[ARCHIVED THREAD] - Preexisting Conditions (Page 1 of 2)
Posted: 7/16/2017 9:32:05 AM EDT
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If insurance companies have to cover preexisting conditions, it isn't insurance. Including these people in the insurance pool dooms their plan to failure. In the many years that health insurance companies have existed before the government stepped in, preexisting conditions were not covered, and I don't remember any outrage, or people dying in the streets. Why are they so dead set on including one of the main things that destroyed Obamacare?
Major insurance groups call part of health bill 'unworkable' (Guess why) http://www.foxnews.com/politics/2017/07/15/major-insurance-groups-call-part-health-bill-unworkable.html? ETA: My ex-wife is diabetic, and has never been denied health insurance. What exactly constitutes a preexisting condition that wouldn't be covered without a specific provision in the bill? |
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Many groups will take you if you HAD cancer or a heart bypass. But if you are buying insurance on your own or just your family, they look for any reason to deny you insurance.
A friend of mine had a bypass the insurance was him, his wife, son-in-law and one employee at his business. When renewal time came up they dropped his business. Then came back with a quote at 15 times the old rate. This was pre-NObamacare. He decided to make his shop a union shop and get insurance through the union trust fund at about the same price as his old policy. |
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I agree, however I think the concept of "preexisting" conditions should show the triviality of this. Â Insurance and health care grow less and less comparable. Â What was terminal is now chronic. Â Insurance is best used at recovering from semi-acute very expensive events, not conditions. Â These days in healthcare we're all waiting on the condition which could kill us, not necisarily the event.
If you get in a car wreck- insurance If your car gets busted they total it - insurance If your car is expected to need repair every month For years - not insurance, but this is what we're trying to do. We need another option.  Be it insurance, HSA, cash pay, or single payer.  What we're trying to do is, at its foundation, is nonsensical now. |
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Fuck the insurance companies, they were happy to cover pre-existing conditions as long as they got the mandate. As long as they got to screw the public they didn't care. Now let's screw them back.
The whole 'it's not insurance' argument is pointless as long as we have medicare, medicaid, and tax subsidized employee 'insurance.' Given our screwed up system, nothing is really insurance. |
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Fuck the insurance companies, they were happy to cover pre-existing conditions as long as they got the mandate. As long as they got to screw the public they didn't care. Now let's screw them back. The whole 'it's not insurance' argument is pointless as long as we have medicare, medicaid, and tax subsidized employee 'insurance.' Given our screwed up system, nothing is really insurance. |
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Well.... Say that you are the owner of your own insurance company.
You are forced to insure a middle aged female patient with a serious, chronic, pre-existing health condition. You cannot charge this person more in premiums than a healthy person of the same age and sex. This patient will require thousands of dollars worth of treatment each month. From time to time, they'll need to be hospitalized for a couple weeks. They are on several expensive medications for their condition. Their expected annual healthcare usage is nearly $100,000 dollars Their plan has a monthly premium of $1,000.00 dollars, and they have a $5,000 annual deductible. Now, do the math... You'll collect $12,000 in premiums annually, but have $95,000 in healthcare expenses. ($100,000 minus the $5,000 deductible) This is a loss of $83,000 dollars. The average premium for a mid-20 year old person, for the same plan costs $250.00 per month ($3,000 dollars per year) This means that for every one chronically ill person, you need to insure roughly 28 young, healthy people who have no claims in the same year in order to account for one sick person. This does not include the expenses incurred by your insurance company to house employees, payroll, taxes, insurance, employee benefits, etc.... Oh.. and dare I say the word "profit" for you and your company. The bottom line? If you force insurance companies to cover pre-existing conditions, AND tell them that they have to charge everyone of the same locale, age, and sex - the same premium - regardless of their health.... healthcare cannot be provided affordably. It just can't be done. |
