4
   

Preexisting Conditions

 
 
livinglava
 
  1  
Reply Thu 6 Dec, 2018 04:12 pm
@maxdancona,
maxdancona wrote:

You have a point here... but the reverse is also true.

If people are going to do it, then it shouldn't be prohibited. There have been several times when laws were changed because enforcing them did more harm than good (i.e. prohibition). And there are other laws that are widely ignored but kept on the books anyway (i.e. speeding).

That's a totally different issue. The point of prohibitions is to stop bad behavior (or at least it should be). If the only reason government is prohibiting something is to have an excuse to arrest/imprison/fine people, that would be wrong. It would be like #metoo being about taxing wealthy men for sexual abuse instead of about stopping the behavior.
0 Replies
 
maxdancona
 
  1  
Reply Thu 6 Dec, 2018 07:19 pm
@livinglava,
Quote:
then the cost of procedures would simply have to be lower for people to afford them.


... or people could just die.

The only way a free market works is if we are willing to people die of curable diseases when they don't have money.

You could have a free market system, it would mean that twenty year olds could gamble with their health, taking a small risk they wouldn't get seriously ill. Some of them would invest the money they save in businesses and win. However, some number of thirty year olds would die of ruptured appendices because they don't have money to pay a hospital bill. Of course in a free market society, we would need to quarantine (or kill) people with communicable diseases like tuberculosis. Those of us who are healthy should be protected.

Once you decide that people without money should still get care when they have an easily treatable disease... like tuberculosis... the free market system breaks down.

Our society isn't comfortable seeing old, poor and stupid people dying of curable diseases... this is part of what we think it means to be civilized.
livinglava
 
  1  
Reply Fri 7 Dec, 2018 06:44 am
@maxdancona,
maxdancona wrote:

Quote:
then the cost of procedures would simply have to be lower for people to afford them.


... or people could just die.

The only way a free market works is if we are willing to people die of curable diseases when they don't have money.

Correction: the only way a free market works is if health care providers are willing to let people die when they don't have money.

If there is no limit on what you can be charged for health care and paramedics scoop you up whenever you are dying and bring you to a hospital that charges you an arm and a leg and then bills you long-term after releasing you, then you effectively have a situation where people have to hope they die completely before the paramedics catch them if they want to protect their savings for their families.

Quote:
You could have a free market system, it would mean that twenty year olds could gamble with their health, taking a small risk they wouldn't get seriously ill. Some of them would invest the money they save in businesses and win. However, some number of thirty year olds would die of ruptured appendices because they don't have money to pay a hospital bill. Of course in a free market society, we would need to quarantine (or kill) people with communicable diseases like tuberculosis. Those of us who are healthy should be protected.

Who says anybody gets to kill anybody because they are sick?

Quote:
Once you decide that people without money should still get care when they have an easily treatable disease... like tuberculosis... the free market system breaks down.

Why? You can just set the price low.

Quote:
Our society isn't comfortable seeing old, poor and stupid people dying of curable diseases... this is part of what we think it means to be civilized.

That's good. If not, then come up with medical educational innovations that allow more people to learn and practice more medicine for more people. There are lots of people who go to school for business, marketing, or something else useless that gets funded by corporate welfare.

Instead of putting everyone in middle-management and service jobs, let them learn as much about health care as they can and then let them get middle-management and service jobs where they can be available to practice some medicine for others when needed. That way less people need to go to hospitals and doctors and health insurance can be eliminated.

Basically, we should be evolving as a culture toward more sophisticated decentralized competency. Internet and AI should make it possible for people to do most if not all things for themselves. It's ridiculous that people keep focusing on making more money so they can pay other people to do everything for them.

People are taking the enormous liberation potential of modern technology and wasting it on business and commerce instead of turning it into the means of achieving self-sufficiency and self-determination it should be.
maxdancona
 
  1  
Reply Fri 7 Dec, 2018 07:57 am
@livinglava,
You can't limit prices in a free market system. I think you are missing the point.

