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The real reason health insurers won’t cover people with pre-existing conditions

slate.com

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Re: The real reason health insurers won’t cover people with pre-existing conditions

#41

Post by tptacek »

anarchotroll wrote: post #37
bunderbunder wrote: post #24

Earlier quoted context omitted.

Last time I saw a hard figure on it, which was admittedly a long time ago, was while I was working at an immediate care clinic. Uninsured folks were getting billed roughly 170% what insured folks were thanks to these negotiated rates.

That's cause most of the people are insured and there is no pressure for lowering rates for the uninsured.

Virtually everyone is insured as a side effect of being an employee at a company that provides access to a group health insurance plan as a benefit. This has the side effect of coupling people's jobs to their health insurance, which drastically reduces labor mobility.

Re: The real reason health insurers won’t cover people with pre-existing conditions

#42

Post by anarchotroll »

It just doesn't make any sense for a health insurer to cover people with pre-existing conditions. Insurance is all about risk; if you have a pre-existing conditions, there isn't a risk involved anymore, since you already know you have a problem (unless the provider doesn't cover anything that derives from that pre-existing condition which would also increase processing costs).

Re: The real reason health insurers won’t cover people with pre-existing conditions

#43

Post by anonymoushn »

tptacek wrote: post #22
anonymoushn wrote: post #6

Earlier quoted context omitted.

I came here to say just this. In the United States, though, we use "Insurance" to refer to a very expensive form of prepaid health plan. We keep costs up by making laws that prevent employees from knowing how much their prepaid health plan costs. Just in case people might want to react to the high costs by not purchasing a plan, in the near future everyone in the U.S. will be required by law to purchase a prepaid hea…

It's the nature of the social contract that we give up certain freedoms to gain the benefits of society; that's what contracts do: they bind us. It's not hard to make a list of "freedoms" we're mostly happy that people give up: the "freedom" to drive 100mph through school zones, the "freedom" to sell patent medicines with Pfizer branding on it, the "freedom" to set tire fires on our lawns. Those "freedoms" are respec…

A single-payer health care system would be excellent. I eagerly await its implementation in the United States.

Re: The real reason health insurers won’t cover people with pre-existing conditions

#44

Post by anonymoushn »

crag wrote: post #34
ars wrote: post #4

This article demonstrates a very common mistake: People think health insurance covers health bills. It doesn't. It covers unexpected health bills, which is a very different thing. Any type of situation that is expected to happen can not be covered by insurance, it needs to be covered by savings instead. However many people want insurance premiums to be a type of forced savings plan, which is why there is such a huge…

"Any type of situation that is expected to happen can not be covered by insurance, it needs to be covered by savings instead." Yeah right. Until you run out of money. Then what? In your world, you die. Good for everyone, until it's you or someone you care about. Then, like everyone else, you off running to the SS office to apply for (Medicare) disability. The whole point of insurance is to protect against risk. Else…

Insurance is for unexpected events. Paying for expected events using insurance is not a worthwhile thing to do because you must pay for the cost of care plus the cost of running the insurance company, which is more expensive than just paying for the cost of care. So, if someone is worried about running out of money due to foreseeable medical expenses, buying insurance to cover those foreseeable medical expenses will cause him or her to run out of money earlier.

Re: The real reason health insurers won’t cover people with pre-existing conditions

#45

Post by [deleted] »

tptacek wrote: post #38
anarchotroll wrote: post #35

Earlier quoted context omitted.

Individuals can opt into an insurance plan. That's sharing risk. What "society" (government) can do is force everyone to share THE SAME risks single-payer insurance == monopoly

Part of the notion that suggests people should be forced into sharing those risks is that nobody can rationally rule out future unbounded medical expenses; you can't predict the future, and virtually nobody has enough money to cover every plausible medical expense they might face. So the freedom we're really talking about is --- notionally --- the freedom to make what basically must be an irresponsible choice. It's t…

[deleted]

Re: The real reason health insurers won’t cover people with pre-existing conditions

#46

Post by anonymoushn »

tomx wrote: post #25

As a UKer, it strikes me the US system of health insurance is just inefficient, even if only from a time management perspective. Do 300M people really have to negotiate their own insurance, and research carefully all the terms and conditions and so on?

