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Should Insurance Charge You for Your Pre-existing Condition?

  

Category:  News & Politics

Via:  perrie-halpern  •  5 years ago  •  197 comments

Should Insurance Charge You for Your Pre-existing Condition?
Pre-existing conditions: That's insurance speak for a disease, injury, or medical condition you had before you got a health insurance policy. As the democrats and republicans gear up for how to fix the American healthcare system, you can be sure that pre-existing conditions will either be on the table, or on the chopping block. The bottom line question: should an insurance company have the right to turn you down or charge you more money if you have one?

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Perrie Halpern R.A.
Professor Principal
1  seeder  Perrie Halpern R.A.    5 years ago

Everybody at some point in their life will have a pre-existing condition, so what are we really discussing here? 

I think it's the right for insurance companies to charge you more. 

What do you think? 

 
 
 
Raven Wing
Professor Guide
1.1  Raven Wing  replied to  Perrie Halpern R.A. @1    5 years ago
What do you think? 

I agree that it is just a scam by the insurance companies to rip off their customers.  If a person moves to a new location and their prior insurance company does not serve that new area, they would need to find a new insurance company. This happened to me when I moved from California to No Virginia and my prior insurer did not have coverage in Virginia. Thus, I had to find a new insurance company. 

Thus, any illnesses or such that they had while with the prior insurer would be considered as pre-existing, and subject to either a higher rate or no coverage for those pre-existing conditions. Luckily, I didn't not have any pre-existing condition that fell into that category. 

 
 
 
Thrawn 31
Professor Guide
1.3  Thrawn 31  replied to  Perrie Halpern R.A. @1    5 years ago

I think health insurance is a total scam. When I have been paying my premiums for several years, never had a medical issue, but my wife's miscarriage goes badly and I still have to pay $900, what would you call it? I mean, in what other industry do you pay for a product monthly, and then have to pay more when you actually need the product you are already paying for? 

No other modern nations deal with this kind of bullshit, we are the only outlier. 

 
 
 
Thrawn 31
Professor Guide
1.3.2  Thrawn 31  replied to    5 years ago

And it is horseshit.

Health insurance in the US is more or less a hostage situation. You have to get it because if something actually happens almost no one has the money to pay for it out of pocket, but when you do have it you pay out the ass for it monthly and then pay even more when something actually happens. And that doesn't even take into account that a lot of people can't leave their current jobs because they can't lose their insurance. 

Universal healthcare would be just about the best thing to ever happen to this country. 

 
 
 
Thrawn 31
Professor Guide
1.3.4  Thrawn 31  replied to    5 years ago

Yep. Opting out that is. Everyone still pays via taxes, but you can choose a private company or to pay out of pocket if you want. 

 
 
 
Thrawn 31
Professor Guide
1.3.7  Thrawn 31  replied to  XDm9mm @1.3.5    5 years ago
Sure, if you want to see it bankrupt, or operated like Amtrak

So basically where we are now? 

I can see it now.  Emergency room care with a two week waiting list, and that's for the most urgent needs like heart attacks strokes and bleeding out.

So basically what we have now? Except now after you wait for forever you also get to shell out a couple grand. 

 
 
 
Greg Jones
Professor Participates
1.3.8  Greg Jones  replied to  Thrawn 31 @1.3.2    5 years ago
Universal healthcare would be just about the best thing to ever happen to this country. 

You would pay more for less coverage, fewer options, and long waiting periods for appointments and procedures.

 
 
 
Sean Treacy
Professor Principal
1.3.9  Sean Treacy  replied to  Greg Jones @1.3.8    5 years ago
are would be just about the best thing to ever happen to this country. 

Universal healthcare is great as long as you don't get sick.  

 
 
 
Jack_TX
Professor Quiet
1.3.10  Jack_TX  replied to  Thrawn 31 @1.3.2    5 years ago
Health insurance in the US is more or less a hostage situation.

Health CARE is the hostage situation.

You have to get it because if something actually happens almost no one has the money to pay for it out of pocket,

And yet people bitch about the one thing that pays those bills.....

but when you do have it you pay out the ass for it monthly and then pay even more when something actually happens. And that doesn't even take into account that a lot of people can't leave their current jobs because they can't lose their insurance. 

Their insurance has been portable since 1985.  

Universal healthcare would be just about the best thing to ever happen to this country. 

"Universal" healthcare doesn't solve the problem, which is that we pay more for care than every other nation, often by a factor of 10 more.  

 
 
 
TᵢG
Professor Principal
1.4  TᵢG  replied to  Perrie Halpern R.A. @1    5 years ago

I have more to say @10, but briefly I can see individuals paying more based on poor lifestyle choices; not strictly because of a pre-existing condition outside of their control.   Consider the extreme cost of healthcare when dealing with certain forms of cancer that manifest not from poor lifestyle choices (not from individual choice) but as a result of genetics and the environment.    So often shit just happens to people that is outside of their domain of choice.   This is the main reason why the notion of distributed risk makes sense.

 
 
 
Perrie Halpern R.A.
Professor Principal
1.4.1  seeder  Perrie Halpern R.A.  replied to  TᵢG @1.4    5 years ago
I have more to say @10, but briefly I can see individuals paying more based on poor lifestyle choices; not strictly because of a pre-existing condition outside of their control. 

That is exactly right. There is a difference between what you can control and what you can't.

 
 
 
TᵢG
Professor Principal
1.4.3  TᵢG  replied to  Kathleen @1.4.2    5 years ago

Lifestyle choices are fair game when determining participation 'price' in the system.   We can choose to smoke or work out.   We cannot, however, choose our genes or (to a large degree) our environment.   And we have very little choice when it comes to the basic 'luck of the draw' factors.

 
 
 
Jack_TX
Professor Quiet
1.5  Jack_TX  replied to  Perrie Halpern R.A. @1    5 years ago
Everybody at some point in their life will have a pre-existing condition, so what are we really discussing here? 

