Pre Existing Conditions?

Off Topic Politics & World Issues
1

I want some liberals to explain why they think an insurance company should take on a client who has a pre-existing condition which they know they are going to have to pay out? I am an insurance agent, would you expect me to insure every person who has damage to thier car already and tell them, Oh sure, let me fix that for you.

If that were to be allowed, then nobody would buy collision insurance until they needed it. Why the hell would I pay month after month for something that I could just buy when I needed it. I mean you people do understand the concept of INSURANCE don’t you? Insurance is the thing where you PAY into a pool so that if something out of the ordinary happens and impacts you financially, the pool will cover your expenses. If people don’t pay into the pool, people should not get the benefit of someone paying for their unexpected problems, be it monetary, health, or property related.

When did the government become the entity which is responsible for making sure that no american has an experience where luck, thier own stupidity, or some other force causes them to suffer a loss? Do you think it’s possible to prevent anyone in our country from dealing with hardship, lack of planning, or consecuences of thier own actions.

I just don’t understand the liberal mindset with regard to some people being forced to give to others who may or may not deserve help.

V

2

I understand what you are saying, but your example has a lot of holes in it.

P and C insurance does not have a history of being bundled in with employee benefits. If you have not carried collision coverage for a considerable time, have an accident, then want to get coverage and have them pay for an accident that happened before the relationship and is due to your negligence, of course that does not make sense.

Now, assume you have worked for Company X for ten years. You take advantage of their health plan. Somewhere in year five you have a health crises. Call it cancer, heart attack, diabetes, whatever. During year ten the economy goes to hell in a handbag and you you are out of a job.

You have Cobra that you can take advantage of for a few months. It takes a lot longer than that to find new employment. When you do, it is with a small business that does not offer health care. Now what do you do. Your Cobra window is now expired. You can continue the original coverage, but the premiums will double (or more).

The whole purpose of insurance (in theory) is to pool risk and manage cost. In truth is has turned into a horrible scam. My best friend and next door neighbor is a doctor. Very conservative. We get together and he will tell me horror story after horror story of insurance companies willfully trying to screw over customers. Their definitions of what might or might not be “preexisting” is very nebulous.

Let me throw another thing in. A few weeks ago, I went to fill a prescription for my son. I get to the counter and the clerk says, “That will be $189.00.” In shock, I say no thank you. On my way out, I notice a display with the same name on it as the prescription name. I pick it up and go back to the counter. I ask them the difference between this and the prescription I had. The clerk smiles and says “the price.” Nothing else? No. “Why is this?” Insurance.

I walked out with the same prescription for $16 out of my own pocket. Yes, I know some of you will say that is not the insurance companies’ fault. I could come up with all kinds of scenarios to defend insurance company practices. But I won’t because they do not deserve it.

Health insurance is a parasitical industry that gained access to its host (the public) through ignorant and foolish government interference. Once in, with big money and high paid lobbyist, they have games the system extraordinarily well.

Do I believe we need health care reform? Absolutely.
Do I believe the current version of reform before congress is needed? Absolutely not.

This is not reform, it is bragging rights for Obama and the Dems to go back to their people, pump their chest, and tell them how hard they worked for them.
Bullshit.

Tort reform. Opening up business across state lines. Allowing small business to pool for better rates. These are the bare beginnings of reform. We have none of this in this bill.

3

[quote]JEATON wrote:
Tort reform. Opening up business across state lines. Allowing small business to pool for better rates. These are the bare beginnings of reform. We have none of this in this bill. [/quote]

Exactly.

Anything and everything that actually would be reform and lower costs is not in the bill.

Everything that is in the bill will increase overall cost. It may shift who pays, but the total paid by the American people will be higher.

No one in their right mind could believe that (for example) adding heavy taxes on medical services, devices, and pharmaceuticals is a way to lower cost.

On the matter of pre-existing conditions:

It makes zero sense for an insurance company to be forced to sell a policy for some modest price per month, same as for anyone else, to an individual who obviously is going to cost say hundreds of thousands of dollars in payouts.