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I agree, however I think the concept of "preexisting" conditions should show the triviality of this.  Insurance and health care grow less and less comparable.  What was terminal is now chronic.  Insurance is best used at recovering from semi-acute very expensive events, not conditions.  These days in healthcare we're all waiting on the condition which could kill us, not necisarily the event. If you get in a car wreck- insurance If your car gets busted they total it - insurance If your car is expected to need repair every month For years - not insurance, but this is what we're trying to do. We need another option.  Be it insurance, HSA, cash pay, or single payer.  What we're trying to do is, at its foundation, is nonsensical now. Doctors can choose voluntarily to accept individual indigent patients and treat them. The doctor can then "bill" the govt in the form of 1:1 personal income tax reduction, but only according to his published rate for the service/procedure. Advantages: Drs aren't obliged to treat ungrateful despicable patients. Patients understand that the care isnt an entitlement and the doc isnt their slave. There is a natural cap on fraudulent billing. They cant dedudt more than their tax obligation, and only good docs who have a number of paying/insured patients will get anything - shitty docs who can only attract FSA will benefit little or none. Fees get published. Govt makes very few decisions. Dr-Pt relationship is improved. |
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The bottom line? If you force insurance companies to cover pre-existing conditions, AND tell them that they have to charge everyone of the same locale, age, and sex - the same premium - regardless of their health.... healthcare cannot be provided affordably. It just can't be done. |
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If insurance companies have to cover preexisting conditions, it isn't insurance. Including these people in the insurance pool dooms their plan to failure. In the many years that health insurance companies have existed before the government stepped in, preexisting conditions were not covered, and I don't remember any outrage, or people dying in the streets. Why are they so dead set on including one of the main things that destroyed Obamacare? Major insurance groups call part of health bill 'unworkable' (Guess why) http://www.foxnews.com/politics/2017/07/15/major-insurance-groups-call-part-health-bill-unworkable.html? ETA: My ex-wife is diabetic, and has never been denied health insurance. What exactly constitutes a preexisting condition that wouldn't be covered without a specific provision in the bill? In my case it was lower back pain. Not crushed discs or anything, just occasional back pain from overexertion, like about 80% of the population. Like DonofKalifornia says, they look for any reason to avoid individual policies. |
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Since 1996 (HIPAA)Â it has been illegal to deny coverage for anyone in a group plan. Â 85% get insurance that way. Before ACA, every state except CA as TN had subsidized high risk pools. Community rating (increased rates based upon 20% over what the average for the area) was also the law in 42 states.
At the time ACA was passed, Kaiser health (a very left wing org) estimated there were only about 275k who couldn't get insurance. Most others didn't due to cost and all were in non-Community rating states. Obamacare did away with all that and put that group of near 100% risk in the pool. That defeats the entire system insurance is based on. |
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Insurance should only really be for catastrophic stuff (imagine that).