Actually most people won't.

Most people stay insured, therefore any conditions they develop are not pre-existing.

 
 
 
Perrie Halpern R.A.
Professor Principal
2  seeder  Perrie Halpern R.A.    5 years ago

As we learn more about genes, we learn that hidden conditions we didn't know about. And as our DNA becomes more and more of the public domain, it can be used against us. 

Be careful with that 23 and me you were going to take.

 
 
 
FLYNAVY1
Professor Guide
2.1  FLYNAVY1  replied to  Perrie Halpern R.A. @2    5 years ago

I was going to add that point myself Perrie.  The movie Gattica from 1997 yields a very possible scenario where biological predispositions are identified in your DNA and are qualifiers/disqualifiers for work, and even basic survival.  Knowing how human greed works, you can bet insurance companies and the pharmaceutical industry will try to capitalize/monetize knowledge gained from our DNA.

With respect to pre-existing conditions, there is much to work out.  I'm now leaning towards the system we have here in Germany where there is a public medical system that everyone has access to, while there is still a private system available for those that want or need it.  This would work in the US. 

The real money saver is access to preventative medicine and dental care.  That's what we should be focusing our efforts on as it stretches every dollar further to cover more people.     

 
 
 
Perrie Halpern R.A.
Professor Principal
2.1.1  seeder  Perrie Halpern R.A.  replied to  FLYNAVY1 @2.1    5 years ago

Germany is supposed to have the best healthcare system in the world. I have been reading up on it. I think it's worth thinking about. 

The real money saver is access topreventative medicine and dental care.  That's what we should be focusing our efforts on as it stretches every dollar further to cover more people. 

I have to agree. If you can stop a health issue before it becomes critical, then you are saving money

brw.. loved the movie GATTACA. Very much a cautionary tale. 

 
 
 
Thrawn 31
Professor Guide
2.1.2  Thrawn 31  replied to  Perrie Halpern R.A. @2.1.1    5 years ago

Germany is the model we should follow when it comes to healthcare. I have been saying that for years.

 
 
 
Enoch
Masters Quiet
2.2  Enoch  replied to  Perrie Halpern R.A. @2    5 years ago

Dear Friend Perrie: I took the 23 and Me test.

Turns out 8.5% of me is New York State sales tax.

They rated my policy to accodmodate accountant fees as a pre-existing condition.

Enoch, Filing My Lab Tests Jointly with Mrs. E.

 
 
 
Enoch
Masters Quiet
2.2.2  Enoch  replied to    5 years ago

You too, dear friend.

E.

 
 
 
sandy-2021492
Professor Expert
4  sandy-2021492    5 years ago

Unsafe drivers pay more.

Homeowners who live far from a fire department pay more.

So, yes, people with pre-existing conditions should pay more.  They are more likely to require care, often expensive care.  If insurance companies don't charge them higher premiums, then we all end up paying higher premiums to cover their increased utilization.

I have no problem with subsidizing them to some extent, either by way of a government subsidy or through premiums that are higher, but not reflective of their actual increased risk.  But it is not fair for someone with uncontrolled type II diabetes to pay the same premiums as someone who eats right, exercises, and either controls their disease or never develops it in the first place.

 
 
 
Thrawn 31
Professor Guide
4.1  Thrawn 31  replied to  sandy-2021492 @4    5 years ago
So, yes, people with pre-existing conditions should pay more. 

But what counts as a pre-existing condition? I had an asthma attack brought on by an allergy to cats 16 years ago. I have not had a single incident of asthma since (I was running 5 minute miles in my 20s just fine) but prior to the ACA my insurance labeled me as a high risk asthmatic and tried to charge through the roof. Should I really be charged far more, because I had an allergic reaction 16 years ago, than most people even though I am far healthier than 97% of the people in this country? 

 
 
 
sandy-2021492
Professor Expert
4.1.1  sandy-2021492  replied to  Thrawn 31 @4.1    5 years ago

That would be something that would have to be hashed out.  It seems to me that, if a condition has not required treatment for a long period of time, it should no longer be considered to be a condition from which you suffer.

But for people who have chronic conditions that are still being treated, yes, IMO, that should qualify as a pre-existing condition.  You do not contribute to increasing the risk of the pool of insured members.  A person with uncontrolled diabetes or COPD does, though.  If insurance companies don't charge them higher premiums, the costs get passed along to every other insured member.  That's just math.  The money has to come from somewhere.

 
 
 
sandy-2021492
Professor Expert
4.1.3  sandy-2021492  replied to  XDm9mm @4.1.2    5 years ago

Unfortunately true.

Companies selling life insurance policies are fairly good at estimating their odds of having to pay out benefits vs. how much they'll receive in premiums via actuarial science.  I believe the same could be done for health insurance.  We know enough of the pathologies of most diseases to determine their likelihood of returning to say whether they should be considered pre-existing or not.  One asthma attack in decades - probably shouldn't be considered pre-existing.  Breast cancer, unfortunately, should.

 
 
 
Thrawn 31
Professor Guide
4.1.8  Thrawn 31  replied to  sandy-2021492 @4.1.1    5 years ago
That would be something that would have to be hashed out.

And that is the sticking point isn't it? 

It seems to me that, if a condition has not required treatment for a long period of time, it should no longer be considered to be a condition from which you suffer.

But if I am a for profit health insurance company, fuck that. I am not taking the risk. Not without significant compensation that is.

But for people who have chronic conditions that are still being treated, yes, IMO, that should qualify as a pre-existing condition. 

So when a person like a coworker of mine develops breast cancer at age 50 (she is dead now) and requires constant treatment for almost 2 years is that a pre-existing condition? Or what about my mother-in-law who was diagnosed with Parkinson's at age 58 and has required treatment over the last 10 years? Does she have a pre-existing condition? What about people born with various disabilities that will require lifelong treatment? Aren't they the living definition of a pre-existing condition? You see how this becomes very tricky very quickly. 

