Date ►►► December 4, 2013
Just Checked In to See What Condition My Pre-Existing Condition Is In
I have had "pre-existing conditions" for as long as I've had my own health insurance, starting in the 1970s. They focus mainly on allergies, some serious enough to provoke anaphylaxis or an asthma attack that can, e.g., send my blood pressure plummeting or prevent me from breathing. I take expensive medicines that keep me asymptomatic, so I can hike and run and work out without worrying about dying from eating the wrong food or inhaling cat dander.
Much of the cost of those medicines is borne by my insurance companies... which they knew going in. Hence the term "pre-existing condition" (PEC).
In every instance where I have had to change insurance, whether a new group plan or buying individual coverage, I have had to go through a special process: For the first few months, my PECs aren't covered by insurance at all; then for a few months, my coverage goes through a "vesting" period, where coverage is phased in month by month. Finally, at the end of that vesting, I'm fully covered.
Note the timeframe -- from decades before Obamacare until now. Somehow, all these non-government insurers managed to cover me, PECs and all, for decades.
So it appears that, on the one issue that everyone was most worried about -- people with PECs who "couldn't get insurance>" -- we already had a model of how to handle that without utterly remaking health insurance. (What Man has done, Man can aspire to do.)
The General PEC Model is two-pronged:
- Use some kind of a vesting schedule during which insurance coverage for PECs is gradually increased until the insured has full coverage.
Now, some PECs are much more expensive for the insurance companies than others; consider somebody born with a series of medical problems that lead to many, many surgeries on the heart, liver, lungs, and so forth.
Natually, insurers would rather not cover those people; yet it would be dreadful public policy to tell everyone with a serious PEC that he should just die and reduce the surplus population. (Dickensian death panels, anyone?) Hence the second prong of the General PEC Model:
- Include an assigned risk element for the very small number of people whose PECs are serious enough that insurers are guaranteed to lose money on them that no rational premium could compensate. Each insurer must take a certain number of such assigned risks, just as they must in the realm of automobile liability insurance, for the public good.
This way, no one insurer gets hit too hard, and nobody gets to skate with only healthy people on its rolls. That's the model, and we know it works because it was already working for nearly everyone; nobody seriously disputed that the vast majority of uninsured pre-Obamacare comprised young, healthy people who could have afforded health coverage -- but rejected it. The few "uninsurables" could be absorbed by the rest without much cost; that is, after all, the basis of all insurance!
So if anyone, from Progressivist peon to President of the United States, tells you that we needed Obamacare because of the problem of pre-existing conditions... he's lying in his teeth.
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