# Who are the uninsured with pre-existing conditions in the US, and will they bankrupt health care **URL:** \ **Category:** Great Debates\ **Created:** [December 16, 2010, 8:53pm UTC](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420 "2010-12-16T20:53:41Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![Desert\_Nomad](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/desert_nomad/32/177_2.png) [@Desert\_Nomad](https://boards.straightdope.com/u/Desert_Nomad)\ **Post date:** [December 26, 2010, 11:21pm UTC](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420/21 "2010-12-26T23:21:16Z")
> [@Wesley\_Clark](#): > > who are the uninsured with pre-existing conditions among the 60 million total uninsured? I am one. I have a genetic disorder called Neurofibromatosis (NF1). I have been declined by every insurer licensed in my state (Nevada) so in 2002, I left the USA. I was easily able to obtain insurance overseas from a UK firm (I don’t live in the UK), that is valid everywhere in the world except the USA… US law prevents them from providing coverage in the US. I am a small business owner with just my wife and I running it, so I don’t qualify for a group plan. We earn $200K per year and my medical costs for my condition have been less than $10,000 in 40 years. ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [December 27, 2010, 4:49am UTC](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420/22 "2010-12-27T04:49:04Z")
> [@amarone](#): > > It’s all very well to say that insurance companies should cover people with pre-existing conditions when it only costs a few dollars a year extra for their meds. If it were that simple, they would do it and make a healthy profit from those customers. Actuaries expert in their field know a lot more than random (but generally intelligent) posters to a message board. Why is it presumed that health insurance as a profitable enterprise must be preserved? Why not set the rules (no pre-existing conditions refused, no recission on diagnosis of disease) and let the market sort it out? If they can’t make a profit, let them get out of the business. If no one can make a profit without victimizing the weak, then it is not a industry that should be protected. ---
**Author:** ![amarone](https://avatars.discourse-cdn.com/v4/letter/a/e0b2c6/32.png) [@amarone](https://boards.straightdope.com/u/amarone)\ **Post date:** [December 27, 2010, 4:51am UTC](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420/23 "2010-12-27T04:51:36Z")
> [@Fear\_Itself](#): > > Why is it presumed that health insurance as a profitable enterprise must be preserved? Who is making that presumption? ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [December 27, 2010, 4:54am UTC](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420/24 "2010-12-27T04:54:08Z")
> [@amarone](#): > > Who is making that presumption? It sounded like you were, when you implied we must trust the company actuaries whose job it is to protect the company profits. ---
**Author:** ![amarone](https://avatars.discourse-cdn.com/v4/letter/a/e0b2c6/32.png) [@amarone](https://boards.straightdope.com/u/amarone)\ **Post date:** [December 27, 2010, 4:58am UTC](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420/25 "2010-12-27T04:58:25Z")
> [@Fear\_Itself](#): > > It sounded like you were, when you implied we must trust the company actuaries whose job it is to protect the company profits. I trust the company actuaries to know better than I (or posters on this board) which prospective customers will be profitable and therefore best for their company. That’s all I was saying. I do not trust the actuaries or their employers to determine what sort of health system is best for the nation as a whole. ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [December 27, 2010, 5:03am UTC](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420/26 "2010-12-27T05:03:54Z")
I understand now. However, I don’t care which customers are profitable, so the opinion of the actuaries is irrelevant to the question of whether excluding preexisting conditions should be mandated. ---
**Author:** ![amarone](https://avatars.discourse-cdn.com/v4/letter/a/e0b2c6/32.png) [@amarone](https://boards.straightdope.com/u/amarone)\ **Post date:** [December 27, 2010, 5:10am UTC](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420/27 "2010-12-27T05:10:45Z")
> [@Fear\_Itself](#): > > I understand now. However, I don’t care which customers are profitable, so the opinion of the actuaries is irrelevant to the question of whether excluding preexisting conditions should be mandated. It is, but that is not what I was addressing. I was addressing posters who suggest that many pre-existing conditions are cheap to treat and therefore it should not cost much to cover these patients. Overall, it does cost quite a bit, or the insurance companies would be happy to cover them (for an increased premium). After all, businesses need to acquire customers, not refuse them. So we need a system that treats everyone, and part of that is acknowledging that some groups of people, such as those with pre-existing conditions, can get expensive and therefore these costs need to be covered. As to the original OP question of whether this will bankrupt healthcare, I don’t see why it should. After all, all the other developed countries in the world can afford it. ---