If I go to a car dealer and say, "I need a new car, I have $500 and no credit". They are going to ignore me. I will leave without a new car. I might be able to buy a crappy used car for that... but I wouldn't have money to keep it running. I would end up without a car.. and everyone in society will think that it alright.

No one would ever tell a car dealer that they have to sell me a car for the money I have. If they did that, car dealers would go out of business. That is what you seem to be telling health care providers... that they have to lower prices.

When my appendix burst, I was whisked into surgery. There were doctors, and nurses and an ER staff (kept open 24/7) and medicine and cleaning crews and electrical bills for the hospital.... the cost to keep me alive was tens of thousands of dollars. You can't lower the price below the cost... you have to pay the doctors, and buy the medicine and keep the electricity on.

I had insurance... good for me. But, if I was poor and without insurance, they would have spent the tens of thousands of dollars to save my life even with the knowledge that it would cost them money. Anyone who stumbles into an ER with a ruptured appendix is going to receive the life-saving medical attention they need.

This insistence in spending money to save someone's life (even when they don't have the money) is one reason the free market doesn't work for health care. We let poor people go without cars, which is why the free market works quite well for the automobile industry.
livinglava
 
  1  
Reply Fri 7 Dec, 2018 08:53 pm
@maxdancona,
maxdancona wrote:

You can't limit prices in a free market system. I think you are missing the point.

If I go to a car dealer and say, "I need a new car, I have $500 and no credit". They are going to ignore me. I will leave without a new car. I might be able to buy a crappy used car for that... but I wouldn't have money to keep it running. I would end up without a car.. and everyone in society will think that it alright.

The problem is you have a large class of people who make fairly little money but they don't have access to good education because they only understand the concept of easy money affording them all the spoils of a wealthy society. They need to understand that if they learn how bodily processes function and how medicines work, they can provide their own health care.

Quote:
No one would ever tell a car dealer that they have to sell me a car for the money I have. If they did that, car dealers would go out of business. That is what you seem to be telling health care providers... that they have to lower prices.

If you want to build your own car, the best thing you could do would be to build a bicycle, i.e. because bicycles run without dependency on fuel and with only a fraction of the parts and materials needed for a car. The problem is that too many people want cars instead of just wanting a bike that they can manage with the money and labor and skills they have and/or can develop on their own.

It is the same with health care. There would be so many possibilities for affordable health care if people would just focus on making generic drugs cheaply and learning basic medical and dental techniques. No, people wouldn't get access to the most expensive patented drugs, etc. but they would have basic healthcare and medicine, which they could provide for themselves instead of making healthcare an entire socialist global stimulus project.

Quote:
When my appendix burst, I was whisked into surgery. There were doctors, and nurses and an ER staff (kept open 24/7) and medicine and cleaning crews and electrical bills for the hospital.... the cost to keep me alive was tens of thousands of dollars. You can't lower the price below the cost... you have to pay the doctors, and buy the medicine and keep the electricity on.

You can lower the price of everything by lowering interdependency and consumerist expectations. Everyone doesn't need to drive a car. Everyone doesn't need air-conditioning and heating except in a single, well-insulated room. These consumption cuts are the same cuts needed to reduce greenhouse gases. Reducing the amount of developed square footage and pavement per capita is also needed to restore trees to re-absorb all the CO2.

In short, everyone needs to reduce their economic footprint for the sake of sustainability anyway, and if they do that then everything will cost less because everyone involved with the economy will be making much less money than they are now. People call this communism but it is just austerity. It is good for the environment and sustainability, and when people can afford less unnecessary things, that gives people more free time to study medicine, healthcare, and otherwise improve their quality of life without it requiring expensive machines, drugs, etc.

Quote:
I had insurance... good for me. But, if I was poor and without insurance, they would have spent the tens of thousands of dollars to save my life even with the knowledge that it would cost them money. Anyone who stumbles into an ER with a ruptured appendix is going to receive the life-saving medical attention they need.

