Posted on 01/23/2010 8:21:06 PM PST by SeekAndFind
One of the things on most people's health care reform to-do list is fix the pre-existing condition problem. In real life, this problem is a lot smaller than it used to be. For the most part, so long as an individual has continuous health care coverage, he or she can change insurers and have any pre-existing conditions covered. The problem comes when the individual stops paying for health insurance and then develops a health problem. For obvious reasons, insurance companies aren't going to just start covering a person who is already sick or injured. That's like providing auto insurance after the crash.
Fixing this problem isn't easy. Senator Claire McCaskill, speaking Wednesday about a scaled down health care bill, described the difficulty pretty clearly:
Smaller packages are hard because they are all so interrelated. You can't do pre-existing conditions unless you do a mandate. And you can't do a mandate if you make insurance affordable. So someone has to explain it to me. Do you think everybody around here wanted a bill this big?
Just to make clear what the Senator is saying: If Congress mandated that insurance companies cover pre-existing conditions and did not mandate that everyone buy insurance, many people would simply not buy insurance, wait to get sick or injured, then sign up and leave the insurance company with tens or hundreds of thousands of dollars of bills that haven't been paid. Mandating that everyone buy insurance fixes this problem, but it leads to the following hideous policy cascade:
A) Because all individuals will be required to buy insurance, there must be a public option. Otherwise people will be forced to buy insurance from private companies with no brake on what private companies will charge for it. Even assuming a transparent and functioning insurance market (an entirely different issue) -- mandated coverage will "artificially" increase demand, drive up prices, etc.
B) Under a universal insurance mandate, lots of people who can't afford (over-priced) insurance will nevertheless be forced to buy it. So, compassion (or, perhaps, simple practicality) requires that we subsidize that purchase for them. If the mandate didn't drive up insurance prices, that subsidy certainly will.
At which point, the costs of health care reform and the bureaucratic burden -- to control both demand and prices -- spin wildly out of control.
Herewith is a modest attempt to get along with these people (reform advocates) -- a smaller, cheaper fix for the pre-existing condition problem.
(1) Everyone who doesn't buy health care insurance must pay into a "pre-existing condition" fund.
(2) The fund will only cover the costs of catastrophic pre-existing conditions and will only pay those costs when a person decides to start buying health insurance. There is room to argue about what's catastrophic, but at a minimum expenses related to a condition would have to exceed $5,000 -- and a $5,000 deductible would apply.
(3) Actuaries would make sure that the premiums paid in (1) would cover the expenses incurred in (2).
For most people health insurance is not their highest priority. There are other things they prefer to buy. If they aren't willing to provide for ordinary health expenses -- if they'd rather get a car -- fine. And -- above the poverty level -- they can then be expected to pay out of pocket what others have insured for. Up to a point. If they suffer something catastrophic, that they are unable to personally finance then, as all the policy wonks have been saying, people without insurance should not be able to ride free on our compassion.
This should not be an excuse to provide a subsidized, full coverage plan for every American. Instead, keep the program small. The program should cover one thing: catastrophic pre-existing conditions. Treat it like Social Security -- make everybody pay in to the program. Manage the fund federally, or at the state level, or even privatize it. Just keep the program small enough so that it doesn't become a pretext for a trillion dollar transfer of wealth from those who do pay for insurance to those who don't.
Here is my idea: KEEP THE GOVERNMENT OUT OF HEALTH CARE. End Medicaid, phase out Medicare and end all talk of Obamacare. Let people take care of themselves. That is what freedom is all about. You take your chances, rise or fall on your own merits and live with the consequences.
I live in a state that the insurance company cannot rule agaisn’t you for a pre-exisiting condition.. It just drives me batty when I hear that...I read that post earlier a woman in Mass. health care was a right.
http://www.freerepublic.com/focus/f-news/2435762/posts
Just keep the government out of it please.
This is not a direct relationship. Health insurance is not a limited-supply product, on which demand can drive up prices.
In fact, it's the opposite. Any one company can write coverage for every single person in the world. There is no "supply" problem at all -- and better, the more people an insurance company covers, the lower their risk and therefore the less they have to charge. So driving up demand will actually DECREASE prices.
But indirectly, the actual HEALTH CARE is limited. If twice as many people try to go to the doctor, they will not be able to find enough doctors, so doctors would be able to charge more -- until we get more doctors through medical training.
However, we could help solve that problem if we loosened restrictions on who could be primary care physicians. Doctors are overtrained for that role, which is why under HMO rules a lot of that work is done by nurse practitioners. You bump up to a doctor if the problem's solution isn't obvious.