No, generally we have less than four options for insurance provided by our employer. When we are not employed, most of us cannot afford to carry insurance.

Re: The real reason health insurers won’t cover people with pre-existing conditions

#47

Post by chernevik »

tptacek wrote: post #39
chernevik wrote: post #36

Earlier quoted context omitted.

Individuals can share risk, that's what insurance does. The transformation of insurance into a savings scheme puts considerable distortion on that model. It becomes impossible to see what payment is for expected treatment, and what is for risk assignment. The model then encourages people to use more ("I've already paid for it") and to pay no attention to cost. And it encourages the attitude that any problem should be…

This is a concern that could be addressed by providing guaranteed issue and a mandate for high-deductible health insurance, and then leaving it to the market to resolve the financing of everything below that high deductible. That system is in fact not too far from what we're trending towards in the US.

I don't see how you can say that. We're currently headed towards comprehensive insurance whose holders pay very little out of pocket. Consumers will have no incentive to limit consumption or make cost / quality tradeoffs, and none to police providers for cost.

And "guaranteed issue" is never _insurance_, it's cost sharing. Because it takes the known costs of some individuals and spreads them to others. It is a mandated subsidy. Doing it through "insurance" introduces opacity into the system, which obscures from the electorate the costs of the choices they're making, and reduces accountability throughout the entire system.

Re: The real reason health insurers won’t cover people with pre-existing conditions

#48

Post by bunderbunder »

tptacek wrote: post #41
anarchotroll wrote: post #37

Earlier quoted context omitted.

That's cause most of the people are insured and there is no pressure for lowering rates for the uninsured.

Virtually everyone is insured as a side effect of being an employee at a company that provides access to a group health insurance plan as a benefit. This has the side effect of coupling people's jobs to their health insurance, which drastically reduces labor mobility.

83% is certainly a large majority, but it is not "virtually everyone".

Re: The real reason health insurers won’t cover people with pre-existing conditions

#49

Post by anonymoushn »

tptacek wrote: post #38
anarchotroll wrote: post #35

Earlier quoted context omitted.

Individuals can opt into an insurance plan. That's sharing risk. What "society" (government) can do is force everyone to share THE SAME risks single-payer insurance == monopoly

Part of the notion that suggests people should be forced into sharing those risks is that nobody can rationally rule out future unbounded medical expenses; you can't predict the future, and virtually nobody has enough money to cover every plausible medical expense they might face. So the freedom we're really talking about is --- notionally --- the freedom to make what basically must be an irresponsible choice. It's t…

It is entirely possible for a person to rationally rule out future unbounded medical expenses if he or she has no desire to live in agony and spend hundreds of thousands of dollars to prolong his or her life by weeks or months. Such people are forced to subsidize people who want to live in agony at high cost for small periods of time.

I don't think this is a significant problem, because the people who receive this subsidy vastly outnumber the people who provide it.

Edit: A liver transplant is a procedure with a very high expected value in terms of QALY/USD. Americans in aggregate spend a great deal of money and effort on procedures with very low expected QALY/USD. Some people, myself included, would prefer not to purchase a procedure with very low expected QALY/USD.

There was a good discussion on a similar subject earlier: http://news.ycombinator.com/item?id=3313570

Re: The real reason health insurers won’t cover people with pre-existing conditions

#50

Post by ars »

tomx wrote: post #25

As a UKer, it strikes me the US system of health insurance is just inefficient, even if only from a time management perspective. Do 300M people really have to negotiate their own insurance, and research carefully all the terms and conditions and so on?

Do 300M people really have to negotiate their own home purchases/rent? Or cable tv? Or car insurance? Or home/renters insurance?

Why do you single out health insurance?

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