Right, because they are printing money for themselves and then taxing the insurance companies, government, or whoever will pay to cover the costs. In short, they are spending someone else's money to help you instead of doing it pro-bono by paying themselves and everyone else involved less.

Quote:
This insistence in spending money to save someone's life (even when they don't have the money) is one reason the free market doesn't work for health care. We let poor people go without cars, which is why the free market works quite well for the automobile industry.

You are confused. Poor people mostly have cars. We subsidize their driving by paving car-sized public roads and not charging tolls. The so-called middle class are just poor people who are kept fat by socialism. If the great depression had run its course, there would be no middle-class, or rather the middle-class would have adapted to meager conditions and become much more self-sufficient and less consumeristic.

If you want to understand what life would be without socialism, you have to think in terms of what people can learn to do for themselves using what they have available to them. People can mostly manage their own health and basic medicine if they put effort into learning biology, etc. We could then socialize expensive procedures by simply allowing people to learn medical specialties for free instead of giving them giant loans to pay for expensive medical schooling. That would require knowledgeable medical professors working for relatively little money, though. Sufficing on low pay is something most people aren't accustomed to being expected to do, so it doesn't happen; but how can you ever get affordable health care if they don't? Taxing those with money to pay others handsomely just causes those with money to pass the costs on to the market and consumers in various ways. I mean, it's not like you can just starve the rich to death to force them to keep losing money forever. All socialism does is torture people into slavery with the threat of being taxed into poverty - and that threat is only terrifying because of the dependency that has been instilled in people culturally.
0 Replies
 
Real Music
 
  3  
Reply Fri 7 Dec, 2018 10:23 pm
This old article is dated:

MARCH 29, 2010



Quote:
Being a woman is no longer a pre-existing condition. That’s the new mantra, repeated triumphantly by House Speaker Nancy Pelosi, Senator Barbara A. Mikulski and other advocates for women’s health. But what does it mean?

In the broadest sense, the new health care law forbids sex discrimination in health insurance. Previously, there was no such ban, and insurance companies took full advantage of the void.

“The health care industry and health care insurance in general has been riddled with the most discriminatory and unfair practices to women,” said Marcia D. Greenberger, the founder and co-president of the National Women’s Law Center. “This law is a giant leap forward to dismantling the unfairness that has been a part of the system.”

Until now, it has been perfectly legal in most states for companies selling individual health policies — for people who do not have group coverage through employers — to engage in “gender rating,” that is, charging women more than men for the same coverage, even for policies that do not include maternity care. The rationale was that women used the health care system more than men. But some companies charged women who did not smoke more than men who did, even though smokers have more risks. The differences in premiums, from 4 percent to 48 percent, according to a 2008 analysis by the law center, can add up to hundreds of dollars a year. The individual market is the one that many people turn to when they lose their jobs and their group coverage.

Insurers have also applied gender-rating to group coverage, but laws against sex discrimination in the workplace prevent employers from passing along the higher costs to their employees based on sex. Gender rating has taken a particular toll on smaller or midsize businesses with many women, like home-health care, child care and nonprofits. As a result, some businesses have been unable to offer health coverage or have been able to afford it only by using plans with very high deductibles.

In addition, individual policies often excluded maternity coverage, or charged much more for it. Now, gender rating is essentially outlawed, and policies must include maternity coverage, considered “an essential health benefit.”

“It has to be a part of the premium just like heart attacks, prostate cancer or any other condition,” Ms. Greenberger said.

Despite her enthusiasm for many aspects of the new law, Ms. Greenberger said she was profoundly disappointed in provisions that she thought would limit women’s access to abortion services.

Advocates for women’s health said one of the new law’s benefits would be to ban the denial of health coverage to women who have had a prior Caesarean section or been victims of domestic violence. Some companies providing individual policies have refused coverage in those circumstances, regarding Caesareans or beatings as pre-existing conditions that were likely to be predictors of higher expenses in the future.

