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Subject: An injection of common sense on pre-existing conditions

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Ed Gooding (VA)    Posted 05-06-2017 at 09:30:48 [URL] [DELETE]        [Reply] [Email]  
  • An injection of common sense on pre-existing conditions
  • This is really one of the best commentaries I've seen on the uproar about the possibility that insurance companies will no longer be forced to cover pre-existing conditions. From Michael Owen, who you can find on FaceBook:


    Coming from the GOP, I'm sure whatever is in the bill the house passed today is awful. But I see a lot of emotional response, mainly around "pre-existing conditions." How awful it is to deny people insurance if they have a pre-existing condition.

    I'm about to say something that is going to hurt your feels. You cannot buy insurance for a pre-existing condition, not as a matter of "market failure", but as a matter of the definition of insurance. You cannot buy homeowner's insurance after your house burns down. You cannot buy car insurance after you've wrecked the car. You cannot buy life insurance after your spouse dies. That's not what insurance is. Insurance is the pooling of risk BEFORE something bad happens. That's what keeps the price down when it is allowed to work properly. Something bad but unlikely is costly (rebuild a house, get cancer treatment), so people pool their risk and pay a small amount up front. The pool then has the funds to pay out to those few unlucky enough to get cancer, wreck their car, or have their house burn down.

    I'm going to hit you in the feels even more: mandating that pre-existing conditions be covered by insurance completely breaks this. It is no longer insurance, and unsurprisingly, it makes costs shoot up. Imagine if the government mandated that insurance companies had to sell you a homeowner's policy, even after your house burned down. Who would buy a policy BEFORE their house burned down? You'd have to be a sucker to do so. The risk pool would collapse, with the only people buying policies being those that needed payouts. But of course there is no money in the pool. So of course to "fix" the market it just destroyed, the government then has to mandate that everyone buy into the system. Individual mandate; sound familiar?

    Philny    Posted 05-07-2017 at 22:46:39 [URL] [DELETE]        [Reply] [Email]  
  • Re: An injection of common sense on pre-existing conditions
  • I don't understand much about the whole health care plan so here's my question if you had a medical condition that was covered under Obamacare and under the GOP healthcare plan it wouldn't be covered.i wonder how much money the insurance companies give to the politicians.

    steveVa    Posted 05-06-2017 at 22:59:36 [URL] [DELETE]        [Reply] [No Email]  
  • Re: An injection of common sense on pre-existing conditions
  • I have to say that I disagree with this one. The house burn down is a bad anology. Let's say you have a small kitchen fire and your insurance company pays you $299 after a year of arguing over $800. Then they drop you. And now you have a pre existing condition and cannot get insurance. Or all the insurers want $20,000 a year to "give" you insurance. You will get no sympothy for insurance companies out of me. Not after looking at their astronomical profits!!!

    Dean    Posted 05-06-2017 at 13:16:11 [URL] [DELETE]        [Reply] [No Email]  
  • Re: An injection of common sense on pre-existing conditions
  • Bingo, Ed.

    Somethings are so obvious that they simply reach out from the page and slap one in the face.

    Of course, such obviousness cannot be used to buy votes so government will simply ignore it.

    Dean

    Bruce Dorsi    Posted 05-06-2017 at 10:32:56 [URL] [DELETE]        [Reply] [No Email]  
  • Re: An injection of common sense on pre-existing conditions
  • Perhaps I misunderstood some of what is written in the article, but I think there is an area of legitimate concern regarding pre-existing conditions.

    In 1989, I had spinal surgery for a herniated disc. ...Blue Cross paid approx. 45% of the total cost, the rest was out-of-pocket. ...Surgery was a success, with no further issues.

    When changing insurance companies, I was told everything but my back was insured, since that was a pre-existing condition. ...Had I been covered by an employer's plan, the insurance company would have insured by entire body, but since I was on an individual plan, they could deny coverage for my back.

    During Bill Clinton's term, a mandate was issued that insurance companies could not deny pre-existing conditions, so coverage for my back was reinstated.

    I do not equate buying house insurance after the house burns down, with the situation above. ...If I build a new house, should I be denied new coverage?