If we relax restrictions, some people can be gatekeepers after a 4-year college degree, driving up supply and lowering costs since those gatekeepers won't have 10 years of expensive medical school to pay for.
TO do this, you need tort reform, so people can't sue when the gatekeeper makes a mistake.
The Federal Government would never be able to keep its hands off the “pre-existing conditions” fund, just as it hasn’t kept its hands off of Social Security contributions. They would issue funny bonds, just like they have for SS, which we would redeem via our tax dollars. So, we’d pay twice: once for the fund and then through higher taxes/inflation.
The Federal Government would never be able to keep its hands off the “pre-existing conditions” fund, just as it hasn’t kept its hands off of Social Security contributions. They would issue funny bonds, just like they have for SS, which we would redeem via our tax dollars. So, we’d pay twice: once for the fund and then through higher taxes/inflation.
Too late they have been in it for years! The plan must be to get the federal government out of anything not enumerated in the constitution including: health care, health insurance, home mortgages, education, toilet capacity, the efficiency of light bulbs, food stamps, mandatory seat belts, Social security, required gas mileage of new vehicles, minimum wage, union-labor laws, child labor laws, OSHA, EPA,FDA, wetlands protection, paying landowners not to produce, farm subsidies, price supports, firearms restrictions, national endowment for commercially un-viable art, IRS police powers, ...
But if they want to protect our borders I suggest build the fence!
I have no intention of paying for people who wait around until they get sick to bog down my insurance company with kidney transplants. . Shut down all our foreign military occupation. Put those troops on the border then take the $300 billion a year savings and pay $200 billion on the national debt. Then take the $100 billion and build Public Assistance hospitals and staff them with salaried Doctors and bulk purchases on medical supplies like the VA!!! That is it!!. If you want free — go there . If you want good, work hard — make money and go get a $1 million dollar a year Doctor. PROBLEM SOLVED!!! Then do “star wars” and nuke anyone that threatens our borders in hostility. Its over.Move on.
It's a simple answer...High Risk Pools.
A majority of states have them, if you don't qualify for the standard risk pool, you can get into the high risk pool.
You should be able to get the same level of coverage as standard risk people for a little higher premium.
Most risk pool rates are less than Maine's community rating/guaranteed issue mess that everyone would have (if only they could afford it).
If later you can qualify for the standard risk pool, you can get the lower rates.
High risk pools are designed for the guaranteed chronic treatment patients. In other words, previously uninsured cancer and AIDs patients can still get coverage and have high claims...the claims are just paid out of a different fund than the standard risk pool.
To people who consider any interference with the health care market an affront to capitalism, consider this: many people who have pre-existing conditions can't enter the job market and those who have something go wrong and have insurance can't ever leave their job, making the labor force much more static than it should be. I am fortunate (not B.S. “fortunate”, but God-given fortunate) not to have these problems, but I know people who do - and their skills are underutilized or not utilized at all in their present positions.
Or die with them?
In principle I agree with you. From a pragmatic viewpoint, the problem is not that simple. While millionaires don't depend on these government programs, and many in the upper middle class could tighten their belts to handle the costs, that leaves the rest of Americans in a tough spot. The poor would be up a creek without a paddle. Same for the hard-working but unlucky ones who lose their jobs.
I prefer to have the governments tax us strictly for what's absolutely necessary to take care of their legitimate responsibilities. The bulk of peoples' earnings should stay with them. I would rather keep, and control, our money and take care of our own future. Frankly I don't know if we could handle all the huge medical bills that can hit anyone at any time.
That isn't entirely correct. As I understood it, back in the days when I toiled for an insurance company, "Pre-existing conditions" meant that an individual had been treated for something in the past. There was an interval of 6 months before that individual could obtain a new policy, if that individual had stopped paying for health insurance, or otherwise had a break in coverage.
Maybe I'll finish reading the article later...
ping
Some conditions effectively prevented one from getting private individual insurance almost for life. I was excluded from private insurance for 25 years because of a skin cancer that was potentially lethal but was removed and did not return. I was willing to have a high deductible, etc. but I couldn’t find any company that would insure me.
Many of the people considered to have “pre-existing conditions” actually do not have current, life-threatening or expensive conditions but simply have something in their medical history that might, statistically, possibly reappear in the future.
So there is work that needs to be done, but I think it lies with increasing the competitiveness of the insurance companies and not with giving the government more money to waste (even though the money is theoretically being held for a specific use). More and more people are self-employed now, and there is a growing pool of people who need to buy their own health insurance. But the insurers do not see this as a competitive chance and instead are busy excluding this group entirely.
