Why should pre-existing conditions be covered by INSURANCE.

[Pua]

Insurance is complicated, particularly health insurance.

In the United Kingdom, for example, the overwhelming majority of people support the National Health Service, but a number of them don't realise that it doesn't technically exist any more (since the Health and Social Care Act 2012 was passed). The reason it worked was, largely, because everyone paid for it via National Insurance contributions, deducted directly from your salary. What this did was effectively remove the ability to avoid paying for health insurance when you didn't feel you needed it, and thus increasing premiums for those who felt that they did. It's no secret that young, healthy people don't feel they need health insurance - while those who are older, or have existing health problems, are more likely to have a policy.

So I suppose the OP's question is answered there: companies provide policies to people more likely to be sick, because they wouldn't have anyone to sell policies to otherwise.

Now I can't pretend to fully know the American system, but my understanding is that this was ultimately what the Affordable Care Act (Obamacare) was, in general terms, designed to replicate. Stop health tourism, ensure everyone can receive primary care when they need it, and pull down premiums for those who take out policies. Unfortunately, it didn't work especially well because America isn't Britain; Americans view the world quite differently in a lot of subtle, but important, ways.

Maybe the question is much simpler - what do you think health care should do, and how do you think it should be provided?

Thinking about that is potentially more fruitful than simply arguing that people who get sick shouldn't be insured. The logical endpoint of that is insurance companies that sell policies they never pay out on, because nobody gets sick; it just becomes another upward transfer of wealth.

[Stormspark]

This isn't specifically about healthcare, it's more to describe the US economy, but it applies to healthcare too.

[belfpala]

They're a business. If they covered conditions that were likely to happen they wouldn't be making any money.

Aaaaand that's the crux of the issue. A person's health (or lack thereof) should not be another's profit. It's a social good. A healthy population is better for everyone.

[Raptor With a Saber]

Because if they aren't then one could successfully argue that Life is a preexisting condition and thus you are not covered by anything without paying out the ass.

[melodramocracy]

The better question is why are you allowing your healthcare to be managed by a for profit, shareholder driven insurance industry in the first place.

[Azrile]

It makes no sense to me, and defeats the whole purpose of insurance.
Insurance is there to help you AFTER something happens. You buy insurance hoping that you don't have to use it, but if something happens and you do have to use it, its there.
For instance, if you have a car with no insurance on it, and you crash it, you don't call up an insurance company and ask for coverage on the car after its already been totaled
If you have a house with no home insurance on it, and your house burns down, you don't call up an insurance company and ask them for coverage since your house burned down.
If insurance is there to help you when something happens, why should an insurance company give you insurance for something thats already happened to you.
Can someone explain it to me?

You are exactly right, if you are looking at it from a purely business standpoint, the car accident or house fire analogy is completely appropriate. From a business stand-point insurance companies should be able to exclude you if you have pre-existing conditions the same way they shouldn´t have to give you car insurance if your car is already totaled or house insurance if your house is on fire.

But this isn´t a car or a house, this is a human life we are talking about. This is human suffering we are talking about. Your argument is the very grounds upon which so many countries do not want healthcare to go by ´capitalism´ rules. It is why many people like myself who are very much for capitalism think healthcare and education should be social programs that avoid cutthroat survival of the fittest rules that make America great. Having a pizza shop close because it makes inferior pizza to the pizza shop down the street is not the same thing as allowing a person to suffer in pain because they changed jobs and now the new insurance company won´t cover them.

It is inhumane to apply full market forces and capitalism to healthcare.

[cuafpr]

my view on pre-existing is basically if you have insurance and are changing due to job, loss or change, or just looking for a better rate /coverage then no it shouldn't be allowed to deny based on pre-existing conditions. However, if you don't get insurance for whatever reason then wait till you get sick to get it, i'm ok with being denied or charged an arm and leg for it....

even prior to ACA you could get catastrophic type plans are cheap rates, they essentially only kicked in around 100k or higher mark. Thing is most people didn't know about them b.c. they were not advertised.

[Felya]

Lets take a look at your examples and see if we can get you looking at it a different way.

You totaled your first car. You buy a new car. You go to get insurance for the new car. Nope, you have previously totaled a car therefore you cannot have more insurance.