  If insurance companies don't charge them higher premiums, the costs get passed along to every other insured member.  That's just math.  The money has to come from somewhere.

Oh I know, to the tune of thousands per year. 

 
 
 
Thrawn 31
Professor Guide
4.1.9  Thrawn 31  replied to  XDm9mm @4.1.6    5 years ago
That was the failure of the system. 

I have dual solutions. Raise the age and eliminate the cap. Problem solved.

 
 
 
sandy-2021492
Professor Expert
4.1.10  sandy-2021492  replied to  Thrawn 31 @4.1.8    5 years ago
But if I am a for profit health insurance company, fuck that. I am not taking the risk. Not without significant compensation that is.

That is where we could introduce government oversight.  It is not new for contracts of any kind to have requirements to be considered legal, to protect all involved.  Certain exclusions could be made illegal.

So when a person like a coworker of mine develops breast cancer at age 50 (she is dead now) and requires constant treatment for almost 2 years is that a pre-existing condition? Or what about my mother-in-law who was diagnosed with Parkinson's at age 58 and has required treatment over the last 10 years? Does she have a pre-existing condition?

If they weren't insured when they were diagnosed, yes.

For those born with certain disabilities, we as a civilized society should be caring for them, preferably without them needing to purchase private health insurance.

to the tune of thousands per year.

Yes, unfortunately.  I pay for my own health insurance, as I'm self-employed.  So, yeah, I know it's expensive.  And I've been turned down for disability insurance because, like you, I had issues with my hands almost 20 years ago for which I've never needed treatment since.  Sucks, but there it is.

 
 
 
sandy-2021492
Professor Expert
4.1.11  sandy-2021492  replied to  Thrawn 31 @4.1.9    5 years ago
Raise the age and eliminate the cap.

I agree, but a lot of people get pissed when you mention raising the age, especially if they're close to their retirement age.

 
 
 
sandy-2021492
Professor Expert
4.1.13  sandy-2021492  replied to    5 years ago

IMO, there should be no means testing for SS benefits.  We all pay in, and we should all receive that to which paying in entitles us.

 
 
 
JBB
Professor Principal
4.1.14  JBB  replied to    5 years ago

I sincerely doubt that. At full retirement age Social Security is not means tested so if you are eligible the application is fast and easy either in person or online. Besides, Social Security has nothing to do with either health insurance or preexisting conditions. Everyone must apply several monts before they anticipate starting to receive benefits. It does not start automatically or immediately and all payments are always one month behind. I applied about three months ahead of my eligibility date yet my first check came in exactly on time about two months after I reached eligibility. It is though based on your income up until full retirement age. If you apply early while still working and you still have income above, I believe, $18,500.00 per year then your benefit check is either reduced or any excess received is due back to the Treasury at tax time. In any case, that whopping story your FIL told is implausible...

 
 
 
TᵢG
Professor Principal
4.1.15  TᵢG  replied to    5 years ago

I agree.   Means testing is a consequence of inept management of SS over the decades; it will no doubt be in effect.   Government as usual goes to the people to correct its mistakes.   In this case, those who contributed to the system (by force) during their careers may be challenged so that they get a lesser return than what they have been promised (and no doubt counted on in their retirement planning).

 
 
 
lib50
Professor Silent
4.1.19  lib50  replied to    5 years ago

If you apply for SSI I believe they can look into your bank accounts. but not regular Social Security, which has nothing to do with how much you have.  Sounds like an anomaly.  

 
 
 
Texan1211
Professor Principal
4.1.22  Texan1211  replied to  XDm9mm @4.1.18    5 years ago
As to raising the cap, remember that benefits are predicated on total contributions made, so if you raise the cap, you need to raise the benefit amount a corresponding amount.

You nailed it. Some want to pretend that benefits aren't determined by contributions.

They simply want successful people to pay for others' retirements.

They want to raise the cap but don't want to raise benefits for those who pay in the most.

 
 
 
Texan1211
Professor Principal
4.1.25  Texan1211  replied to  XDm9mm @4.1.23    5 years ago

I stand happily corrected!

 
 
 
sandy-2021492
Professor Expert
4.1.26  sandy-2021492  replied to    5 years ago

Um, no.

 
 
 
Ender
Professor Principal
4.1.27  Ender  replied to  Thrawn 31 @4.1.9    5 years ago

Don't agree with raising the age. Waiting for full retirement now is close to seventy.

Average life expectancy in the US is about 78.

From what I gather, most people would collect 10 years or less.

 
 
 
Ender
Professor Principal
4.1.28  Ender  replied to  XDm9mm @4.1.17    5 years ago

Federal general funds and SS funds are separate accounts.

If someone gets a refund at the end of the year, it does not come out of SS funds.

 
 
 
Ender
Professor Principal
4.1.30  Ender  replied to  sandy-2021492 @4.1.1    5 years ago

Raising cost on certain people would not help that much. The price they raised the monthly bill to on the people would likely not even cover their cost for treatment.

Imo it would only make it to where the people that need it most could not afford it.

 
 
 
sandy-2021492
Professor Expert
4.1.31  sandy-2021492  replied to  Ender @4.1.30    5 years ago

That would depend on the condition.  For those with conditions maintained primarily with medication, such as high blood pressure, diabetes, and some autoimmune conditions, it would.  Many of those can be managed at a reasonable cost, but higher than the cost of care for a healthy person.

 
 
 
TᵢG
Professor Principal
4.1.35  TᵢG  replied to  Have Opinion Will Travel @4.1.21    5 years ago
SSI is already means tested by the IRS.

We are talking about a future condition which would be a pure means test based on the financial situation of the individual upon the distribution of their SS benefits.

You are referring to the graduation formulas for income which provide progressively lower social security credits at each level of earned income.   This occurs during earning, not during distribution.

But, as I noted, I fully expect means testing (reduced benefits at distribution time based on one's financial position) to be implemented by politicians passing on their mistakes to the public.