The answer I believe is that there should be no distorting forces from the government. If people are given their own choice as to insurance company, rather than experience the distortion where their employer can purchase insurance for less and they are therefore heavily pushed into a single choice, who wouldn’t choose a company where their coverage is safely locked in by contractual agreement versus one where they can be dumped?

4

Insurance would not be necessary for the average doctor visit if prices were under control. Prices can be stabilized by:

  1. deregulating employer insurance mandates
  2. opting out of coverage for routine visits and procedures
  3. tort reform
  4. legalizing interstate competition
  5. allowing all young people the right to opt out of medicare/medicaid

Insurance should be structured so that it covers only life altering situations and if people want a policy that covers routine care (drugs) they should have a separate policy.

5

…can this scenario happen?

  1. Young woman is raped.
  2. Rapist has AIDS and is not caught.
  3. Girl contracts HIV but does not know this.
  4. Girl starts a job.
  5. Girl becomes sick, finds out she’s HIV positive.
  6. Since it’s a pre-existing condition, it’s not covered by her healtcare plan.
  7. Girl can’t afford the drugs to combat HIV.
  8. Girl dies a horrible death.
6

So you’re saying I should be taxed to pay, or other insurance policy holders should be made to pay?

Or is that you think that the evil “corporation” will pay and this does not mean ordinary people wind up paying?

Are you aware that either every or almost every pharmaceutical company offers drugs at extreme discount to those that genuinely can’t pay full price or anything like it?

Is there some reason – other than perhaps government distortions to the market causing it to not happen – that it isn’t a consequence of her own decisions to not pay that she wasn’t covered prior to being infected with AIDS by this crime?

7

[quote]ephrem wrote:
…can this scenario happen?

  1. Young woman is raped.
  2. Rapist has AIDS and is not caught.
  3. Girl contracts HIV but does not know this.
  4. Girl starts a job.
  5. Girl becomes sick, finds out she’s HIV positive.
  6. Since it’s a pre-existing condition, it’s not covered by her healtcare plan.
  7. Girl can’t afford the drugs to combat HIV.
  8. Girl dies a horrible death.[/quote]

Can this scenario happen?

  1. I get in my car in my driveway.
  2. I pull out of my driveway and am protected because I have full insurance on my car
  3. As I’m driving some asshole runs a red light and broadsides my car killing me.

Why do people blame insurance companies for not being able to prevent every catastrophe? Would the example you listed be sad? Yes, however. What if we extend the chain of events a little farther down. Say in your scenario the girl gets paid for the treatments. They are very expensive. The money doesn’t come out of thin air and as a result of this new policy rates go up drastically. Now small businesses all over the country can no longer afford to pay the premiums for thier employees and start policies where the employees have to chip in or exclude themselves for coverage. All across the country hundres fo thousands or even millions of workers opt out of healthcare coverage because it is either healthcare or paying the utility and grocery bill.

As a result of this, Many more people get sick and die from routine ilnesses which could have easily been prevented had the origional healthcare not increased in price.

Here is what I am saying, healthcare costs do not allow for our society to make sure everyone gets 100% perfect care. The healthcare system and pharmacutical industry is too inefficient and corrupt for this to be possible. SO, we can help a LARGE number of people to overcome common things, or we can help all of the worst case scenarios and let some of the others slip through the craks. You can’t save everyone without the reform that we actually need, Healthcare and pharmacutical. Not nationalized health insurance.

V

8

[quote]Bill Roberts wrote:
So you’re saying I should be taxed to pay, or other insurance policy holders should be made to pay?

Or is that you think that the evil “corporation” will pay and this does not mean ordinary people wind up paying?

Are you aware that either every or almost every pharmaceutical company offers drugs at extreme discount to those that genuinely can’t pay full price or anything like it?

Is there some reason – other than perhaps government distortions to the market causing it to not happen – that it isn’t a consequence of her own decisions to not pay that she wasn’t covered prior to being infected with AIDS by this crime?

