Wednesday, August 12, 2009

Health Care - Part 1-2 Access to health care regardless of pre-existing conditions.

2) Access to health care regardless of pre-existing conditions.
Recently someone defended the practice of denying health insurance for “pre-existing” conditions with the analogy of an auto insurance provider being required to cover someone for an accident that occurred prior to coverage. Does this sound like a relevant analogy to you? Well, it’s probably one of the most relevant analogies I’ve heard and yet it’s wholly irrelevant.

The assumption is that “pre-existing” conditions are both predictable and the fault of the individual and that they should have had insurance before. There are so many levels on which this is a bogus comparison. Let’s take the congenital condition. Many, if not most, inherited conditions are undiagnosed and none of them are the fault of the sufferer, though some may be exacerbated by lifestyle issues. Yes, we have legislation that prevents discrimination based on genetic information/testing but we don’t have legislation that prevents discrimination based on the health outcomes of those conditions. Once that condition is present or determined to be something that should have been disclosed/known prior to insurance being issues, the company is free to either deny or rescind coverage.

Well, you ask, why don’t such people have insurance already so that the condition can’t be considered “pre-existing?” As I’ve mentioned before, it’s very easy to lose coverage as a result of a long term illness or a chronic condition, as many congenital conditions are. If you fall ill due to such a condition and lose your employment and, as a result, your health insurance you will find yourself in the position of having a “pre-existing” condition when you apply for health insurance anew. So, even if you manage to recover sufficiently to resume working and have sufficient income to pay for insurance you are no longer insurable. . . or, at least, the condition for which you most need insurance will be excluded.

And then, of course, there are children. What happens when I child is diagnosed with any condition, let alone a congenital one? Well, if there parents manage to maintain insurance, no problem. They should get the care they need, assuming the insurance company does deny the claim for other reasons. What happens when the child is either uninsured or loses insurance because the parent loses a job, is also sick or something else breaks uninterrupted coverage? Well, when circumstances allow and the child is to be insured again, they now have a “pre-existing” condition that may call for wholesale or partial exclusion. If the child wants to purchase that same insurance as an adult they may well find themselves locked out of the private insurance pool.

OK, I have to be honest here. There is an insurance pool for people with pre-existing conditions. Yeah, I know, gotcha. Not so fast. These are high risk insurance pools, they vary in the terms available, quality of care and cost, which is generally astronomical. The problem with charging such high rates to people with such chronic conditions is that they are just the type of population least able to bear the burden of such costs. They may miss work or even change or lose jobs often due to health issues. Many times they find their earning potential limited by their health problems or they enter a downward spiral of increasing health care costs and decreasing income.

I can go on and on but I do want this to be readable and digestible and I’m afraid I’ve already exhausted the patience of my readers with this tome. So, on to. . .


Michael Ejercito said...

Have you ever wondered why health insurance is often tied to employment?

It can be traced back to the price controls of the 1940's. Companies could not raise wages, so they started offering benefits.

EMG said...

Hi Michael, thanks for the comment. Interesting historical tid bit but I'm not certain how relevant it is to the question of where we go from here. I assume you've making a comment about price controls and the problems of government intervention. I don't know enough about your specific claim to comment on that but I don't see a clear connection between the two. I'd really like to hear more from you on the topic and how it connects to the issue at hand.

BTW while insurance isn't specifically "tied" to your employer in Germany, or elsewhere, your employer does pay a portion of the cost, just like with social security here.

Michael Ejercito said...

It is always important to remember how we got here.

One can not understand the history of World War II without knowing the background of the Versailles Treaty, for example.

EMG said...

Quite right, Michael. In general it's important to know any situations antecedents. Those of the health care situation as well. Thanks for that. I do think there are some critically important differences between now and then, however, and that this one issue is not one that will determine the debate. Interestingly, I think the one thing most parties agree on is that insurance should no longer be tied to the employer but be, at a minimum, truly portable. That right there requires massive changes in the current system.

What are your ideas on where to go from here? Any thoughts?

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