 
 
 
Ender
Professor Principal
4.1.36  Ender  replied to  sandy-2021492 @4.1.31    5 years ago

Ok, but if those that need certain medications have to pay an increase and higher premiums to cover the cost, what would be the purpose of having the insurance.

 
 
 
sandy-2021492
Professor Expert
4.1.37  sandy-2021492  replied to  Ender @4.1.36    5 years ago

To avoid paying the even higher costs they would have if they were uninsured.  Same as high-risk drivers are still better off paying for auto insurance, even though their premiums are higher.

 
 
 
Ender
Professor Principal
4.1.38  Ender  replied to  sandy-2021492 @4.1.37    5 years ago

I don't see how it would be higher if they are basically paying for the medication.

If they are basically paying for the medication themselves they could drop the general plan and just get a catastrophic plan.

Just like a driver could get collision only. (liability, whatever)

 
 
 
sandy-2021492
Professor Expert
4.1.39  sandy-2021492  replied to  Ender @4.1.38    5 years ago

They're not paying just for the medication.  They are also paying to defray the risks that go along with their conditions, if not maintained.  Heart attack, kidney disease, stroke, for example.  But for many with those conditions, they can be maintained on medications for decades without developing the sequelae.  Their risk is higher than average, though, so IMO it is fair to expect them to pay more, if they had those conditions when they became insured.

 
 
 
sandy-2021492
Professor Expert
4.1.40  sandy-2021492  replied to  sandy-2021492 @4.1.39    5 years ago

They're also paying for the same care as any healthy person - they get coverage for preventive care, routine care like acute care visits for minor illnesses like strep and flu, accidents, unpredictable illnesses like cancer.

 
 
 
Ender
Professor Principal
4.1.41  Ender  replied to  sandy-2021492 @4.1.39    5 years ago

If someone is paying extra to cover their medication and then there is a thousand dollar deductible, they are paying for their doctor visit as well.

They could maintain on the meds and doctor visits without dipping into the pool, paying their higher price. If they are going to do that anyway, no point in the general policy.

Imo it is basically saying people that are not as healthy as others should pay more to live.

So guess we gotta agree to disagree on this one.

 
 
 
sandy-2021492
Professor Expert
4.1.42  sandy-2021492  replied to  Ender @4.1.41    5 years ago

Insurance premiums are determined only by actual costs.  They're also determined by the risk one introduces to the insured pool.  Certain conditions carry higher risks.  If those with those conditions don't pay higher premiums, we all do.

I can agree to disagree.

 
 
 
Ender
Professor Principal
4.1.43  Ender  replied to  sandy-2021492 @4.1.42    5 years ago
we  all  do

My point is someone that needs medication should not have any impact on premiums overall when the insurance companies are raking in record profits.

Big 8 health insurers rake in more than $7B in Q3, setting up strong finish to 2018

So them saying that everyone needs to pay more because of one or two people is a lie.

Frank was startled to see that Aetna had agreed to pay NYU Langone $70,000. That's more than three times the Medicare rate for the surgery and more than double the estimate of what other insurance companies would pay for such a procedure, according to a nonprofit that tracks prices.

Fuming, Frank reached for the phone. He couldn't see how NYU Langone could justify these fees. And what was Aetna doing? As his insurer, wasn't its duty to represent him, its "member"? So why had it agreed to pay a grossly inflated rate, one that stuck him with a $7,088 bill for his portion?

"You pay for everything, but you can't see what you pay for," he said.

With a practiced eye, Frank scanned the billing codes hospitals use to get paid and immediately saw red flags: There were charges for physical therapy sessions that never took place and drugs he never received.

One line stood out — the cost of the implant and related supplies. Aetna said NYU Langone paid a "member rate" of $26,068 for "supply/implants." But Frank didn't see how that could be accurate. He called and emailed Smith & Nephew, the maker of his implant, until a representative told him the hospital would have paid about $1,500. His NYU Langone surgeon confirmed the amount, Frank said. The device company and surgeon did not respond to ProPublica's requests for comment.

They are wildly inflating prices. An implant that costs 1,500 is being charged at 26,000. The man in this article even with his coverage still had to pay over 7k.

Until we have regulation over the industry, this will continue. It should not be a for profit industry where the insurance companies rake in millions while saying that people with conditions need to pay more.

 
 
 
sandy-2021492
Professor Expert
4.1.44  sandy-2021492  replied to  Ender @4.1.43    5 years ago

It's not the insurance company that's inflating the cost of the implant.  That's the hospital.  Same for many medications.  And it's the hospital that charged fraudulently for PT sessions.  I agree that insurance company profits are obscene, but we should place blame where blame lies.

 
 
 
Ender
Professor Principal
4.1.45  Ender  replied to  sandy-2021492 @4.1.44    5 years ago

True. I blame both though as they negotiate the prices.

 
 
 
Ender
Professor Principal
4.1.46  Ender  replied to  sandy-2021492 @4.1.44    5 years ago

Anyway, have a happy 4th!

Heading out in a little bit. Having a BBQ and a few libations on the beach and watch the show around here. It is wild as everyone shoots of fireworks on the beach, quite a spectacle.

 
 
 
sandy-2021492
Professor Expert
4.1.47  sandy-2021492  replied to  Ender @4.1.46    5 years ago

Have a great time. I'm travelling to my parents'.  We have a family reunion this Saturday.  The crazy side is getting together. If I post an address, it means I need to be rescued jrSmiley_82_smiley_image.gif

 
 
 
JohnRussell
Professor Principal
5  JohnRussell    5 years ago

Many conditions are not pre-existing conditions in the sense that they developed before the individual got health insurance. 

Most people got their health insurance through their jobs, and start working in their mid 20's at the latest. If you had health insurance when you were 27 and you develop diabetes when you are 40 that is not a pre-existing condition in terms of you having insurance. Let's say you change jobs when you are 42 and need new health insurance. Should the new insurance company be able to charge you more for a pre-existing condition, when you have had health insurance dating back to before you developed the diabetes? NO. 