Since insurance companies are not now forced to cover pre-existing conditions, do you have real-life examples of your scenario supporting your argument that this should be forced, else the above will happen?[/quote]

…do you realise that, even if drug companies ‘give’ away drugs to low-income households, you’re the one paying for it? I realise we’re oceans apart on this one, and i concede that in your culture this way of thinking has no place, but to me healthcare should not be business but the main concern of everyone, including government, to make afforable healthcare available to all…

9

[quote]Vegita wrote:

Can this scenario happen?

  1. I get in my car in my driveway.
  2. I pull out of my driveway and am protected because I have full insurance on my car
  3. As I’m driving some asshole runs a red light and broadsides my car killing me.

Why do people blame insurance companies for not being able to prevent every catastrophe? Would the example you listed be sad? Yes, however. What if we extend the chain of events a little farther down. Say in your scenario the girl gets paid for the treatments. They are very expensive. The money doesn’t come out of thin air and as a result of this new policy rates go up drastically. Now small businesses all over the country can no longer afford to pay the premiums for thier employees and start policies where the employees have to chip in or exclude themselves for coverage. All across the country hundres fo thousands or even millions of workers opt out of healthcare coverage because it is either healthcare or paying the utility and grocery bill.

As a result of this, Many more people get sick and die from routine ilnesses which could have easily been prevented had the origional healthcare not increased in price.

Here is what I am saying, healthcare costs do not allow for our society to make sure everyone gets 100% perfect care. The healthcare system and pharmacutical industry is too inefficient and corrupt for this to be possible. SO, we can help a LARGE number of people to overcome common things, or we can help all of the worst case scenarios and let some of the others slip through the craks. You can’t save everyone without the reform that we actually need, Healthcare and pharmacutical. Not nationalized health insurance.

V[/quote]

…how would you reform the current system then?

10

[quote]ephrem wrote:
…do you realise that, even if drug companies ‘give’ away drugs to low-income households, you’re the one paying for it? I realise we’re oceans apart on this one, and i concede that in your culture this way of thinking has no place, but to me healthcare should not be business but the main concern of everyone, including government, to make afforable healthcare available to all… [/quote]

No, if a company chooses to give away product that has almost no direct per-unit cost of production in cases where the drug would not be purchased anyway, that does not mean that I am paying for it.

(And yes, most pharmaceutical drugs cost almost nothing per unit to manufacture, at least relative to their wholesale price.)

But in any case, let’s imagine you were right on that.

If the drug company of its own free will chooses to do this, what exactly is your problem with it?

Is the problem that it botches your example trying to show why supposedly need to force insurance companies to accept pre-existing conditions where the policies would be obvious major losses?

Other than that I can’t begin to imagine your problem with it?

11

[quote]ephrem wrote:
I realise we’re oceans apart on this one, and i concede that in your culture this way of thinking has no place, but to me healthcare should not be business but the main concern of everyone, including government, to make afforable healthcare available to all… [/quote]

Then I suggest you sell everything you have that you don’t actually NEED, cut your living costs to the minimum you can, and make this YOUR main concern. Spend only enough time at paid jobs to just get by, and spend most of your time volunteering health care services for people.

We wouldn’t want you to be a hypocrite.

After all, you want the doctors, the hospitals, the insurance company stockholders (which includes vast numbers of very ordinary people), the taxpayers, and policy holders who DIDN’T wait till they had a condition to buy their policy to make it the main concern for others to have healthcare that they don’t have to pay for themselves, or not as much.

Surely it cannot be that you aren’t going to go out there and volunteer many hours per week to help, and sell most of your possessions to be able to donate and help, given your stated philosophy.

Or is the usual deal of, for example, liberals claiming tax rates should be higher – meaning that they would like to see others pay more – when they already could readily write checks as big as they wanted to the US Treasury but don’t do so?

12

[quote]ephrem wrote:

[quote]Vegita wrote:

Can this scenario happen?

  1. I get in my car in my driveway.
  2. I pull out of my driveway and am protected because I have full insurance on my car
  3. As I’m driving some asshole runs a red light and broadsides my car killing me.