You buy a new house. You want insurance - sorry your previous house burned down therefore no insurance for you.

_

Or maybe you shouldn't have to worry about being able to ever get insurance again if for some reason you loose your coverage and it lapses for even 1 day. You might currently live in a situation where this isn't a concern or maybe the threat of this happening to you hasn't come to pass but try to think outside your bubble.

You should have continued. You are sick, don't get insurance. Try to get insurance and find out that zombification is counted as a preexisting condition. Still screwed... even as the undead...

[Felya]

my view on pre-existing is basically if you have insurance and are changing due to job, loss or change, or just looking for a better rate /coverage then no it shouldn't be allowed to deny based on pre-existing conditions. However, if you don't get insurance for whatever reason then wait till you get sick to get it, i'm ok with being denied or charged an arm and leg for it....

even prior to ACA you could get catastrophic type plans are cheap rates, they essentially only kicked in around 100k or higher mark. Thing is most people didn't know about them b.c. they were not advertised.

lol I love how such flippant colloquialisms work, like the bold, when applied to healthcare. I'm guessing costing you an arm and a leg can be taken literally?

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He is right from a business perspective it makes no sense to cover pre-existing conditions. Which is why having business cover health care is absurd.

Yeah, the OP is actually how insurance work in most countries. The reason why it doesn't in US, is because our universal coverage doesn't kick in until 65.

[vondevon]

It makes no sense to me, and defeats the whole purpose of insurance.

Insurance is there to help you AFTER something happens. You buy insurance hoping that you don't have to use it, but if something happens and you do have to use it, its there.

All good so far.

For instance, if you have a car with no insurance on it, and you crash it, you don't call up an insurance company and ask for coverage on the car after its already been totaled

False equivalence, cars =/= people and a totaled car =/= "pre-existing condition".

But let's talk about it by way of another example. In much of Southern California, if you buy a home, you must get earthquake insurance. Why? Because Southern California has many, very large and somewhat active fault lines. The risk of having an earthquake that causes damage to your home is high, so you buy insurance to make sure you're covered on the slightly-elevated chance that it happens.

So if you are born with a congenital heart disease, there is a higher-than-normal chance that you will suffer various complications from that over the course of your life. The level of medical care that you will require is going to be expensive, making you more likely to need insurance to pay for such things. Prior to the ACA, insurance companies had no requirement to cover you if you had a pre-existing condition (or pre-disposition) to illness, because they argued it was just too expensive over the long-run.

If you have a house with no home insurance on it, and your house burns down, you don't call up an insurance company and ask them for coverage since your house burned down.

Yes, but you will never see a house for sale that is on fire. However, if you buy a house in a dry/desert area that is prone to fire, as a responsible homeowner you would want to buy insurance. Denial of pre-existing conditions, in this case, would be the insurance companies refusing to sell you insurance because they believe your house is too likely to catch fire.

It's important to distinguish houses from humans, insofar as houses are constructs built to a spec and humans are organisms that arise organically and not everyone is born with perfect health. In fact, plenty of people are born with a genetic pre-disposition to heart disease or diabetes, which prior to the ACA, would have excluded you from ever being able to purchase insurance in a lot of cases.

If insurance is there to help you when something happens, why should an insurance company give you insurance for something thats already happened to you.

Can someone explain it to me?

So now we've established that nobody goes to insurance when "something happens to you" - you go to the doctor for that. You go to insurance because there is a risk of something happening (or something happens to increase the risk of something worse happening) and you need protection from that.

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Ultimately, though, I personally feel that insurance is not the right way to address this issue. Making a market from the concept of buying and selling risk hardly works when nothing but money is at stake. When health and human life are at stake, the concept frankly makes me sick.

Universal health coverage would serve the purpose of a blanket "insurance" policy insofar as: everyone pays in -- everyone is covered in the event of illness. But Americans generally don't like that idea because the threat of Socialism re: the Cold War Era is still very much alive in many minds.

[Kalis]

It makes no sense to me, and defeats the whole purpose of insurance.

Insurance is there to help you AFTER something happens. You buy insurance hoping that you don't have to use it, but if something happens and you do have to use it, its there.