 
 
 
JohnRussell
Professor Principal
6  JohnRussell    5 years ago

If someone is 50 years old and has never bought health insurance before, and has heart disease, it makes sense that this individual might have problems getting insured. That would be like having an unsafe car which could cause an accident at any time and expecting to get auto insurance anyway. 

But people who have had insurance continually should not be penalized because their "car" goes bad all of a sudden. Such a thing would negate the concept of "insurance", which is a large group of people pooling their funds into one fund which is then drawn from as needed. 

 
 
 
charger 383
Professor Silent
7  charger 383    5 years ago

Insurance companies have failed the American Citizens, they can not be trusted

I have been covered by health insurance from birth, never had a gap so nothing can be a pre existing condition 

 
 
 
JohnRussell
Professor Principal
7.1  JohnRussell  replied to  charger 383 @7    5 years ago

You are correct. 

 
 
 
Thrawn 31
Professor Guide
7.2  Thrawn 31  replied to  charger 383 @7    5 years ago

Being alive is a pre-existing condition to them. 

But you are right, private insurance has failed our country super hard. There is a reason we pay significantly more and achieve similar (if not worse) results. 

 
 
 
Thrawn 31
Professor Guide
8  Thrawn 31    5 years ago

Fuck no, they try to define everything as a pre-existing condition. In the eyes of insurance companies, unless you have never gotten hurt or sick in your entire life then you are a walking pre-existing condition. 

It made me so happy to see our insurance have to eat the entire bill for my last daughter's birth. 

 
 
 
luther28
Sophomore Silent
9  luther28    5 years ago

Should Insurance Charge You for Your Pre-existing Condition?

Not unless one gets to send the insurance company their pre-insurance medical bills. I should have done it in one word, no.

 
 
 
TᵢG
Professor Principal
10  TᵢG    5 years ago

Logically it makes sense for everyone to pay according to their own health, but this is very problematic.   Take a person who develops cancer.   The treatment of that common affliction can bankrupt a family.   Because medical costs can vary so dramatically it makes sense to distribute them across a large population.   Same thing goes for pre-existing conditions.   If cancer was a pre-existing condition for an individual (continuing the example), the insurance costs for the individual will be staggering.    The need to distribute applies here as well.

But pre-existing conditions pose a substantial problem.   Unless everyone is participating as part of the paying population, those who are not participating have a loop hole.   If they are healthy, they can pay medical bills without insurance until the point in time when they get really sick.  Then, and only then, can they opt into the system with their pre-existing condition and get the benefits.   This is of course grossly unfair to this who were participating all along.

Thus pre-existing conditions should be covered due to the staggering individual financial burden but this means the loophole has to be closed.    This is a profound problem.

The obvious resolution is to have everyone contribute to the national pool.    Everyone pays for basic insurance (healthy or not) and the risk is distributed across the entire population.   That could cover the problems outlined.   On top of that, it makes good sense to have tiered support where individuals can pay more for special services (picking their own doctors, access to advanced treatments, bypass waiting lines, etc.).    The tiered support provides a market for continued R&D by providing an avenue for those who can and wish to spend more for health services to do so.

 
 
 
luther28
Sophomore Silent
10.2  luther28  replied to  TᵢG @10    5 years ago
The obvious resolution is to have everyone contribute to the national pool.    Everyone pays for basic insurance (healthy or not) and the risk is distributed across the entire population.
A sensible solution in my estimation.

 
 
 
Thrawn 31
Professor Guide
10.2.1  Thrawn 31  replied to  luther28 @10.2    5 years ago

And one that every other modern nation on the planet has adopted, except us. 

 
 
 
TᵢG
Professor Principal
10.2.3  TᵢG  replied to    5 years ago

You are presuming the government is making medical decisions.   I did not stipulate that (and I too am against government being involved except in an administrative capacity).

 
 
 
TᵢG
Professor Principal
10.2.5  TᵢG  replied to    5 years ago
The administrative part is what scares me the government making decisions

The concept of government administration has a very broad range.   At its very core, a government is an administrative agent.   Unless you envision civil society without a government, the notion of administration is inevitable.

The specifics is what matters.

As I noted, I also am against government making medical decisions.

 
 
 
lib50
Professor Silent
10.2.7  lib50  replied to    5 years ago

The government doesn't make healthcare decisions.  And how can one underwrite a massive medical incident?   It costs MILLIONS.   And national healthcare is paying for your own heathcare.  

 
 
 
livefreeordie
Junior Silent
10.2.8  livefreeordie  replied to  lib50 @10.2.7    5 years ago

Sure it does. With Medicare, Medicaid, Obamacare and VA 

when you have statutory definitions, limits of coverage, and or limits of reimbursement to doctors and hospitals, then government is making those decisions 

we need to repeal them all except VA care for disabled Vets (thats the same as Workman’s Compensation)

 
 
 
sandy-2021492
Professor Expert
10.3  sandy-2021492  replied to  TᵢG @10    5 years ago

This is sensible, but too many have ideological objections.  Frankly, I doubt that we'll ever have such a system. 

 
 
 
TᵢG
Professor Principal
10.3.1  TᵢG  replied to  sandy-2021492 @10.3    5 years ago

Having discussed this topic for years, I agree that no matter what is proposed people will zero in on the parts they dislike and then reject the entire proposal.

There is no such thing as a system that makes everyone happy.   It is quite possible that the USA is so divided (and divisive) at this point that we will wallow in our own shit for perpetuity.   Clearly we cannot rely upon our politicians to devise a good quality, cost effective system and put it into effect.   At best, they will deliver a political gesture and move on to the next political battle in the endless pursuit of gratuitous power.

My view is that healthcare in the USA is overly expensive and that is due, in part, to our inability to standardize and achieve economies of scale.   While I focused on the risk aspect @10, we are just tossing $ into the fire by leaving economies of scale on the table.