Why do people blame insurance companies for not being able to prevent every catastrophe? Would the example you listed be sad? Yes, however. What if we extend the chain of events a little farther down. Say in your scenario the girl gets paid for the treatments. They are very expensive. The money doesn’t come out of thin air and as a result of this new policy rates go up drastically. Now small businesses all over the country can no longer afford to pay the premiums for thier employees and start policies where the employees have to chip in or exclude themselves for coverage. All across the country hundres fo thousands or even millions of workers opt out of healthcare coverage because it is either healthcare or paying the utility and grocery bill.

As a result of this, Many more people get sick and die from routine ilnesses which could have easily been prevented had the origional healthcare not increased in price.

Here is what I am saying, healthcare costs do not allow for our society to make sure everyone gets 100% perfect care. The healthcare system and pharmacutical industry is too inefficient and corrupt for this to be possible. SO, we can help a LARGE number of people to overcome common things, or we can help all of the worst case scenarios and let some of the others slip through the craks. You can’t save everyone without the reform that we actually need, Healthcare and pharmacutical. Not nationalized health insurance.

V[/quote]

…how would you reform the current system then?
[/quote]

Obviously by removing ALL governemnt interference, which has only stacked the deck in the favor of the already rich and powerful, and let the free market sort it out. At first it would probably be uncomfortable, but eventually, price competition would drive the cost of healthcare down, it would also drastically drive down the cost of pharmacuticals.

The next step as someone else said would be for judicial reform. Judges are elected officials too, people need to elect judges who will protect doctors from frivolous lawsuits. Actually judges should protect anyone from frivolous lawsuits. Throw them out and tell them to go fuck off.

V

13

[quote]ephrem wrote:
…can this scenario happen?

  1. Young woman is raped.
  2. Rapist has AIDS and is not caught.
  3. Girl contracts HIV but does not know this.
  4. Girl starts a job.
  5. Girl becomes sick, finds out she’s HIV positive.
  6. Since it’s a pre-existing condition, it’s not covered by her healtcare plan.
  7. Girl can’t afford the drugs to combat HIV.
  8. Girl dies a horrible death.[/quote]

Pre-existing conditions, at least with every plan I’ve ever had, are conditions you had received treatment for within a certain timeframe prior to enrolling with the current plan. This would not be a pre-existing condition.

14

[quote]Vegita wrote:

[quote]ephrem wrote:

[quote]Vegita wrote:

Can this scenario happen?

  1. I get in my car in my driveway.
  2. I pull out of my driveway and am protected because I have full insurance on my car
  3. As I’m driving some asshole runs a red light and broadsides my car killing me.

Why do people blame insurance companies for not being able to prevent every catastrophe? Would the example you listed be sad? Yes, however. What if we extend the chain of events a little farther down. Say in your scenario the girl gets paid for the treatments. They are very expensive. The money doesn’t come out of thin air and as a result of this new policy rates go up drastically. Now small businesses all over the country can no longer afford to pay the premiums for thier employees and start policies where the employees have to chip in or exclude themselves for coverage. All across the country hundres fo thousands or even millions of workers opt out of healthcare coverage because it is either healthcare or paying the utility and grocery bill.

As a result of this, Many more people get sick and die from routine ilnesses which could have easily been prevented had the origional healthcare not increased in price.

Here is what I am saying, healthcare costs do not allow for our society to make sure everyone gets 100% perfect care. The healthcare system and pharmacutical industry is too inefficient and corrupt for this to be possible. SO, we can help a LARGE number of people to overcome common things, or we can help all of the worst case scenarios and let some of the others slip through the craks. You can’t save everyone without the reform that we actually need, Healthcare and pharmacutical. Not nationalized health insurance.

V[/quote]

…how would you reform the current system then?
[/quote]

Obviously by removing ALL governemnt interference, which has only stacked the deck in the favor of the already rich and powerful, and let the free market sort it out. At first it would probably be uncomfortable, but eventually, price competition would drive the cost of healthcare down, it would also drastically drive down the cost of pharmacuticals.

