As hyper-literal as I am, even I know this is looney tunes.
I have a pre-existing condition: Diabetes. What pre-existing conditions
usually do, is that they make you keep the job you have when you were
diagnosed with the disease, or pay for ALL diabetes related care for a
given time period (usually a year) before they will cover Diabetes
related claims. And you must pay all of the premiums, even if they
insurance company doesn't pay a dime because they excluded everything.
How is that so bad?
Well, Diabetes impacts everything, so they could say that anything you
were treated for in that year was Diabetes related; therefore, YOU pay
for it all, not the insurance company. Can't afford that? Well, then you
cannot afford to change jobs. Drop these exclusions and people with
chronic conditions are no longer held as slaves to their existing employer.
Paying for pre-existing conditions NEVER MEANT that they would go back
and pay for everything back to 1982 when I was first diagnosed. I also
did not suddenly lose my insurance in 1982, but it HAS been a challenge
sometimes to maintain insurance while changing jobs, unless an employer
had a truly "open enrollment." "Pre-existing condition exclusion" has as
its unstated presumption that the insurer in place at the time or your
diagnosis is then responsible for all subsequent treatment, should you
be fortunate enough to keep them.
The old model worked great for my dad's generation where you ALMOST had
a job for life. As we move away from that, some things need to change.
David
To compel a man to subsidize with his taxes the propagation of ideas
which he disbelieves and abhors is sinful and tyrannical
To compel a man to subsidize with his taxes the propagation of ideas
which he disbelieves and abhors is sinful and tyrannical.*--Thomas
**Jeff**erson*
On 12/14/2013 1:39 PM, [email protected] wrote:
*naked capitalism*
Why Obamacare Cannot "Insure" for Pre-Existing Conditions
Posted on December 13, 2013
<http://www.nakedcapitalism.com/2013/12/obamacare-insure-pre-existing-conditions.html>
by Yves Smith <http://www.nakedcapitalism.com/author/yves-smith>
One of the biggest selling points for Obamacare is that it requires
insurers to offer policies to people with so-called pre-existing
conditions, as in known, fairly to extremely costly-to-treat ailments,
like diabetes, HIV, and autoimmune diseases.
Not surprisingly, two things have started happening. One is that the
early evidence suggests that people with pre-existing conditions are
signing up for the new plans in disproportionate numbers. For
instance, the individuals determined to be eligible to enroll in
federal exchanges through the end of November had a much lower
proportion of people eligible for subsidies than anticipated
<http://healthaffairs.org/blog/2013/12/11/implementing-health-reform-the-november-exchange-enrollment-report/?utm_source=rss&utm_medium=rss&utm_campaign=implementing-health-reform-the-november-exchange-enrollment-report>.
Those who had health issues would naturally be highly motivated to
obtain coverage. Insurers and the Administration no doubt hope this
will balance out and more of the "young invincibles" will sign up as
the deadline approaches.
Second is that the insurers, par for the course, are finding clever
ways to make the actual coverage offered to people with pre-existing
conditions so minimal as to come as close as they can to covering
them, apparently with the hope that they will go elsewhere. As the
Washington Post reported earlier this week
<http://www.washingtonpost.com/national/health-science/aids-advocates-say-drug-coverage-in-some-marketplace-plans-is-inadequate/2013/12/09/0fca0fd0-5d18-11e3-95c2-13623eb2b0e1_print.html>:
Some plans sold on the online insurance exchanges, for instance,
don't cover key medications for HIV, or they require patients to
pay as much as 50 percent of the cost per prescription in
co-insurance --- sometimes more than $1,000 a month....
"The easiest way [for insurers] to identify a core group of people
that is going to cost you a lot of money is to look at the
medicines they need and the easiest way to make your plan less
appealing is to put limitations on these products," [Marc] Boutin
[executive vice president of the National Health Council] said.
The ugly reality is that, logically speaking, a known condition isn't
a matter of insurance but subsidy or socialization of costs. Readers
in comments have raised this issue by saying these conditions aren't
"insurable risks". Let's unpack that.
In lay terms, insurance is a product that gives you a financial
payment that helps offset the damage you suffer if something bad
happens in the future. You might have a flood in your house. You might
lose your job. You might get cancer. See these dictionary definitions:
1. a practice or arrangement by which a company or government
agency provides a guarantee of compensation for specified loss,
damage, illness, or death in return for payment of a premium.
2. a thing providing protection against a possible eventuality.
Now what is the uncertainty if you have, say, HIV? You have a baseline
of costs that is already baked in: a certain level of payment for meds
you are on that will presumably continue, and a certain number of
doctor visits and tests over the course of a year. The uncertainty for
you is if something bad happens on top of that, say an opportunistic
infection, or a medical problem independent of your HIV, like breaking
an ankle.
In other words, the cost of medical coverage for that person is the
cost of baseline coverage for that condition, and the uncertainty is
around adverse developments. The latter component falls properly in
the insurance realm. The former component is more akin to a simple
cost division: if I am pretty sure this person with HIV in Topeka will
incur a baseline of costs of $4000 in a year, I'd want to make sure I
am fully compensated for whatever portion of that cost I bear.
So if we as a society want to make people like this more productive,
does this really fall in the insurance paradigm? This really is about
socializing costs and hence the single payer model of a single risk
pool is the only logical way to go (aside from the benefit that it
also cuts out unnecessary layers of bureaucracy and profit margins).
New York City, for instance, has programs that pay for meds for people
with HIV. I know at least two people who'd be dead by now without this
assistance, and both have been able to hold jobs as a result.
But within the insurance paradigm, the insurer will simply see this as
a question of who eats the risk, and the policy-holder can be expected
to be asked to bear a great deal of the cost of any known problem. As
Don McCanne writes on the PHNP blog
<http://www.pnhp.org/news/2013/december/insurers-using-high-drug-cost-sharing-to-scare-away-patients-with-expensive-chron>:
It is no surprise that private insurers would use every devious
trick to try to limit their payments for expensive drugs,
including requiring the patient to pay more through higher cost
sharing, or by omitting expensive drugs from their formulary
altogether. From the insurers' perspective, that's just good
business....
When the insurance lobbyists are saying that they are trying to
"give consumers better value for their health-care dollars," they
really mean keeping insurance premiums low enough to compete in
the marketplace. They do that by paying as little as possible for
health care, shifting ever more of the costs to patients. The sky
is the limit on innovations when they are driven by greed.
We have the wrong people in charge -- the insurers. We need our
own public financing system that is designed to help patients get
care by removing financial barriers. That's what an improved
Medicare that covered everyone would do for us.
Enough of this, "Boy, do we have a plan for you, and it's cheap,
but if you have anything wrong, study this plan carefully since
you'll find that it won't cover what you need (and then go away
kid, you bother me)."
Mind you, that does not mean people with existing conditions won't
benefit from getting access to Obamacare plans. They will get some
subsidization from the healthier members in each pool, as well, as we
discussed, underwriting of incremental risk. And when they visit
hospitals in network, they'll also gain from negotiated discounts. But
this approach of using insurance in lieu of subsidies or socialization
of costly conditions is just as misguided as using housing finance as
a way to subsidize housing for the low income. It's indirect,
inefficient, and the complexity lends itself to fraud and abuse. But
that paradigm worked well for the financiers, so it's no surprise that
the insurers are using a similar playbook.
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