 
 
 
sandy-2021492
Professor Expert
10.3.2  sandy-2021492  replied to  TᵢG @10.3.1    5 years ago

Some are angry at the idea of government replacing private insurers as administrators.  They think it's too much government intrusion.

Many who don't mind government "intrusion" balk at the notion of a tiered system, as it's too elitist.  Never mind that the wealthy have always had access to better food, housing, clothing, etc.  Health care, for some, must be egalitarian.

I heard a phrase last week that applies - "perfection is the enemy of good enough."  Perfection would be pleasing everybody.  Since we can't do that, we won't do anything.

 
 
 
Thrawn 31
Professor Guide
10.3.4  Thrawn 31  replied to  sandy-2021492 @10.3.2    5 years ago

Pretty much. In America perfect is now the enemy of the good. We cannot make any progress because if we cannot get it perfect all at once it just isn't even worth striving for.

 
 
 
TᵢG
Professor Principal
10.3.6  TᵢG  replied to  sandy-2021492 @10.3.2    5 years ago
Some are angry at the idea of government replacing private insurers as administrators.

There are so many ways to tackle this.   For one, I am not in favor of government official making medical decisions.   The administration I have in mind is more along the lines of administering the process of standardization, distributing resources, collecting funds, etc.   There is plenty of ways to architect a national system, administered in a federated fashion by government and implemented by private sector organizations.

Many who don't mind government "intrusion" balk at the notion of a tiered system, as it's too elitist.  Never mind that the wealthy have always had access to better food, housing, clothing, etc.  Health care, for some, must be egalitarian.

Those with the means will be funding R&D (in effect) that will benefit everyone.   Besides that, those with the attitude you outlined have a major personal problem to deal with because they will never be in an egalitarian society (nor would they want to be if they understand what that would mean).   People with more money (and power) get better things.   No way that is going to change.    Given the nature our our society, no way that should change either; the inequality is critical and net good.

 
 
 
TᵢG
Professor Principal
10.3.7  TᵢG  replied to    5 years ago
No wealth redistribution sucks and isn't a good idea even if you want to pay less for healthcare.

Any taxation or variant of that is wealth redistribution.   In civil society some level of wealth redistribution is necessary (and good) for the society.   In other words, wealth redistribution is not a single thing that is bad or good, it depends on the specifics.

 
 
 
sandy-2021492
Professor Expert
10.3.8  sandy-2021492  replied to  TᵢG @10.3.6    5 years ago

Oh, I agree.  I was just pointing out why I think we're unlikely to change anything.  We're too polarized on this issue, as on many others.  We won't compromise.  If some can fine one point on which they disagree with a proposed plan, they'll throw out the baby with the bathwater.

 
 
 
sandy-2021492
Professor Expert
10.3.9  sandy-2021492  replied to    5 years ago
I would say if we did what some want we would punish people for being successful like the income tax system. 

How?  Please be specific.

 
 
 
TᵢG
Professor Principal
10.3.10  TᵢG  replied to  sandy-2021492 @10.3.8    5 years ago

I understand you were posing the problems.   And the problems do indeed exist.   Hard to imagine how we will ever make progress on important issues in the USA.

 
 
 
TᵢG
Professor Principal
10.3.13  TᵢG  replied to    5 years ago
If you are the one seeing over 70,000 of your income taken a year now a little less thanks Trump I would suggest you think it sucks.

What makes you think that I have not paid dearly in taxes during my career?   Or that I have not paid more than you?

 
 
 
sandy-2021492
Professor Expert
10.3.14  sandy-2021492  replied to    5 years ago

No.  In TiG's scenario, all will pay in and receive basic care.  If you want more, and can afford more, you pay for more yourself, or by purchasing private insurance.  All have skin in the game.

 
 
 
TᵢG
Professor Principal
10.3.17  TᵢG  replied to    5 years ago

You should be able to secure a decent business LOC in this economy.  jrSmiley_100_smiley_image.jpg

 
 
 
sandy-2021492
Professor Expert
10.3.19  sandy-2021492  replied to    5 years ago
If you pay nothing

You're the only one who's said anything about paying nothing.

Even under the ACA, those who get subsidies are paying part of their premiums.  I'm not sure how that's "nothing".

 
 
 
TᵢG
Professor Principal
10.3.20  TᵢG  replied to    5 years ago

First, my CPA has told me that I cannot offer an interest free loan - the loan must be above the prime rate.   Second, even if I could offer an interest free loan, you would need to provide a reason for me to do so.   How much of your company equity are you willing to sell?

 
 
 
TᵢG
Professor Principal
10.3.22  TᵢG  replied to    5 years ago

Happy 4th MUVA.

 
 
 
Ender
Professor Principal
10.4  Ender  replied to  TᵢG @10    5 years ago

I have liked the Australian system. They basically have Medicare for all yet still have private insurance, private hospitals etc. for those that can afford it or choose to go that route.

 
 
 
Kavika
Professor Principal
10.4.1  Kavika   replied to  Ender @10.4    5 years ago

That is correct. My kids, grandkids and great grandkids are all covered by their Medicare for all. A couple feel that they need private insurance so they purchase it. It much much much less expensive in Aussie than it is here in the US (private insurance).

 
 
 
JBB
Professor Principal
12  JBB    5 years ago

We all pay one way or the other. We pay in higher premiums, padded billls to cover all those who don't or can't pay or lack insurance. We all pay in higher taxes to cover the poor and the elderly. We pay too often for emergency care for chronic conditions that would be better and cheaper to address woth comprehensive care but because so many lack insurance gets poorly treated on an emergency basis costing exhorbatently more. In the end, Americans in total pay about twice as much per person compared with other industrialized nation for a less effective less efficient system resulting in a sicker, less happy and less productive population. This effects everything else in our economy adversely especially businesses. What we will eventually end up with is a two tier system of basic non-life extensive care for all and then a second tier of premium care for those with premium insurance or enough money to pay market price for elective life extending or life enhancing therapies...

