Home » Understanding “health insurance” and pre-existing conditions

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Understanding “health insurance” and pre-existing conditions — 9 Comments

  1. Among other things, health insurance is sort of like auto insurance if auto insurance covered oil changes, car washes, and new tires. And gasoline.
    The premium for a regular, frequent expense is that expense plus the cost of administering the claim.
    Cheaper to take care of it yourself.
    Unless it’s group insurance and the cost is passed on to the customer in the form of higher prices. That wouldn’t be so bad except that it sets the expectations for individual coverage which also has to cover…oil changes, new tires, car washes, and gasoline. And the premiums reflect that.
    Lastly, health care premiums are deductible to the employer and not reportable to the employee.
    So, if the employer has, say, $500 more per employee to spend on compensation, putting it toward health insurance is a good deal. If he paid the guy W2 income, he’d be out his share of Soc Sec., the employee would be out his share of Soc Sec, plus state, local, and federal income taxes. And, if the employer offered benefits such as disability income or pensions, those would have to be tweaked as well.

  2. Glad to see you put “health insurance” in quotes. If you look in the dictionary, health is a personal condition, not a commodity or service you can buy so there is actually no such thing as health insurance or health care. Health is a do it yourself project and if you don’t care for your health the doctor can’t provide health care for you. You can, of course, buy medical insurance and medical care.

  3. Health care is not a right under Natural Law, no matter what all the semi-socialist countries in Europe allege. They are all ethically compromised anyway.
    The “right” to health care is just a stalking horse, from which our increasingly totalitarian government will eventually seize the reins and provide “health care” to all, as part of their total control of the population. If you have not read or heard Dr. Ezekiel Emanuel and his Quality-Adjusted Life Year cost-benefit approach, I warn you to learn the QALY concept and details before reading Emanuel. It will chill your marrow. He is a Josef Mengele for the masses, benignly patting you as he directs you to the gas oven of no care. From Harvard, too. And a “medical ethicist”!

  4. The sad truth is that not enough Americans understand for what insurance is. Health insurance shouldn’t pay for anything that isn’t an emergency outlay, and it should have deductibles that are quite high- at least as much as one might spend on a brand new car. With that standard, it is ok if insurers offer things like free checkups and vaccinations, but they will only do so if they are pretty sure such freebies actually reduce the expected emergency cost later on.

    However, we will never have that. An honest broker would simply come down on this side- let insurers set absolute caps on what will be paid out that you agree to when you sign the insurance contract, and fund all excess charges via taxation only. Trying to fund what is essentially an unlimited demand via the premium system is guaranteed to bring the system down anyway.

  5. Tough question. Intellectually, I agree that pre-existing conditions negates the very term insurance. On a personal level, I think of my 25 year old granddaughter, 4 years removed from her leukemia diagnosis, and still under the care of Oncologists. So, in a few months, one way or the other, she must leave her mother’s HMO, which has seen her through this very well; but, where does she turn? She could get insurance through her job right now before anything changes; but this is not a forever job. Will there be options for her, as she moves forward?

    Human considerations tend to make things a bit messy.

    PS The massive expense of my mother’s lengthy struggle with terminal cancer cost my Dad his business, and our home, back before health insurance was ubiquitous. But, folks were a little more resilient in those days. Not sure we can go back, or want to.

  6. Our medical insurance and delivery system was messed up before Obamacare, (By employer medical insurance, by Medicare/Medicaid, by EMTALA) but Obamacare has really poisoned the punch bowl. Too many people don’t understand that Obamacare has made things better for only a small number – maybe nine million (mostly Medicaid and older, poorer people) out of 325 million population. But it has also made things much worse for about nine million people – mostly individual medical insurance purchasers whose premiums and deductibles are ruinously high. And it is costing us much more than it should while it does nothing about skyrocketing medical care costs.

    No plan will remedy these issues perfectly. But the Congress must start. by dismantling Obamacare (piece by piece if necessary) and working toward a more market driven, more cost transparent, more efficient medical care model where doctors and patients are more in control. Maybe it can’t be done, but I hope we give it a try before going down the universal (government controlled) medical care path.