**Author:** ![AboutAsWeirdAsYouCanGet](https://avatars.discourse-cdn.com/v4/letter/a/22d042/32.png) [@AboutAsWeirdAsYouCanGet](https://boards.straightdope.com/u/AboutAsWeirdAsYouCanGet)\ **Post date:** [December 27, 2010, 8:59am UTC](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420/28 "2010-12-27T08:59:19Z")
> [@](#): > > have pre-existing conditions, but my medications to control them cost less than $30 a year. I have heard numerous stories of other people saying the same thing. They have a chronic condition, they take generic medications that cost $50 a year and it is controlled. But they can’t get insurance because of it. Or the chronic condition is something that is chronic, but doesn’t make you medically fragile or result in tons and tons of doctor visits or obscure meds. I have a genetic disorder. I need to be followed by multiple medical specialists. I very rarely see them except for my audilogist. But I never see my GP. (except for physicals) Why the hell should I be denied health care simply b/c I have chronic issues? ---
**Author:** ![Stratocaster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/stratocaster/32/16393_2.png) [@Stratocaster](https://boards.straightdope.com/u/Stratocaster)\ **Post date:** [December 27, 2010, 1:07pm UTC](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420/29 "2010-12-27T13:07:27Z")
> [@amarone](#): > > It is, but that is not what I was addressing. I was addressing posters who suggest that many pre-existing conditions are cheap to treat and therefore it should not cost much to cover these patients. Overall, it does cost quite a bit, or the insurance companies would be happy to cover them (for an increased premium). After all, businesses need to acquire customers, not refuse them. I have to just add a “yes!” to this post–I’ve offered this exact sentiment many times on this board. If an insurance company can cover you profitably, they will, I can assure you. If they turn a dollar away, it’s because they don’t think it can make them an acceptable return. > [@](#): > > So we need a system that treats everyone, and part of that is acknowledging that some groups of people, such as those with pre-existing conditions, can get expensive and therefore these costs need to be covered. This is an arguable, subjective assertion, of course (the first part). But what is not, is that once we are in the arena of “pre-existing conditions,” we are no longer discussing insurance. Perhaps society as a whole has a moral obligation to cover such conditions, but (as I also said in another thread), CIGNA has as much of an obligation to do so as Microsoft; neither firm’s business model is set up to accommodate such conditions. That is NOT insurance. As it relates to their pre-existing conditions, people don’t want insurance; they want someone to pay their medical bills. Hell, I feel the same way about _all_ my bills, but damned if I can convince anyone they ought to. ---
**Author:** ![amarone](https://avatars.discourse-cdn.com/v4/letter/a/e0b2c6/32.png) [@amarone](https://boards.straightdope.com/u/amarone)\ **Post date:** [December 27, 2010, 1:24pm UTC](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420/30 "2010-12-27T13:24:13Z")
> [@Stratocaster](#): > > This is an arguable, subjective assertion, of course (the first part). But what is not, is that once we are in the arena of “pre-existing conditions,” we are no longer discussing insurance. Perhaps society as a whole has a moral obligation to cover such conditions, but (as I also said in another thread), CIGNA has as much of an obligation to do so as Microsoft; neither firm’s business model is set up to accommodate such conditions. That is NOT insurance. > > As it relates to their pre-existing conditions, people don’t want insurance; they want someone to pay their medical bills. Hell, I feel the same way about _all_ my bills, but damned if I can convince anyone they ought to. My use of “coverage” is perhaps a poor choice as it tends to make one think of insurance. I mean “health care coverage”. However, the way the US system is set up, that may have to equate to “insurance coverage” as we have an insurance-based system. I don’t see why covering everyone would not be insurance, though. I also don’t agree that “people” (all people? most people?) want someone else to pay their medical bills. There’s only one source of money - taxpayers - so however it is done, taxpayers foot the bill. If healthcare were funded out of payroll taxes, then we would all be paying for it. But we would be insured against catastrophic medical bills. The UK pays for its system out of payroll taxes, and these taxes are called… National Insurance. ---
**Author:** ![Stratocaster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/stratocaster/32/16393_2.png) [@Stratocaster](https://boards.straightdope.com/u/Stratocaster)\ **Post date:** [December 27, 2010, 2:57pm UTC](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420/31 "2010-12-27T14:57:50Z")
> [@amarone](#): > > My use of “coverage” is perhaps a poor choice as it tends to make one think of insurance. I mean “health care coverage”. However, the way the US system is set up, that may have to equate to “insurance coverage” as we have an insurance-based system. > > I don’t see why covering everyone would not be insurance, though. I also don’t agree that “people” (all people? most people?) want someone else to pay their medical bills. There’s only one source of money - taxpayers - so however it is done, taxpayers foot the bill. If healthcare were funded out of payroll taxes, then we would all be paying for it. But we would be insured against catastrophic medical bills. The UK pays for its system out of payroll taxes, and these taxes are called… National Insurance. Insurance guards against the\* risk\* of some unfavorable outcome. That’s why covering a pre-existing condition is not insurance; it’s not a risk, it’s a certainty, whatever the UK calls it. If I have stage IV cancer, I don’t need insurance. I need a benefactor. That’s what I meant by someone with pre-existing conditions wanting someone else to pay their medical bills. That’s exactly what they want, if they are pursuing coverage for their pre-existing conditions. They aren’t looking to guard against a possibility. They’re looking for someone they can forward their medical bills to. Not surprisingly, there aren’t lots of firms lining up for that privilege. Perhaps society ought to play that role, and there are certainly those that do. But it’s not insurance and it’s illogical to make it the burden of insurance companies. Why not make Ford and Microsoft pay for pre-existing conditions? ---