The next step as someone else said would be for judicial reform. Judges are elected officials too, people need to elect judges who will protect doctors from frivolous lawsuits. Actually judges should protect anyone from frivolous lawsuits. Throw them out and tell them to go fuck off.

V[/quote]

“Judicial reform” is a bit off the mark. What is needed is tort reform with teeth. In states where true tort reform exists, it has had a dramatic impact on the number of medical malpractice cases and payouts. Caps are needed across the board on pain and suffering. Med Mal cases should be pre-screened by an expert panel for certification before they can proceed to suit. And leaving complex medical matters in the hands of a jury of laymen is idiotic but to do otherwise would require a dramatic change to how torts are now litigated.

Juries simply jury cannot comprehend complex medical issues such that they should be final arbiters in a matter. As for judges, they all have the same pressures - it doesn’t matter who you elect - they work within the same system. And that system does not reward judges who are appealed often. No judge wants to be appealed so the common practice is to let a jury decide and then only step in as a last resort if there is some egregious error.

A judge dismissing a case against the plaintiff only guarantees an appeal. And the Court as a whole is loathe to deny a citizen their day in court. Suits that are frivolous on their face should be dismissed but unfortunately, that is not common - at least not in medical malpractice. There is a big difference between “non-meritorious” and “frivolous”.

Suits without merit are for a jury to decide and that is our system of tort law. And you cannot decide if a suit is without merit without litigating or hearing it in some manner. The judges are a small part of the problem.

15

[quote]pushmepullme wrote:

[quote]ephrem wrote:
…can this scenario happen?

  1. Young woman is raped.
  2. Rapist has AIDS and is not caught.
  3. Girl contracts HIV but does not know this.
  4. Girl starts a job.
  5. Girl becomes sick, finds out she’s HIV positive.
  6. Since it’s a pre-existing condition, it’s not covered by her healtcare plan.
  7. Girl can’t afford the drugs to combat HIV.
  8. Girl dies a horrible death.[/quote]

Pre-existing conditions, at least with every plan I’ve ever had, are conditions you had received treatment for within a certain timeframe prior to enrolling with the current plan. This would not be a pre-existing condition.[/quote]

…i didn’t know that, thanks…

16

[quote]Vegita wrote:

[quote]ephrem wrote:

[quote]Vegita wrote:

Can this scenario happen?

  1. I get in my car in my driveway.
  2. I pull out of my driveway and am protected because I have full insurance on my car
  3. As I’m driving some asshole runs a red light and broadsides my car killing me.

Why do people blame insurance companies for not being able to prevent every catastrophe? Would the example you listed be sad? Yes, however. What if we extend the chain of events a little farther down. Say in your scenario the girl gets paid for the treatments. They are very expensive. The money doesn’t come out of thin air and as a result of this new policy rates go up drastically. Now small businesses all over the country can no longer afford to pay the premiums for thier employees and start policies where the employees have to chip in or exclude themselves for coverage. All across the country hundres fo thousands or even millions of workers opt out of healthcare coverage because it is either healthcare or paying the utility and grocery bill.

As a result of this, Many more people get sick and die from routine ilnesses which could have easily been prevented had the origional healthcare not increased in price.

Here is what I am saying, healthcare costs do not allow for our society to make sure everyone gets 100% perfect care. The healthcare system and pharmacutical industry is too inefficient and corrupt for this to be possible. SO, we can help a LARGE number of people to overcome common things, or we can help all of the worst case scenarios and let some of the others slip through the craks. You can’t save everyone without the reform that we actually need, Healthcare and pharmacutical. Not nationalized health insurance.

V[/quote]

…how would you reform the current system then?
[/quote]

Obviously by removing ALL governemnt interference, which has only stacked the deck in the favor of the already rich and powerful, and let the free market sort it out. At first it would probably be uncomfortable, but eventually, price competition would drive the cost of healthcare down, it would also drastically drive down the cost of pharmacuticals.