    What about the people with an illness such as MS, or MD ? ...How about people who have had a heart attack in the past or required heart surgery/valve replacement/stent ?? ...What about people who are cancer survivors? ...Should they all be banned from coverage due to pre-existing conditions?

    Insurance companies have actuaries to calculate risks and assess premiums. ...They should not be allowed to discriminate against some insureds, and only insure those who are profitable to them.

    Ed Gooding (VA)    Posted 05-18-2017 at 09:05:10 [URL] [DELETE]        [Reply] [Email]  
  • Re: An injection of common sense on pre-existing conditions
  • >> What about the people with an illness such as MS, or MD ? ...How about people who have had a heart attack in the past or required heart surgery/valve replacement/stent ?? ...What about people who are cancer survivors? ...Should they all be banned from coverage due to pre-existing conditions? <<

    I certainly don't think people with pre-existing conditions should be banned, but I do believe they should be charged more for insurance premiums. To Dean's point, insurance is about predicting and managing risk of an event. The risks are spread by pooling premiums from subscribers. Folks who have MS, MD, cancer, pick-one have already had their risk event take place, so when they sign on, they are immediately taking benefits for which they have paid no premiums. So in essence, they are asking for free healthcare, NOT health insurance. Those two things are getting muddied in this debate taking place right now.

    Any of you remember "assigned risk" car insurance policies for new drivers, or drivers with bad driving records? My understanding of assigned risk is that regulators force insurance companies to pool their coverage to cover high-risk drivers. I'm wondering why that approach could not be applied to health insurance? Why put it on taxpayers? If the insurance companies are so profitable, then let them allocate a portion of those profits to those who need healthcare, i.e. immediate benefits before paying into the system vs. health insurance? As people with pre-existing conditions contribute premiums and fund their own risks, then premiums could decline.

    John in Mich    Posted 05-18-2017 at 09:52:37 [URL] [DELETE]        [Reply] [No Email]  
  • Re: An injection of common sense on pre-existing conditions
  • In 1961 I had a car accident and I was in the hospital a week. BC/BS through Ford Motor Co, my father's union shop employer, paid my medical expenses. The car insurance company paid for the totaled car AND the medical expenses in a check to my father (kinda profitable in a morbid sense). I can see coordinated medical insurances and that should be cheaper premiums for medical benefits in a case like this.
    On the pre-existing conditions I think it has to be a case by case. With the current juggling and dropping of insurances around Obamacare, a person who had coverage has lost coverage through no fault of theirs and may now be looking for insurance with a pre-existing condition.
    People who had insurance, liked their insurance and their doctor but lost them with Obamacare are now lumped in with people who did not have insurance until Obamacare.
    Sorting all that is not going to be easy.
    I also have learned that with Medicare, which I was forced onto at 65 as a General Motors retired salary employee, there is no coordination with auto insurance medical or any reduction in car insurance premiums because I'm on Medicare and a Medicare supplement that we pay monthly.
    The last 3 years I've been under doctor's care for non-hodgkins lymphoma. Medicare and my supplement have covered it very well. I'm just wondering when that will change. At 74, more premiums or deductibles could break the bank.
    It appears to me that both government and the insurance companies see the "baby boomers" as a gold mine of assets accumulated over lives of working and saving for retirement that they can tap by writing new social intervention laws.
    AND, none of this accounts for the $10 trillion dollars that has disappeared in 8 years or the trillions that would be in social security if not for Johnson's "Great Society".
    That is my opinion and I'm sticking to it.

    Dean    Posted 05-06-2017 at 13:14:17 [URL] [DELETE]        [Reply] [No Email]  
  • Re: An injection of common sense on pre-existing conditions
  • "I do not equate buying house insurance after the house burns down, with the situation above."

    I do.

    By definition, insurance is the assumption of risk by a pool of subscribers BEFORE an insured event happens.

    Covering ANY event after it happens is simply not insurance but, rather, a taxpayer subsidy.

    Whether government should mandate that taxpayers subsidize others for whatever event may affect them AFTER it happens is an entirely different subject.