 
 
 
lib50
Professor Silent
12.2  lib50  replied to  JBB @12    5 years ago

I have tried to have a conversation about this and its impossible when one side doesn't even understand the issue beyond their own world.  No understanding of macro healthcare, no understanding of costs and outcomes.  Not to mention they believe lies every day, why should this be different?

 
 
 
TᵢG
Professor Principal
12.2.1  TᵢG  replied to  lib50 @12.2    5 years ago

Thing is, I suspect most do indeed understand the macro issues.   Makes the objection to honest discussion even more curious.

 
 
 
It Is ME
Masters Guide
13  It Is ME    5 years ago

"should an insurance company have the right to turn you down or charge you more money if you have one?"

Yep !

Insurance companies are a business, that you can contribute to for YOUR future, if YOU CHOOSE !

It's no different than wrecking your car, than trying to get Car insurance after the fact, for cheap !

Any intelligent business person wouldn't even touch it with a 40 ft. pole.

Every intelligent person knows somethings going to happen some day, and the Intelligent person does something to insure that that situation is covered before it happens.

People need to stop this fucked up reasoning that someone owes them when they haven't even contributed to ANYTHING !

 
 
 
Thrawn 31
Professor Guide
13.1  Thrawn 31  replied to  It Is ME @13    5 years ago

So then we really should all be paying about $2,000 a month because eventually something will happen. Being alive is a pre-existing condition. 

 
 
 
It Is ME
Masters Guide
13.1.1  It Is ME  replied to  Thrawn 31 @13.1    5 years ago
So then we really should all be paying about $2,000 a month because eventually something will happen.

[Removed]

 
 
 
It Is ME
Masters Guide
13.1.3  It Is ME  replied to    5 years ago

We're at $ 664.00 a month for three. My $ 80,000 hospital visit a few years ago, cost us $ 2,500.00 out of pocket.

Of course, I've paid for "Insurance" for quite sometime now. A few hundred bucks a month is well worth it. Imagine having to shell out 80 Grand in one fell swoop cause I didn't have insurance, and then bitching at insurance companies for not covering me AFTER THE FACT. Personally, folks should feel like "FOOLS" for even attempting to bitch at a COMPANY for not funding them, when they didn't contribute in the first place.

 
 
 
It Is ME
Masters Guide
13.1.5  It Is ME  replied to  It Is ME @13.1.1    5 years ago

Truth is Truth !

A "Blog" doesn't make truth false !

 
 
 
Nerm_L
Professor Expert
15  Nerm_L    5 years ago

People who consume more, pay more.  That's the way it works for any type of consumption.  So, what's the argument?

 
 
 
lib50
Professor Silent
15.1  lib50  replied to  Nerm_L @15    5 years ago

So if they can't pay, they die. 

 
 
 
Nerm_L
Professor Expert
15.1.1  Nerm_L  replied to  lib50 @15.1    5 years ago
So if they can't pay, they die. 

If someone cannot pay, they cannot consume.  That is an unremarkable observation.

The pertinent question is whether or not medical care should be delivered in the consumer marketplace?

It's a fundamental question of rights.  Opportunity to consume is always limited by ability to pay.  Is access to fundamental rights simply a matter of consumption?

 
 
 
TᵢG
Professor Principal
15.1.2  TᵢG  replied to  Nerm_L @15.1.1    5 years ago
Is access to fundamental rights simply a matter of consumption?

Your opening comment @15 presented this issue as a simple matter of choice in what to consume.    Lib50 is now focusing your attention on the problem inherent in such a simplistic view when it comes to healthcare.

She is clearly asking you if it is desirable for people who cannot afford to pay for their (as an example) expensive cancer treatments (and this is an easily achieved state even with insurance) to just die.   She is asking if this is what you propose for civil society.

 
 
 
It Is ME
Masters Guide
15.1.3  It Is ME  replied to  TᵢG @15.1.2    5 years ago
Lib50 is now focusing your attention on the problem inherent in such a simplistic view when it comes to healthcare.

But YOU loath simplistic !

What changed ?

 
 
 
TᵢG
Professor Principal
15.1.4  TᵢG  replied to  It Is ME @15.1.3    5 years ago

Read what I wrote.  You are clearly confused.  Worse, you even quoted the operative part.

 
 
 
It Is ME
Masters Guide
15.1.5  It Is ME  replied to  TᵢG @15.1.4    5 years ago
Read what I wrote.  You are clearly confused. 

I did, along with all your other comments throughout my time here !

But one is AOK when being "Simplistic", if it fits your narrative !

Your "Interpretation" of what I just wrote, isn't my problem.

Simplistically speaking that is !

Maybe you should really review your own "Overall" narratives from time to time ?

 
 
 
Nerm_L
Professor Expert
15.1.6  Nerm_L  replied to  TᵢG @15.1.2    5 years ago
Your opening comment @15 presented this issue as a simple matter of choice in what to consume.    Lib50 is now focusing your attention on the problem inherent in such a simplistic view when it comes to healthcare.

Arguing over mechanisms to pay for medical delivery means that delivery will continue to be governed by the principles of the marketplace.  Therein lies the central problem.

She is clearly asking you if it is desirable for people who cannot afford to pay for their (as an example) expensive cancer treatments (and this is an easily achieved state even with insurance) to just die.   She is asking if this is what you propose for civil society.

But that question is based upon the idea that medical care is a consumer product.  Why should I pay for your pumpkin spice latte?

Is education a consumer product?  Are the courts a consumer product?  Is infrastructure a consumer product?  Why don't we utilize insurance to pay for education, legal needs, and infrastructure?

The argument over insurance is idiocy.  The insurance industry has transformed a fundamental right into a consumer product.  See the problem?

