Don’s LTE spotlights a serious problem: pre-existing conditions.

“…absent an effective mandate…”

Can’t argue with that.

Recall why ACA had momentum. The recession was at its peak. Millions lost their jobs and health insurance. Getting private insurance for most was impossible. Premiums had gotten to ridiculous levels far exceeding inflation. And the practices of private insurance (and small business groups, too) were designed to cherry pick the insured pools. Dropped, delayed, denied and rescinded coverage was the norm.

If you had pre-existing conditions that were treated by your previous coverage you could not afford or even get coverage when jobless or even changing employment in some cases.

Ideology squelched truly effective mandates. So the young and healthy just stalled as long as they could. There were some waiting periods as I recall, but not enough.

The most effective mandate is a tax, payroll or self-employment. Which is what many countries do for universal single payer. And health insurance, as you have argued, should not be tied to employment. This is particularly true in our economy in which people change jobs more frequently than in the past. No longer is 40 years and a gold watch the norm.

Under a private insurance system, if there is no prohibition against pre-existing conditions, a person could not change companies should his go under, raise rates or have bad service and the insured had been treated for some medical problems.

And we also need to recall that ACA was at its core, an insurance subsidy plan, not true healthcare reform. Prices were still high for all aspects of healthcare from providers to pharmaceuticals. So premiums followed.

There are so many issues involved that it would require pages to even address them.

Good letter.

9 thoughts on “Don’s LTE spotlights a serious problem: pre-existing conditions.

  1. Sorry. I forgot to put in the “more” break. I meant to put it after the second line. I can’t edit. Could you stick it in so the home page is not stretched to far?


    Liked by 1 person

  2. RE: “Politicians know that; they just hope you won’t stop to think about it.”

    Well, it’s not the first time politicians have exploited the ignorance of the masses. But when it comes to medical insurance, the masses create their own delusions on top of whatever snake oil the politicians are peddling.

    Too many people think of medical insurance as a means to finance their own health care. It doesn’t occur to them to see that medical insurance was actually invented for the purpose of financing hospitals, and that that remains the primary purpose it serves.

    The model is horribly inefficient, but until more people see through it nothing will change.


  3. What Republican politicians know is that absent a mandate or some way to require insurance, avoiding pre-existing condition constraints is impossible. Yet they promise that they won’t remove that protection.

    Republicans are the ones selling snake oil.

    From the beginning the mandate was known to be necessary, but it was watered down by the conservatives as to be pointless. And of course it is long gone now.

    True, Blue Cross was hospital centered in the early days. But the expansion of insurance to cover all healthcare in general has created a pretty normal business model for health insurance: spreading risk.

    The horrible inefficiencies are the myriad of different companies, forms, administrations that really don’t compete among themselves nor are they in a position to dampen rising costs in too many markets. It used to be that insurance companies could negotiate good rates for their customers. They held the clients and could deliver them if the price was right.

    Today however, large healthcare corporations like Sentara are also bringing doctors into the fold. So now insurance companies need to “cooperate” if they want good providers in their network. So much for market based medicine, if there were ever to be such a thing.

    Liked by 1 person

    1. RE: “But the expansion of insurance to cover all healthcare in general has created a pretty normal business model for health insurance: spreading risk.”

      As I said, “When it comes to medical insurance, the masses create their own delusions on top of whatever snake oil the politicians are peddling.”

      What you call a “pretty normal business model” is actually a model in which most people pay for services they will never receive. That doesn’t sound normal to me.

      Also, there is no “spreading” of risk. There is only pricing of risk. That’s how the math works.


      1. Home owners insurance, auto insurance, disability insurance, art insurance, term life insurance for a breadwinner with a family are all insurance coverages that most will never need.

        But it is a way to protect assets that is more affordable, practical and efficient than hiring an army, building a castle with a moat, driving a tank or hoarding gold. And that is assuming you are wealthy enough to do all that.

        And it some cases, like auto or home, you are protecting not only your assets, but a third injured party you may have to compensate for losses that exceed what you are worth.

        If you don’t have health insurance or assets sufficient to cover catastrophic illnesses, then you are also putting your family at risk of losing a home, income, assets and whatever else you may have to get rid of to pay for medical bills.

        As Don loves to say at times, he invests in a fire extinguisher for his boat. He’ll probably never need it, but if he did, nothing else would suffice.

        Liked by 1 person

      2. Oh, I understand why people take out insurance for any number of things. I am continually amazed, however, at the fairly tales so many people tell themselves about their decision.

        Here’s a rule of thumb that illustrates the point: If the premiums are low, it is because the probability the Bad Thing will happen is low. But instead of realizing that they are protecting themselves against unlikely things, people with insurance will typically say, “I have peace of mind, now that I am protected.”


        1. The events may be unlikely, but certainly not impossible.

          It is a matter of assessing risk. If you feel that you can weather catastrophic events without insurance, then by all means do so.

          It did give me a certain peace of mind to know that my assets were protected, with deductibles and such to keep premiums low.

          I carried disability insurance for decades when I was running my own shop. But I dropped it once I had accumulated enough wealth to where I could “retire” and still have a reasonably comfortable life in the case I could not work anymore due to some injury or illness.

          Looking back, I could have saved a lot of money over the years in premiums, but for most of it, not enough to cover my losses in case I was disabled. And obviously I am happy I did not need the insurance.

          Liked by 1 person

        2. RE: “The events may be unlikely, but certainly not impossible.”

          That’s exactly what compulsive gamblers say. But hey, if you’re happy I’m happy.

          I would just ask a social justice question: Are you comfortable having “profited” from your own insurance indulgence when in fact most other people have suffered as a result of theirs?


  4. Funny question. I don’t know if profited is the right word. Or if suffered is either.

    Let’s say that insurance is the cost of doing business, or living, in a complex, modern industrial society. There were risks I was willing to take and some I wasn’t. Early in my career I insured my cameras and other equipment. After a while, I self insured on that because it was too expensive and I could cover my own losses.

    But I still kept business liability since the losses could be substantial if some client or passerby got hurt because of me.

    Risk assessment and one’s own risk tolerance determine what to cover.

    Liked by 1 person

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