    Dean

    Bruce Dorsi    Posted 05-06-2017 at 15:52:58 [URL] [DELETE]        [Reply] [No Email]  
  • Re: An injection of common sense on pre-existing conditions
  • Maybe I did not make my points clearly, Dean.

    Taxpayer subsidies were not mentioned or discussed by me. ....How are insurance payouts considered taxpayer subsidies? (I'm excluding those participating in Obamacare policies.)

    "Covering ANY event after it happens is simply not insurance but, rather, a tax payer subsidy."

    Clearly, you and I are considering different situations. ...I agree that if insurance was not purchased, then no payouts should be considered.

    I have never been, and I'm still not, a fan of socialized medicine, but medical costs have spiraled out of control. ...I don't trust the government to manage healthcare.

    TheOldHokie    Posted 05-07-2017 at 12:50:45 [URL] [DELETE]        [Reply] [No Email]  
  • Re: An injection of common sense on pre-existing conditions
  • The home insurance analogy is terrible. In the US health insurance is much more than a way to cover unplanned and unexpected catastrophic losses. In fact it's primary purpose has become one of managing planned everyday health expenses. It also serves as a contracting vehicle which allows your insurance provider to negotiate "bulk" discounts from providers. Without it you are one man with no buying power. The more you divide the risk up into little pools the more you penalize the people who need the day to day services the most.

    Depending on which accounting you believe United health Care lost somewhere between 100M to 300M quarterly on the exchanges last year. Here is what their CEO had to say about the year's overall peformance:

    Fourth quarter 2016 results included:
    $47.5 billion in revenues;
    More than $3.5 billion in earnings from operations;
    Net earnings of $1.9 billion; and
    Adjusted earnings per share of $2.11.

    UnitedHealthcare also enters 2017 with strong momentum. Fourth quarter and full year 2016 revenues were well-balanced, growing by double-digit percentages in every product category. Medical costs remained well managed, with the commercial medical cost trend ending the year in line with expectations at approximately 6 percent. 2016 was one of the strongest organic growth years in our history, with more than 2 million medical members joining. UnitedHealthcare continues to build well-diversified growth momentum, as customer and consumer retention rates continue to improve broadly, with notable strength in small and mid-sized commercial groups and in Medicare.

    But that 2B quarterly profit is not good enough - so they do what any good business looking to maximize profit would do - they dump the old and sick people that were costing them the most so they can make even more. Plus to keep those growth figures going you need to squeeze even more from the healthy customers so the rates have to go up for everybody.This model is terribly broken and needs fixing badly. Expecting "free market" competitive forces to do it is pure fantasy. This is not and never has been a competitive or free market. The idea that rates will somehow magically come down if we simply allow companies to "compete" and pool risk is fantasy. Rates will continue to go up as they historically have and sick people will be priced out of the market as they historically have been.

    Steve Dabrowski    Posted 05-18-2017 at 20:50:18 [URL] [DELETE]        [Reply] [No Email]  
  • Re: An injection of common sense on pre-existing conditions
  • Insurance costs may decrease with higher deductibles and limited coverage and that may provide competition in the insurance arena, but health care costs will not be reduced, just the amount of coverage you get. A cheap plan will cover very little, period.

    steveVa    Posted 05-06-2017 at 23:55:04 [URL] [DELETE]        [Reply] [No Email]  
  • Re: An injection of common sense on pre-existing conditions
  • Lots of folks say that medical costs have spirialed out of control. I am not sure that is true. the cost of medical insurance has spiriled out of control. Insurers lead us to believe that we would be better off in the long run if we pay them $1000 a month average over our life time. I am not sure that is true. Where do you think the massive profits come from for the insurance industry? Their profits come from our over payment.

    steveVa    Posted 05-07-2017 at 00:25:55 [URL] [DELETE]        [Reply] [No Email]  
  • Re: An injection of common sense on pre-existing conditions
  • Insurance is suppose to be risk vs reward, but the reward typically goes to the insurance companies. I know one thing for sure. I would be way better off if I had all the hundreds of thousands of dollars I have paid to insurance companies.

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