If everyone had a high deductible, low premium policy, prices would drop by well over 50%. These policies would work for all groups except the poor and those with serious per-existing health problems. Significantly lower prices would immensely help the poor. Many who cannot afford policies would be able to afford policies with lower premiums (caused by lower prices), and many others would be able to afford healthcare itself because of lower prices. There would still be the extremely impoverished who can afford neither. But that would be a small percentage who could be taken care of through volunteerism or some other method. Those with serious pre-existing conditions would have problems finding affordable policies. So they would have to pay out of pocket, which isn't as big as deal as you think since 1) prices would be much lower than they are today, 2) most people with pre-existing conditions are older and have had time to save money, and 3) having to pay for it would act as an incentive to improve their health, as many conditions are caused by ongoing poor choices. Those with rare diseases through no fault of their own could be covered with a tax on the policies of others. Also, there needs be changes to how pre-existing conditions are defined. When applying for insurance Instead of "have you ever had condition X", the question should be "have you ever filed a claim for condition X in the last 7 years?" This does three things: 1) encourages people to pay for stuff out their pocket instead of using insurance, which further drives down prices. 2) Allows people who get caught up in an erroneous health code to have a clear bill of health after a few years. 3) Gives people time to fix their current condition, so they can qualify for lower premiums after a few years. Sort of like how bankruptcy works. No, this isn't perfect, but it would work for 90% of people, drop prices significantly, improve access to healthcare, and be infinitely better than our current corrupt system. |
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So I'm with one insurer now, I move states and have to get a new policy. Should my sleep apnea be covered under the new policy or what? I can see where it's an issue. |
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So I'm with one insurer now, I move states and have to get a new policy. Should my sleep apnea be covered under the new policy or what? I can see where it's an issue. |
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Why should sleep apnea (usually treated with a CPAP device) even be covered? It is the equivalent of buying an insurance policy that pays you to repaint your house every so often. Yes, you are "insured", but I can promise you that you are paying a lot more in premiums to cover your house paint than if you simply paid out of pocket whenever it needed it. Quoted:
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So I'm with one insurer now, I move states and have to get a new policy. Should my sleep apnea be covered under the new policy or what? I can see where it's an issue. |
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I agree, however I think the concept of "preexisting" conditions should show the triviality of this.  Insurance and health care grow less and less comparable.  What was terminal is now chronic.  Insurance is best used at recovering from semi-acute very expensive events, not conditions.  These days in healthcare we're all waiting on the condition which could kill us, not necisarily the event. If you get in a car wreck- insurance If your car gets busted they total it - insurance If your car is expected to need repair every month For years - not insurance, but this is what we're trying to do. We need another option.  Be it insurance, HSA, cash pay, or single payer.  What we're trying to do is, at its foundation, is nonsensical now. what they want.. insurance = you buying a fucked up car, all smashed up, then expect the insurance company to repair damage, that was on the car when you bought it. plus , your a habitual drunk driver, and a reckless driver, since your 1/2 blind, and have rage issues, who has 2-5 wrecks a month, so I need you to fix all these damages as well.. for the same $200 a month. |
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Hate to break it to you - what we have in America isn't insurance and hasn't been for decades. It is and has been a subsidization system.
We already have "single payer" type apparatus in place, it is just very inefficient and expensive. If it were insurance it would be vastly different than it is now. |
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You absolutely can cover preexisting conditions. Â You just charge them a premium commensurate with their risk. Â That's all insurance is anyway. Â The reason that PCs got so screwed up is that Obamacare capped how much you can charge the high risk people relative to the low risk, how much you can charge women relative to men (women consume more healthcare and cost more to insure), and how much you can charge old people compared to young people (the old consume more too). Â So the effect was to charge all of the low risk groups higher premiums to help cover the high risk groups, instead of charging each person a premium in accordance to their own individual risk.
What we have in America for paying for healthcare is not "insurance" by any definition of the word. Â We call it insurance out of habit or ignorance. Â What we really have is a government enforced wealth transfer from the healthy to the sick via inefficient, corrupt, and fraudulent third parties, that also serves to occasionally act as a middle man between you and your healthcare provider when you need to pay for service. |
A while back I was talking to a state employee, with full govt insurance, about the 200 dollar reading glasses he needed to get. Told him he could get some from Zenni delivered to his door for about twenty dollars. Nope, he didn't think his insurance would pick that up.
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The larger the number of people in a plan ( think federal single payer), the less preexisting conditions matter.