**Author:** ![The\_Tao\_s\_Revenge](https://avatars.discourse-cdn.com/v4/letter/t/73ab20/32.png) [@The\_Tao\_s\_Revenge](https://boards.straightdope.com/u/The_Tao_s_Revenge)\ **Post date:** [December 27, 2010, 3:16pm UTC](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420/32 "2010-12-27T15:16:27Z")
Insurance companies heavily lobbied against a public option that could have covered the pre-existing conditions. Why is that? Since they flooded the air waves with propaganda, and made it politically unpalatable. Why shouldn’t they be made to clean up the mess of their propaganda? Fuck those bastards. Further “pre-existing conditions” gives them an excuse to drop someone who develops cancer, after taking their premiums for years, because they had acne at 14 and didn’t think to report it. Since they’ve abused pre-existing conditions, yanking the rug out from people when they need it the most, why should those greedy murderous bastards be allowed to use them? ---
**Author:** ![amarone](https://avatars.discourse-cdn.com/v4/letter/a/e0b2c6/32.png) [@amarone](https://boards.straightdope.com/u/amarone)\ **Post date:** [December 27, 2010, 3:30pm UTC](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420/33 "2010-12-27T15:30:47Z")
> [@Stratocaster](#): > > Insurance guards against the\* risk\* of some unfavorable outcome. That’s why covering a pre-existing condition is not insurance; it’s not a risk, it’s a certainty, whatever the UK calls it. The UK can accurately call it insurance because health care is available from whatever point you choose to call the start of life, so there are no pre-existing conditions. If the US moved to this model, then the pre-existing condition issue is a temporary one that applies only during the (long) transition to the new system. In the meantime, I really don’t care whether covering people with pre-existing conditions is “insurance” or not. It is simply something that a decent society provides for its members. Now I do agree that insurance companies should not be forced to lose money. That is why my earlier posts were emphatic that we should not ignore the fact that pre-existing conditions are a money loser, and that any solution needs to take that into account. That is, of course, why the health bill has the personal mandate in it - it is ok (financially) if you force the insurance company to lose money in one area if you provide compensatory profits elsewhere. ---
**Author:** ![Damuri\_Ajashi](https://avatars.discourse-cdn.com/v4/letter/d/898d66/32.png) [@Damuri\_Ajashi](https://boards.straightdope.com/u/Damuri_Ajashi)\ **Post date:** [December 27, 2010, 4:06pm UTC](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420/34 "2010-12-27T16:06:59Z")
> [@amarone](#): > > Insurance companies need (profitable) customers. … > … > The current system sucks big time, but it is what we have and any improvement has to start from here and acknowledge the reasons why things are. Hiding behind “HI companies are evil and stupid” will not help. I think we have to recognize that people with pre-existing conditions do genuinely pose a significant risk to insurance companies, and then work out how to deal with it. Is replacing HI companies with a single payer system a method of “dealing with it” in your opinion? ---
**Author:** ![amarone](https://avatars.discourse-cdn.com/v4/letter/a/e0b2c6/32.png) [@amarone](https://boards.straightdope.com/u/amarone)\ **Post date:** [December 27, 2010, 4:15pm UTC](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420/35 "2010-12-27T16:15:39Z")
> [@Damuri\_Ajashi](#): > > Is replacing HI companies with a single payer system a method of “dealing with it” in your opinion? It depends what you mean by your question. In abstract yes, a single payer system works in terms of being a method for providing health care. However, it may not be an acceptable way to get there from where we are today (in the US). I do not think it would be right for the government to put a whole lot of companies out of business just because it wants to do something differently. Hence the most pragmatic approach is to try find something that works within the current environment, i.e. based on a significant private healthcare/insurance model. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [December 27, 2010, 4:16pm UTC](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420/36 "2010-12-27T16:16:05Z")
