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In my view the single biggest problem with Obamacare was that it forced Insurers to cover people with pre-existing conditions in the individual policy market.

So, the cost of everyone with pre-existing conditions was put onto the ~25million who buy individual policies, rather than spreading those costs across the entire insured population.

Many pre-existing conditions have the potential for costs that are so high that one hospitalization for one person could wipe out the profit from several thousand average policyholders.

With that kind of insurance pool structure, with ~20 percent of individual policy holders having pre-existing conditions, the insurers can try to make money with huge deductibles and co-pays, but eventually will realize they can’t make money with individual policies and exit the market (which is happening).

I don’t think pre-existing conditions are really insurable by for-profit insurance co’s. And I would propose that pre-existing condition patients be pulled out of the private market, put on medicaid or medicare and charged a fraction of their income as premium.

The costs of health care procedures are actually dropping where insurance and gov’t regulations are minimal eg. cosmetic and veterinary. But as long as trying to limit pre-existing condition costs has the greatest impact on profitability of anything they do, the insurance co’s are going to focus on that, rather than finding efficiencies in treatment for their relatively healthy patients.

You have a valid point. The individual market needs to be based on associations and not on the individual. In Germany the Government has a pool for cases that are out of the norm. The only difference is, is that the insurance schemes request funds from the pool in those cases. The members of the associations/insurance schemes are not expected to cover those extraordinary costs. The member/insured with the expensive condition is not involved in asking the government to cover them. The patient only concentrates on getting better. Plus doctors don't refuse seeing them because they are on “medicaid”. Germany has the individual mandate but does not have universal healthcare run by the government,

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.