The longer people pay premiums, (think cradle to grave) the less the premium per year. I'm against forced insurance but I perceive the above as the rationale of Obamacare. |
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So I'm with one insurer now, I move states and have to get a new policy. Should my sleep apnea be covered under the new policy or what? I can see where it's an issue. lapse then you could still get insurance but there would be a waiting period before your pre existing conditions would be covered. this was so you would think twice about stopping your insurance and waiting until your sick to buy it again. it made sense. There were issues with having to change insurance if you changed jobs or if you moved to a different state and that should be fixed so you can take your insurance policy with you if you want to keep it. |
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how bout dis? Doctors can choose voluntarily to accept individual indigent patients and treat them. The doctor can then "bill" the govt in the form of 1:1 personal income tax reduction, but only according to his published rate for the service/procedure. Advantages: Drs aren't obliged to treat ungrateful despicable patients. Patients understand that the care isnt an entitlement and the doc isnt their slave. There is a natural cap on fraudulent billing. They cant dedudt more than their tax obligation, and only good docs who have a number of paying/insured patients will get anything - shitty docs who can only attract FSA will benefit little or none. Fees get published. Govt makes very few decisions. Dr-Pt relationship is improved. |
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The larger the number of people in a plan ( think federal single payer), the less preexisting conditions matter. The longer people pay premiums, (think cradle to grave) the less the premium per year. I'm against forced insurance but I perceive the above as the rationale of Obamacare. |
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If you have paid enough in premiums to cover the "pre-existing condition" then I don't see the problem. On the other hand, we are probably talking about conditions that cost millions of $ to pay for.  |
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Before Obama care, we had ways for people not in group policies to manage pre existing conditions I had to stay in school to stay on my dad's insurance. When I got out of college I had to pay cobra until my new employer health plan kicked in. I had to show proof of continuing coverage to the new insurance company in order to have my condition covered. I could only be covered under my dad's insurance until I was 24. And I had to be a full time student for that to work. Now a person can be covered until 26 with no restriction, drop coverage, get sick, and still get insurance at a later time for the same price as a healthy person. Of course it's going to collapse. |
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Before Obama care, we had ways for people not in group policies to manage pre existing conditions EVERY HEALTHCARE PLAN INVOLVES COST SHIFTING.  Unlike the market in things like clothing, there can not be a free market in healthcare.  That is because human beings are not able to "monetize" the value of their own life and it is hard to monetize the value of good health. The real question in this healthcare debate is how we are going to shift the costs.  As soon as people can acknowledge this, there can be a meaningful debate over going forward. |
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If health insurance covers existing conditions then auto insurance, home insurance, etc should also. It would be hypocritical to think differently. |
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I get your point but we simply do not treat humans like we treat everything else. Things are not black or white. Quoted:
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If health insurance covers existing conditions then auto insurance, home insurance, etc should also. It would be hypocritical to think differently. |
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Many policies used to make you wait 6 months before they would cover a pre-existing condition. Like if you had injuried a knee badly, and after you get a policy you find out it isn't healed correctly and needs a knee replacement. The policies would require you wait 6 months.
Things like sleep apnathy is covered because not treating it is so much more expensive. Many health insurance companies and medical groups offer stoke smoking and weight loss programs to reduce costs later on. Same with preventive care, a colonoscopy and having a small polyp removed is a lot cheaper than treating cancer including bowel resection and chemo. Biggest problem I see with health care is most people are too stupid to remain healthy and then want the top treatment for something that could be preventable. |
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Insurance companies are a business, there is no difference. As I stated earlier it would be hypocritical to think differently. Maybe we should total a person when saving them is more costly than letting them die, but we will not. And btw, I think if you and I, and doc, and bunch of reasonable people sat down at a table we could come to decisions that would work well enough for most all parties involved. But we are way past a solution that makes sense,imo. |
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If insurance companies have to cover preexisting conditions, it isn't insurance. Including these people in the insurance pool dooms their plan to failure. In the many years that health insurance companies have existed before the government stepped in, preexisting conditions were not covered, and I don't remember any outrage, or people dying in the streets. Why are they so dead set on including one of the main things that destroyed Obamacare? Insurance - by definition - is for "unexpected and unintended occurrences". That is, it is for illnesses and injuries you didn't see coming. Once you KNOW you have something and try to buy insurance for it, it's not insurance anymore ... it's pure welfare. That's why pre-existing conditions HAVE to be handled separate from insurance plans. Put people with pre-existing conditions in a separate "pool", like they do with car insurance for people with bad driving records. And because it's given the insurance companies are going to have to pay for their illnesses right out of the chute, these people must pay higher premiums to offset the expense. That alone won't pay for it, so taxpayers are going to have to pitch in with government support. BUT KEEP IT SEPARATE! |
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Insurance companies are a business, there is no difference. As I stated earlier it would be hypocritical to think differently.Â
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I think the issue comes down to what can be attributed as pre-existing, and as what we conceptualize as "insurance" in the first place.