> [@amarone](#): > > It is, but that is not what I was addressing. I was addressing posters who suggest that many pre-existing conditions are cheap to treat and therefore it should not cost much to cover these patients. Overall, it does cost quite a bit, or the insurance companies would be happy to cover them (for an increased premium). After all, businesses need to acquire customers, not refuse them. > > So we need a system that treats everyone, and part of that is acknowledging that some groups of people, such as those with pre-existing conditions, can get expensive and therefore these costs need to be covered. > > As to the original OP question of whether this will bankrupt healthcare, I don’t see why it should. After all, all the other developed countries in the world can afford it. I thought about that too, and how the actuaries know what they are doing and if most pre-existing conditions would turn a profit for the company then those people would be covered. But according to the new laws, now pretty much everyone 0-19 and 65+ will be covered for pre-existing conditions leaving only those 20-64. And if eliminating pre-existing conditions on kids only results in a fraction of 1% in cost increases I don’t know how much doing it for adults will. Since insurance rates go up 20% a year for many people I’m guessing it might be lower than that. ---
**Author:** ![Damuri\_Ajashi](https://avatars.discourse-cdn.com/v4/letter/d/898d66/32.png) [@Damuri\_Ajashi](https://boards.straightdope.com/u/Damuri_Ajashi)\ **Post date:** [December 27, 2010, 4:17pm UTC](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420/37 "2010-12-27T16:17:02Z")
> [@Fear\_Itself](#): > > I understand now. However, I don’t care which customers are profitable, so the opinion of the actuaries is irrelevant to the question of whether excluding preexisting conditions should be mandated. So I take it you are for a single payer UHC system. ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [December 27, 2010, 4:24pm UTC](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420/38 "2010-12-27T16:24:28Z")
> [@Damuri\_Ajashi](#): > > So I take it you are for a single payer UHC system. Yes. But I have no illusion that it will be implemented any time soon. In the meantime, insurance companies should be heavily regulated, and those who don’t want to reduce their bloated overhead and live with smaller profits can wither and die. The sooner the for-profit health insurance industry in the US is choked to death, the sooner we will see single payer UHC. ---
**Author:** ![Damuri\_Ajashi](https://avatars.discourse-cdn.com/v4/letter/d/898d66/32.png) [@Damuri\_Ajashi](https://boards.straightdope.com/u/Damuri_Ajashi)\ **Post date:** [December 27, 2010, 4:43pm UTC](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420/39 "2010-12-27T16:43:16Z")
> [@Stratocaster](#): > > Insurance guards against the\* risk\* of some unfavorable outcome. That’s why covering a pre-existing condition is not insurance; it’s not a risk, it’s a certainty, whatever the UK calls it. If I have stage IV cancer, I don’t need insurance. I need a benefactor. That’s what I meant by someone with pre-existing conditions wanting someone else to pay their medical bills. That’s exactly what they want, if they are pursuing coverage for their pre-existing conditions. They aren’t looking to guard against a possibility. They’re looking for someone they can forward their medical bills to. Not surprisingly, there aren’t lots of firms lining up for that privilege. > > Perhaps society ought to play that role, and there are certainly those that do. But it’s not insurance and it’s illogical to make it the burden of insurance companies. Why not make Ford and Microsoft pay for pre-existing conditions? You are making a technical (but correct) argument about what constitutes insurance. With that said, insurance companies are in a much better position to administer health care disbursements than Microsoft. As long as the insurance company can charge the person with the pre-existing condition an appropriate premium, I don’t see why that business can’t be profitable. Or in the alternative, if everyone is required to purchase health insurance, we can spread the cost of the cost of covering those with Pre-existing conditions amongst a large enough population that it doesn’t really cost any individual that much money. The second option is a poor substitute for a single payer system or UHC but it was (apparently) the best we could get with both houses of congress and the white house. ---
**Author:** ![Stratocaster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/stratocaster/32/16393_2.png) [@Stratocaster](https://boards.straightdope.com/u/Stratocaster)\ **Post date:** [December 27, 2010, 6:09pm UTC](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420/40 "2010-12-27T18:09:35Z")
> [@Damuri\_Ajashi](#): > > You are making a technical (but correct) argument about what constitutes insurance. With that said, insurance companies are in a much better position to administer health care disbursements than Microsoft. > > As long as the insurance company can charge the person with the pre-existing condition an appropriate premium, I don’t see why that business can’t be profitable. It’s inherently unprofitable, if you’re going to try to cover it in that person’s premium. Medical costs + any additional premium to ensure profit \> medical costs. It’s cheaper just to pay the cost. If you want to dilute the cost among those already paying, well, those already paying will pay much more. If you want to dilute it further by forcing people (who have reasonably decided they have very little risk and don’t need insurance) to buy insurance–well, then you have the cluster@#$% currently on the runway awaiting takeoff. And as far as your first point, let’s let CIGNA administer, but Microsoft covers the actual expense. Problem solved! [Previous page](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420.md?page=1) [Next page](https://boards.straightdope.com/t/who-are-the-uninsured-with-pre-existing-conditions-in-the-us-and-will-they-bankrupt-health-care/564420.md?page=3)