 
 
 
TᵢG
Professor Principal
15.1.7  TᵢG  replied to  Nerm_L @15.1.6    5 years ago

You are dodging the question.   

 
 
 
Nerm_L
Professor Expert
15.1.8  Nerm_L  replied to  TᵢG @15.1.7    5 years ago
You are dodging the question.   

Okay, small words.  No money, no house.  No money, no food.  No money, no clothes.  No money, no phone.  No money, no car.  No money, no medical care. 

No money, people die because they can't consume.  That's the way the consumer marketplace works.

Now, answer the question that should be asked:  should medical care be delivered in the consumer marketplace?  Should a hospital function like Walmart?  Or should a hospital function like a public courthouse?

 
 
 
TᵢG
Professor Principal
15.1.9  TᵢG  replied to  Nerm_L @15.1.8    5 years ago
No money, people die because they can't consume. 

Is that how you think it should be?   (Per lib50's inquiry.)

Now, answer the question that should be asked

Put forth your proposal.

 
 
 
lib50
Professor Silent
15.1.10  lib50  replied to  TᵢG @15.1.9    5 years ago

Seems obvious their proposal is 'tough shit, die'.  And you can't have a rational debate about healthcare when viewed from that prism. 

 
 
 
TᵢG
Professor Principal
15.1.11  TᵢG  replied to  lib50 @15.1.10    5 years ago
Seems obvious their proposal is 'tough shit, die'. 

It would seem so.   Maybe a non-vague proposal will be offered.

 
 
 
TᵢG
Professor Principal
15.1.14  TᵢG  replied to    5 years ago
My proposal is all you wildly successful liberal democrat progressive should just get together and start your own system.

Logically everyone would need to be involved and everyone would benefit from the system.   A system that lacks those basic features will be systemically flawed IMO.

There are quite a few systems that could be devised.   I generally favor those with government administration of standards and regulations with execution taking place in the competitive marketplace (private sector).

 
 
 
TᵢG
Professor Principal
15.1.16  TᵢG  replied to    5 years ago
I just want the government out of my health and life I make enough money I would rather just be left alone.

I understand that.   Government should not be involved in personal healthcare choices.    However, we are all part of a civil society and that means we are all interconnected.   Our ability to make money is a function of our society;  we are not living in isolation.   In result, we have to reserve some part of our time and resources to maintaining our society.

Having people grow sick due to improper preventative care and then dealing with chronic conditions using expensive emergency facilities is net dumb.   It is bad for all of us.   Makes far more sense to devise a system where people get basic healthcare in a cost effective manner that allows those with additional money avenues to get higher levels of healthcare as they see fit by tapping a competitive healthcare delivery market that is regulated to be safe and can tap economies of scales through federated standardization.

 
 
 
TᵢG
Professor Principal
15.1.17  TᵢG  replied to    5 years ago
I would agree with a private sector administration.

The key is coming up with a means of ensuring proper quality of care.   Typically that falls upon government rather than for-profit agencies.   Also, I am a big fan of standardization as a strategy for cost effective operations.   That could be private sector but government is better suited (given its scope) for that task too.

What I don't want to see is a sliding scale for the funding with some paying more while some pay nothing by gaming the system like with the ACA where people under reported income

I hear you.   Government is not without substantial corruption (which leads into loopholes) and is often incompetent (enabling gaming).   Something that has pissed me off for decades (and seems to be getting worse).

 
 
 
Nerm_L
Professor Expert
15.1.18  Nerm_L  replied to  lib50 @15.1.10    5 years ago
Seems obvious their proposal is 'tough shit, die'.  And you can't have a rational debate about healthcare when viewed from that prism. 

IMO the deterioration of our national infrastructure can be attributed to increased reliance on private contractors for upkeep and delivery.

Once upon a time government operated and maintained hospitals.  IMO it isn't a coincidence that our health care system has deteriorated in the same way as our infrastructure for the same reasons.

The military operates its own medical care system as logistical infrastructure necessary to accomplish the mission of the military.  The military trains and maintains its own medical staff and deploys medical staff and facilities as logistical support for military operations.  Medical care is embedded in military planning.  And medical care is not treated as a consumer product; medical care is delivered as needed as part of the military mission.  We already have an alternative model for delivery of medical care that does not utilize the consumer marketplace.

IMO the government should become more involved in direct delivery of medical care by establishing a health care infrastructure.  The government needs to do much more than simply throwing more money at the consumer marketplace; the government needs to remove delivery of medical care from the consumer marketplace.

 
 
 
TᵢG
Professor Principal
15.1.20  TᵢG  replied to    5 years ago

Stepping back, here is my view.

Our healthcare costs are out of control.   We can seriously change that for the positive through good old fashioned management.   In particular, tapping into standardization and economies of scale.    

The USA should be leading the world in basic healthcare for all.   We should have a cost-effective, good quality basic infrastructure wherein anyone can get affordable health care.   The higher quality (choice of doctors, better doctors, better equipment, advanced methods, less waiting time, etc.) services would be available to those who wish to pay more to get them.   I see this as a system that involves federated administration from the government (standardization and safety regulation) with private sector providers in a competitive marketplace (remember the regulated part).

Medical decisions should be between doctor and patient - no administrators denying professional treatment.   I do see the need for a system of professional reviewers (all medical professionals) who will authorize special treatments.   But for the most part, standard care is rather well known and should be available for authorization by the doctor with the approval of the patient.

It is far better to have proactive measures to keep people healthy rather than react to (avoidable) illness.   That is, in the big picture not taking action to organize our disparate systems into an effective healthcare infrastructure is one of the least cost-effective routes we can pursue.

 
 
 
TᵢG
Professor Principal
15.1.22  TᵢG  replied to    5 years ago

I agree.   Our current crop of politicians (regardless of party) would literally shock me if they did something that was not predominantly in their own local interests.   That is one of the reasons the USA has been falling behind other nations in spite of our science/engineering and economic prowess.

 
 

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