The pre-existing conditions clause means it’s welfare, not insurance. Insurance is where the insurance company can safely bet you won’t get sick.
I believe insurance companies should be mandated to provide expensive “pre-existing” policies for five years only. That period of time should be enough to teach the American people what the concept of “insurance” is. Then the insurance companies should be free to not “insure” people for eventualities that have happened. People should provide for the health needs of their familes from birth to death, at least with a low cost no frills catastrophic policy (which all insurance companies selling the USA should be mandated to offer), or not be able to afford medical care.
So - if you don’t make enough money to pay for insurance - what then?
“The pre-existing conditions clause means it’s welfare, not insurance. Insurance is where the insurance company can safely bet you won’t get sick.”
I would say, rather, that “insurance” means the insurance co can calculate your expected cost.
High cost patients (pre-existing) have a cost distribution that is approximately power law (Pareto) with alpha<2.
For such distributions the variance is not finite and the usual probability and expected value estimates do not apply.
Trying to cost insurance products for preexisting conditions isn’t really conventional insurance. It is more like selling options that pay off in a stock market crash.
Which is why I favour pulling the pre-existing out of the insurance pools entirely and putting them on medicare/medicaid and charging them a fraction of income.
And letting the insurance co’s compete over the remaining policyholders where normal insurance actually applies.