t want to deal with the difficulty of attaining affordable health insurance for that path.

[By the way: On caveat I should mention to my story is that I have not yet investigated my health insurance options once COBRA runs out and it could be that things aren’t quite as bad as I think…but given my previous experience in grad school and what I have heard happening since, I think I have some legitimate reasons for expecting it to be a hassle.]

It’s basically the most minimal way of bringing about more or less universal health care.

The obvious way to achieve UHC would be for Uncle Sam to pay for everyone’s health care, and levy taxes to pay for it all. Obama’s chosen a much less overarching method - letting private insurance continue more or less as is.


  1. You can’t have anything like universal coverage if people are excluded for pre-existing conditions.

But if people know they can’t be refused insurance due to pre-existing conditions, they can wait until they’re sick to buy insurance, and then insurance rates go sky-high, since only sick people would bother with insurance.

  1. Hence the individual mandate. But since a lot of people wouldn’t be able to afford insurance on the private market, we have:

  2. Subsidies for poor and working-class people.

1,2, and 3 are the essential pieces of ‘Obamacare.’ There’s more, but those are the interlocking parts that can’t be broken apart and passed piecemeal. (The bill also contains (4) funding mechanisms and (5) cost control mechanisms, which are politically rather than structurally interconnected with 1-3.)

So think of the individual mandate as a tax. That’s essentially what it is, just under another name.

You can, of course, argue against the desirability of universal health care, but that’s another debate, if I understand you correctly. At any rate, jshore’s personal anecdote illustrates a very real problem with NOT having UHC: there’s a real economic cost to our nation as a whole due to people not starting businesses, not moving to more optimal jobs, etc., simply due to their inability to afford to do so in the absence of health insurance. Ultimately, the well-being of just about all of us is deeply connected with being part of a growing economy. So we make the choices, as a nation, that help it grow.

Interesting. Me, I’m very different, I immediately feel sympathy for suffering, its more or less knee-jerk. Perhaps thats because I’m a radical lefty, or I’m a radical lefty because of it. Whatever.

Your approach is quite different, you assess the subject, examine the circumstances and character, and if sufficiently satisfied of the worthiness of the subject, you will accord sympathy. Have you some sort of emotional/spiritual circuit breaker, allows you to forestall the sensation of sympathy until you can thoroughly assess the circumstances? Sounds interesting, I suppose, but not well suited to my temperament.

Someone with a pre-existing condition does not need insurance (at least as it relates to that condition). He needs medical care. There’s a difference, and it’s an important one.

jshore, option #5 doesn’t apply to you, if your COBRA runs out and you’re deemed uninsurable. I don’t mean for this to sound unsympathetic, but what do you think should happen? Should an insurer have to insure you then? Should they have to do so at a standard rate? What should happen then?

No I don’t.

I work 2 jobs (14 hours a day) to support my family. With 10% unemployment and 20% un/underemployed I’m lucky to have 2 jobs and I’m thankful every day.

His mother has been out of work for 437 days.

To cover my son on my tax-payer supported group heath (day job) would have cost over $400 per month on a $2400 takehome paycheck.

I bought private insurance for him at $40 a month while he was with me but for in his best interest he is with his mother and I’m sleeping in a rented room to pay for them to live in a place where she is more likely to find a job. So guess what. No more $40 because insurance can’t cross state lines. Not that it matters apparently because doctors are sending me bills for the time he was covered.

His mother is on public health care in her new state. Apparently she could have gotten it in this state too but we didn’t know about the program until she moved for the second time in a year to LOOK for work. Thank god the new state has low-cost primary and dental for kids as a public assistance. I was worried how much his vaccinations were going to cost. My kid’s FUCKING VACCINATIONS were a fucking budget item before she found that program. How fucking pitiful is that?

All of this because she worked in the banking industry. I’m a math/sped teacher with a year of seniority in my current district so I have the most job security in the U.S. (i.e. almost none).

How so? Are you referring to preventative care? ISTM that most people’s deductibles are so high that they end up paying for the cost of their preventative care themselves.