For instance, if you have a car with no insurance on it, and you crash it, you don't call up an insurance company and ask for coverage on the car after its already been totaled

If you have a house with no home insurance on it, and your house burns down, you don't call up an insurance company and ask them for coverage since your house burned down.

If insurance is there to help you when something happens, why should an insurance company give you insurance for something thats already happened to you.

Can someone explain it to me?

You are correct in that insurance is intended to indemnify you following a loss, which necessitates that you take out coverage prior to any loss.

However, pre-existing medical conditions are somewhat more complicated and can fall into a couple of categories:

1. Conditions that have increased risk. Just because you have such a condition does not mean you will need care for it, it just increases the risk and would typically result in a larger premium. This is similar to how living in a high risk area increases your home insurance premiums.

2. Conditions that need immediate treatment, or will definitely need treatment at some point. In the UK we would call this assurance rather than insurance, as the payout is guaranteed to happen (insurance = might happen, assurance = will happen) and is typically only used for life policies.

I work in commerical insurance, not healthcare insurance or life assurance, but the basics are similar. We might take on 1, depending on the risk, but would never touch 2 with a bargepole. It would be an uninsurable risk as far as we are concerned, there is no potential loss, it is guaranteed and unless the premiums are at least equal to the payments plus admin costs, then it would lose money.


The reason for wanting the pre-existing medical conditions covered is as a benefit to society, from an insurers point of view they are typically crap and, in the case of point 2, utterly crap.

[Catta]

I mean, the OP makes sorta sense. There is no reason from a business perspective for pre existing conditions to be forced upon insurance companies.

Insurance companies are made to make money and pre existing conditions are a guaranteed money sink compared to the expected risk of healthy people.

The only way to fix it is by subsidizing it.

When you are subsidizing it you are just paying the middle man and thus money is lost in the process and the whole thing becomes more expensive than it needs to be

Hence why healthcare shouldnt be managed through insurance.



Interestingly, in my country we have both universal healthcare and health insurance that can deny based on preexisting conditions - but they can never drop you oncee in and as long as you pay and you will always pay the same as everyone else.

[Zogarth]

As a business, no it does not make any sense. Which is the reason why healthcare should not be a business to begin with.

[Shiny212]

The whole "insurance is a business" argument is extremely distasteful, it's a great way to gauge a person's intellect though, every person actually believing it is a moron.

[Exeris]

The American system explicitly involves denying people care they can't afford, either personally or via insurance. If you go to a hospital with a failing heart and needing a transplant, if you don't have insurance and can't afford to pay out of pocket and don't qualify for government assistance, they'll keep you comfortable as long as they can, but they won't give you the transplant, even if they have a donor heart available.

Typing my thoughts after reading that would get me infracted for nation bashing, it's something I can't accept. People are worth more than getting treated like this and I can't understand how a system like this have survived for so long.

[Deleted]

Aaaaand that's the crux of the issue. A person's health (or lack thereof) should not be another's profit. It's a social good. A healthy population is better for everyone.

Of course. Sadly it's just the way these things go

[zenkai]

Health care is not a "business". Making it a for profit business is morally wrong, and makes the people who put that system in place murderers.

No, killing unborn children makes you a murder, making someone overpay for healthcare makes you an asshole.

[Tsimp]

I think you just don't understand what a pre-existing condition is. It's not saying you broke your arm a year ago and that doctors visit should be covered by the insurance you got last week. It's saying that if you have cronic pancreatitis and it flairs up a year after you got insurance, the resulting treatment will be covered even though you had pancreatitis in general before you got the insurance.

[schwarzkopf]

It makes no sense to me, and defeats the whole purpose of insurance.

If you guys insist on making health care more expensive than moon landings, and then insist on only allowing insurance to pay for it - then the only way you keep people alive is to allow inclusion of preexisting conditions.

In Australia - pre-existing conditions are excluded for up to a year from your insurance, but that's because we have alternatives for people.

In summary - blame your health care system for making things whackier and more expensive than they need be.

[Catta]

The whole "insurance is a business" argument is extremely distasteful, it's a great way to gauge a person's intellect though, every person actually believing it is a moron.

Insurance IS a business.

The only way you are gonna get around them losing money on it is subsidizing them