Once upon a time, professional groups of the types of people likely to be self-employed (musicians, translators, writers, real-estate agents, various small business specialties, etc.) offered group insurance plans to their members, but this was killed off by the high costs of covering AIDS. But I think it’s an idea that should be revived.
After all, when uninsured people take a job with a company with a group plan, they are covered after a few months, regardless of their past insurance history (with some exceptions), so I don’t see why this couldn’t work for a voluntary professional organization.
Year’s ago I lived in NY and was an independent businessman. Although healthy, my girlfriend at that time (Now Mrs. Lowbuck), urged me to take out a medical plan.
Now this was during the AIDS crisis and the NY assembly/senate had just passed a bill that required that insurance companies to take on anyone regardless of condition (mainly a PC reaction to AIDS).
Of course, the few remaining companies (most fled the state) offered me a modest plan with a Rolls-Royce price tag.
Needless to say it was not long before I was working in another state and there able to buy an affordable health plan to keep the future hubby happy.
My “pre-insurance-price” bill from the doctor seems to be about $120 (insurance price is $57, which is part of the problem in health care, the fact that the insurance company bargains for cheaper prices, so people without insurance have to pay more. In this sense, insurance is like a union).
We could simply require that any insurance company must cover a pre-existing condition, if the person had insurance previously.
But again, suppose that was the ONLY regulation you had. Then there would be insurance company that would spring up that would offer low-cost, high-deductable coverage, simply so you could get “credit” for having insurance.
Then, if you get an expensive condition, you could simply switch insurance to one that has much better coverage, and they would have to take you. Obviously, that would be a bad thing, because eventually you’d have some $10-a-month “insurance” plan, and the system would be no better off than if you didn’t HAVE to have insurnace but the companies had to cover pre-existing conditions.
Thus, those who want to cover pre-existing conditions have to mandate insurance coverage. AND they have to mandate the minimum services required, and the cost of those services, in order to prevent “cheating”.
And, since an insurance company offering a much better service will always be subject to getting stuck with the pre-existing conditions (because no matter how small the difference in cost/service, people will wait until they have a condition, and then switch to the higher service), in the end NO company will offer a higher level of service than the basic service.
You could partly avoid THAT by only requiring pre-existing condition coverage up to the basic level. Then a company could offer higher-priced, gold-plated service, but NOT to people with pre-existing conditions. But imagine the outcry. That’s why they are taxing cadillac plans.
THis is not hypothetical. My company offers me three levels of dental coverage, and I can freely switch each year. I just switched to “comprehensive” this year, because my son is about to get braces, and I come out ahead even with the extra cost. When he’s done, I’ll switch back to lower cost coverage. This is the 3rd time I’ve done that, and I don’t know why the insurance allows me to, but it’s an employee benefit.
We see this in home insurance. A lot of people wouldn’t insure their homes if the mortgage companies didn’t require it. And many don’t cover for optional things like floods. And then there are floods, and people moan about losing their homes, and the taxpayers end up getting hit for a huge bill to help these “poor unfortunate souls” get their homes back. People like Trent Lott.
I’ve said in the past, unless you are willing to allow poor people to die on the sidewalks in front of hospitals, you might as well institute some government-dictated health care, because your tax dollars are going to pay anyway, and with a program we can at least recover the costs more equitably.
Sure, this means some level of socialized medicine, and I hate it. But if you are going to force hospitals to treat all comers whether they can pay or not, you already have socialized medicine, and the only reason it works is because first, we haven’t quite reached the breaking point where average americans feel good about taking other people’s money, and second, we still allow for treatment disparities between those who can pay, and those who can’t.
Once there is absolutely no difference in treatment and outcome between those spending their own money on insurance, and those who don’t, nobody will want to spend money on insurance.
This is why I wasn’t as down on the original proposed RomneyCare as many here were — I’d rather not have it, but the alternative is still government-run health care, just it’s under the covers and paid for by hard-working americans who already have insurance because they are responsible.
(Of course, by the time the democrats were done with it, Romneycare was a mess. Since Romney won’t admit that, he’s lost my interest).
While my desire has always been to be self-sufficient, not depending on my parents or government to support me, I'm not so sure my husband could handle huge hospital/doctor bills incurred from necessary operations.
Also, despite the fact that he's always carried medical insurance, he's now forced to pay a hefty price due to a pre-existing condition.
I have to think that you view yourself as beyond these kinds of problems, that you are able to afford, on your own, insurance to cover every possible hospital bill, doctor bill, drug bills, and the costs of insurance to cover any pre-existing conditions you have or may have in the future.
My impression is that you are among the very wealthy in our country or you don't see the whole picture.
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