The only thing that will fix many of the fucked up systems is to completely restructure how they work, and largely simplify them. Whether it be insurance, taxes, welfare, etc. Playing Jenga with a top heavy tower isn't going to work forever. Eventually you need to rip down the pieces in a controlled manner, lest it collapse and hurt more people than it otherwise would. |
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Hate to break it to you - what we have in America isn't insurance and hasn't been for decades. It is and has been a subsidization system. We already have "single payer" type apparatus in place, it is just very inefficient and expensive. If it were insurance it would be vastly different than it is now. It's 10 people throwing a small amount of money into a pile, just in case one of them might have to pull out a larger amount of money. |
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That place was by having hospitals not get paid for acute care being used to treat a chronic condition.  The hospitals passed that cost on to the other patients by increased costs. EVERY HEALTHCARE PLAN INVOLVES COST SHIFTING.  Unlike the market in things like clothing, there can not be a free market in healthcare.  That is because human beings are not able to "monetize" the value of their own life and it is hard to monetize the value of good health. The real question in this healthcare debate is how we are going to shift the costs.  As soon as people can acknowledge this, there can be a meaningful debate over going forward. Quoted:
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Before Obama care, we had ways for people not in group policies to manage pre existing conditions EVERY HEALTHCARE PLAN INVOLVES COST SHIFTING.  Unlike the market in things like clothing, there can not be a free market in healthcare.  That is because human beings are not able to "monetize" the value of their own life and it is hard to monetize the value of good health. The real question in this healthcare debate is how we are going to shift the costs.  As soon as people can acknowledge this, there can be a meaningful debate over going forward. 
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Many groups will take you if you HAD cancer or a heart bypass. But if you are buying insurance on your own or just your family, they look for any reason to deny you insurance. A friend of mine had a bypass the insurance was him, his wife, son-in-law and one employee at his business. When renewal time came up they dropped his business. Then came back with a quote at 15 times the old rate. This was pre-NObamacare. He decided to make his shop a union shop and get insurance through the union trust fund at about the same price as his old policy. I just don't really understand how the fuck people ended up at Obamacare. |
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Yea I've heard about situations like this pre-Obamacare. Can someone who was old enough to be doing adult shit pre-obama tell me why the clear answer wasn't just to start up non-employer groups for better rates/negotiating? Like a TX Tech Startups Insurance Group or some shit and just let tons of small people buy in then bring that group to the insurance co like an IBM would. I just don't really understand how the fuck people ended up at Obamacare. Quoted:
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Many groups will take you if you HAD cancer or a heart bypass. But if you are buying insurance on your own or just your family, they look for any reason to deny you insurance. A friend of mine had a bypass the insurance was him, his wife, son-in-law and one employee at his business. When renewal time came up they dropped his business. Then came back with a quote at 15 times the old rate. This was pre-NObamacare. He decided to make his shop a union shop and get insurance through the union trust fund at about the same price as his old policy. I just don't really understand how the fuck people ended up at Obamacare. |
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In the many years that health insurance companies have existed before the government stepped in, preexisting conditions were not covered, Not true. Most were (still are) covered by group plans from employment. Seldom is preexisting conditions at issue with these plans. ETA: My ex-wife is diabetic, and has never been denied health insurance. Above is why your wife was/is covered. What exactly constitutes a preexisting condition that wouldn't be covered without a specific provision in the bill? Anything they want it to be. It is all negotiable. |