  7. “What is a pre-existing condition? A hang-nail, recovery from stage 3 cancer, or something in-between?…

    I think it is reasonable to believe that a binary pre-existing/not pre-existing segregation is nonsense. So either you have perfect health, or you are a train-wreck waiting to happen?” – TommyJay
    http://neoneocon.com/2017/05/02/revisiting-those-high-risk-pools-briefly/#comment-2202911

    This hits at one crux of the “pre-existing” issue.

    One example I know about is one family friend had/has a cyst that her doctor said was/still is nothing to worry about. But, prior to obamacare, the insurance company deemed her with a “pre-existing condition”. Yet, she was in great health, per her doctor.

    She suspects it really was about her age, having just turned 50 at the time. Age naturally increases everyone’s risk. The cyst was probably just the thing the insurance company needed to kick up the premium (by a multiple).

    It is a much thornier issue than, well, she can go to the state subsidized high risk pool and still be covered.
    .

    “The previous GOP bill reflected something like the situation that existed prior to Obamacare…

    they would be covered, just not as easily or as cheaply as those without pre-existing conditions” – Neo
    Fundamentally the medical insurance industry is highly regulated and, thus, is effectively an oligopoly.

    Without great competition, there was (and still is) an incentive for them to seemingly “cherry pick” the healthier, and younger population.

    So, the system prior to obamacare wasn’t all so great either.

    Ultimately, whatever solution (I’d prefer a much freer market – that NOBODY is selling to the public right now) has to be sold to trump’s swing dem voters, and they are likely to be folks who are more likely to be hit by this issue.

    Doubtful that going back to the pre-obamacare situation is sellable.

    But, who knows. If trump endorses it, that might be all they need, nowadays (until reality hits).

  8. “Kimmel implies that opposition to Obamacare-style insurance mandates is both un-American and indecent. Had he been less hysterical, he would have acknowledged that different health care systems have pros and cons — and decent Americans can have legitimate differences of opinion on such matters. …

    Compassion without clear thinking is just a waste of Kleenex.” – Michelle Malkin

    http://www.realclearpolitics.com/articles/2017/05/03/a_thinking_moms_message_for_jimmy_kimmel_133772.html

  9. In the first place, health insurance is health insurance. There’s no point in talking about the “insurance model” when it comes to actual insurance.

    Of course through continued misuse of language, enabled by ignorance and helped along deliberately, it seems that the general public no longer thinks in terms of insurance, when it comes to health insurance.

    .

    But to the issue of “rising costs of health care,” and speaking of increased medical tech and so on, here’s one for the books.

    I will skip the whole back-story, but in January I saw a G.P. new to me, since I now must rely on such largesse as Ms. Pelosi and her gangmates (on both sides of the aisle, but even worse on the D side) are pleased to give me under color of the Wondrous Medicare, Part D, and the Medicare Supplemental Insurance (that used to be called “major medical,” or simply “health insurance”).

    This gentleman wanted me to see a gastroenterologist. The appointment was made. (In the event, I actually saw a “nurse practitioner.”) The lady looked over the results of my latest blood exam. She told me I should have a colonoscopy and an endoscopy. I said, “Not gonna happen.” (I’m 74 in 26 days, and the pulmonologist only gives me maybe three more years — with luck — anyway.) Finally she said, Well, then at least have a DNA Stool Test. I said, “Whazzat.” She never did tell me, but finally I asked her what percentage of those who took the test turned out to have colo-rectal cancer or precancerous polyps. She finally said she didn’t know, so I narrowed the question to ask what percentage of those who tested positive from the Stool Test turned out to have the colonoscopy-endoscopy results confirm the existence of cancer or polyps.

    I hope you are all sitting down, and have put down your hot or sugary drinks. The percentage?

    4 %.

    Yes, boys and girls, this whiz-bang wondrous test that you simply must have or you will die later on today in a bed of pain that you made for your very own self, your very own self, gives

    96 % false positives!

    Stuff like this is part of why medical costs are so high.

    And by the way, stuff like this results from a lot more factors than just “greed.” But it’s past my bedtime, so End of Story.

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