The next step as someone else said would be for judicial reform. Judges are elected officials too, people need to elect judges who will protect doctors from frivolous lawsuits. Actually judges should protect anyone from frivolous lawsuits. Throw them out and tell them to go fuck off.

V[/quote]

…thank you for your explanation V…

17

[quote]Vegita wrote:
I want some liberals to explain why they think an insurance company should take on a client who has a pre-existing condition which they know they are going to have to pay out? I am an insurance agent, would you expect me to insure every person who has damage to thier car already and tell them, Oh sure, let me fix that for you.
[/quote]

I do not consider myself a “liberal”, and I cannot speak for all liberals, but I think your premise is broken. All of the liberals that I know would vastly prefer a universal healthcare system with a single payer, namely a government program that everyone pays into (based on their ability to pay) through taxes, and everyone participates in, and which covers all health issues. In other words, the sort of universal health care system that most other first world countries currently have.

Health insurance would still be available for “concierge service” for those who could afford it and wanted to pay extra for gold-plated service.

Requiring coverage of pre-existing conditions is just an attempt to achieve universal coverage under the existing insurance system. I don’t know any liberals who think this is a good way to go about it, but that it is the only politically expedient way.

I certainly don’t know what the right answer is, but I don’t think the traditional insurance model is a good fit for health care. In every other type of insurance that I can think of, each casualty event has a quantifiable cost to cure. If your house burns down, there is a certain cost to rebuild it and replace the contents. Once that has been done, the insured has been made whole and the insurance company is done writing checks.

But imagine someone born with a birth defect that requires life-long treatment. A single casualty event results in an open-ended cost to the insurance company that cannot be quantified in advance. Should that person be prevented from getting any health insurance because of a single event that happened before they were even born?

Or let’s say that you appear to be in perfect health, sign up for an insurance policy, make one payment and then the next day suffer a CVA that leaves you incapacitated for life. Why does that single $100 payment guarantee you a lifetime of expensive care that is denied to someone who could not afford the same $100 payment?

[quote]Vegita wrote:
I just don’t understand the liberal mindset with regard to some people being forced to give to others who may or may not deserve help.
[/quote]

I think the liberal mindset is that there is no one in need who is undeserving of help. It’s that whole “bleeding heart” thing, you know.

18

Can these liberals name a single-payer (meaning Government) system anywhere in the world that doesn’t have countless true and horrible stories of rationed care? And often hideously long waits for treatment or tests?

If not then why – other than a general philosophy of loving government control, and loving for money to be taken from some people to benefit others, allowing them to not pay for the services or goods they receive – do they want it?

19

[quote]ephrem wrote:

[quote]pushmepullme wrote:

[quote]ephrem wrote:
…can this scenario happen?

  1. Young woman is raped.
  2. Rapist has AIDS and is not caught.
  3. Girl contracts HIV but does not know this.
  4. Girl starts a job.
  5. Girl becomes sick, finds out she’s HIV positive.
  6. Since it’s a pre-existing condition, it’s not covered by her healtcare plan.
  7. Girl can’t afford the drugs to combat HIV.
  8. Girl dies a horrible death.[/quote]

Pre-existing conditions, at least with every plan I’ve ever had, are conditions you had received treatment for within a certain timeframe prior to enrolling with the current plan. This would not be a pre-existing condition.[/quote]

…i didn’t know that, thanks…
[/quote]

First hit on google:

Pre-existing conditions defined:

20

[quote]Bill Roberts wrote:
Can these liberals name a single-payer (meaning Government) system anywhere in the world that doesn’t have countless true and horrible stories of rationed care?

If not then why – other than a general philosophy of loving government control, and loving for money to be taken from some people to benefit others, allowing them to not pay for the services or goods they receive – do they want it?[/quote]

I don’t really know. I suppose because they feel it is more fair to ration care based on patient need than based on patient ability to pay. Also, I think some people believe that most European single payer systems cost less for better aggregate outcomes than what we have in the United States, and that this leads to less rationing overall than what we already have.

I don’t think I can answer Vegita’s question any better than I have done so far, so I will leave you all to it.