Comments on: Pre-existing conditions, ratings and exclusions

By: amdi

amdi — Thu, 04 Feb 2010 20:30:19 +0000

I would be interested in knowing if those that oppose reform have actaully ever paid out of thier own pocket for the health insurance they have. Many of these people have no idea how much it realy cost out there if you have to take it out of your own pocket. We get to pay not only for our own coverage out of our own pocket but we also get to pay for the House, Senate etc. health care out of the taxes we also pay. Let those boys pay out of pocket for what they get and see how fast the reform get going

By: amdi

amdi — Thu, 04 Feb 2010 20:24:37 +0000

Has anyone seen the private carriers step to the plate and make any of these things happen on their own? Reduce premiums? Eliminate the pre- existing condition? Not rate up people 200 t0 300% of the rate for the same age person?The answer to that is no! They will not do this until its mandated. What will happen sooner more than later is the private Companies are pricing people out of the market. The number of uninsured people will get worse. It is no longer a problem for the poor and non working. Price is becoming a real issuie with the middle class. Who can continue to pay 1500 to 2000 a month for insurance. Not every one makes more than $100,000 a year in salary!

By: amdi

amdi — Thu, 04 Feb 2010 13:30:19 +0000

By: amdi

amdi — Thu, 04 Feb 2010 13:24:37 +0000

By: tymlee

tymlee — Sat, 19 Dec 2009 02:47:01 +0000

Although I am not so certain that smoking is purely a lifestyle choice as opposed to an addiction, which is usually described as being a disease in most medical journals, I have to argue vehemently that age is more than just age. It is hell I tell you…pure hell and, as such, is a condition. Age is not meant for the meek. Ha!

By: kcindc

kcindc — Sat, 19 Dec 2009 02:38:53 +0000

That makes sense, but I don't understand why you're writing about smoking and age under the heading "Pre-existing conditions if health care reform passes". It's very unclear what point you're trying to make.

If it's the case that no one can be denied coverage or charged more for a preexisting condition, then why not just say that preexisting conditions don't exist as a concept after reform?

I gather you're bringing in smoking and age because somebody somewhere is mixing them in with preexisting conditions, but the way you've done it you yourself seem to be confusing the issue, so it's hard to understand what point you're making.

So as I understand it now, the last part, about how charging people more money isn't discrimination (which I still don't buy) has nothing to do with preexisting conditions.

By: Karoli

Karoli — Sat, 19 Dec 2009 02:22:58 +0000

“If our putative starting point is that ill people should pay a higher premium, the application of that premium will inevitably result in discrimination.”

Agreed, which is why the only two factors for premium adjustments are NOT for pre-existing conditions. They are for higher risk factors: age and lifestyle choice. We can argue about whether smoking should be there without its first cousin, obesity, but neither are pre-existing conditions. Lung cancer is a pre-existing condition, assuming a remission. Cataracts are a pre-existing condition. Insureds can be turned away at the door for those, never putting a foot in or even offered the right to pay more for peace of mind. That's the basic difference.

By: Karoli

Karoli — Sat, 19 Dec 2009 02:20:11 +0000

smoking and age are not pre-existing conditions. Depression and cancer are.

By: Karoli

Karoli — Sat, 19 Dec 2009 02:19:44 +0000

I agree, Francine. It's risk management 101. This was always the theory behind life insurance. So the saleman goes…If you insure your children or buy insurance when you're young, you pay less because … you're young. If you do it when you're older, you pay more. The only place the theory breaks down is on people like me, who paid into the system when they were younger, and paid faithfully for 50 years, only to be denied it now that I do need it more.

By: Karoli

Karoli — Sat, 19 Dec 2009 02:17:17 +0000

Smoking is a lifestyle choice, not a condition. Age is, well, age. It's pretty clear that if you are 20 and I'm 51 and we both buy into the pool, the probability is that I will need to use more care $$$ than you. That's more or less insurance reality. What's more important to see is what happens right now. As Senator Kerry noted in today's debate, the spread is around 15:1 on average and can be as high as 25:1. So…that's a pretty significant drop, from 15:1 to 3:1 or if the House version were adopted, 2:1.

But neither of those is a pre-existing condition. As it stands today, not only can one be excluded for pre-existing conditions, they can also be dropped for a minor condition that the insurer decides is a precursor to a not as-yet developed but possibly might, condition. This is what I mean by discriminatory. Eliminating ANY selection criteria based on pre-existing is eliminating discriminatory access to risk management tools.