In a statement issued Thursday, Senator Mikulski said: “One of my hearings revealed that a woman was denied coverage because she had a baby with a medically mandated C-section. When she tried to get insurance coverage with another company, she was told she had to be sterilized in order to get health insurance. That will never, ever happen again because of what we did here with health care reform.”

Peggy Robertson, 41, who lives in Centennial, Colo., is the woman to whom Senator Mikulski referred. Ms. Robertson was interviewed by The New York Times in June 2008 and testified at the hearing last October. Her husband, a chiropractor, is self-employed, so they rely on the individual market to cover them and their two sons. In 2007, they had insurance, but considered switching companies when a broker suggested they might find a better deal. They applied to a company called Golden Rule, which is based in Indianapolis and owned by UnitedHealthcare. The company rejected Ms. Robertson because of her Caesarean, explaining in a letter that she would have been eligible if she had been sterilized. When Ms. Robertson went public with her story, the word “sterilized” seemed to provoke particular outrage, she said.

Golden Rule later began offering coverage to women who had had Caesareans, but by charging extra if they wanted maternity coverage, or issuing policies that excluded maternity care.

In a telephone interview on Friday, Ms. Robertson said: “Barbara Mikulski told me, she promised me, ‘This will never happen again.’ She did it. It’s wonderful.”

Ms. Robertson’s only disappointment was that some of the new rules would not take effect until 2014.

But Ms. Greenberger said that while it is true that the specific requirements will be delayed until 2014, some changes should actually happen much sooner, because the law’s overarching ban on sex discrimination takes effect immediately. The legalese outlawing sex discrimination is not easy to find or to parse, but it refers to existing laws, like the Civil Rights Act and Title IX, to say that the same protections apply to people seeking health care and insurance.

The passage, Sec. 1557 on page 368 of the 2,074-page bill, says: “Except as otherwise provided for in this title (or an amendment made by this title), an individual shall not, on the ground prohibited under Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), Title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.), the Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.), or Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any health program or activity, any part of which is receiving federal financial assistance, including credits, subsidies, or contracts of insurance, or under any program or activity that is administered by an executive agency or any entity established under this title (or amendments).”

What it means, Ms. Greenberger said, is that no organization receiving any federal money at all — as insurers generally do — can discriminate on the basis of sex. Gender rating, she said, “is a problem whose days are numbered.”

Ms. Greenberger acknowledged that insurance companies were masters at protecting their bottom line, but said she did not see an obvious way around the new rules. “I never want to underestimate what a creative mind might be able to come up with,” she said, “but I believe this is pretty straightforward.”

https://www.nytimes.com/2010/03/30/health/30women.html?ref=health
maxdancona
 
  1  
Reply Fri 7 Dec, 2018 10:53 pm
@Real Music,
The gender thing is interesting...

If we pay for healthcare based on resources used; hourly rate for doctors, equipment, diagnostic tests and medicine.. women cost more then men even without maternity care. Women are more likely to see a doctor, receive medication and get expensive diagnostic tests (i.e. CAT scans). I searched for studies that happened well before the ACA and it is pretty clear that women utilize more costly services (e.g. https://www.mdedge.com/jfponline/article/60747/womens-health/gender-differences-utilization-health-care-services.)

If we pay for healthcare based on a flat rate per year... we can have equality.

This is another reason that we need single payer. A free market will charge men and women based on services received, and since women use more services they will naturally pay more.
0 Replies
 
TheCobbler
 
  1  
Reply Sat 8 Dec, 2018 01:39 am
Preexisting conditions is just a code phrase used by insurance companies for denying people healthcare after they have paid for it.

The preexisting conditions are not those of the insured but those of the insurer...

Did you read the fine print?

Example:
You have insurance for "fire and theft".

Your house needs to be being robbed while it is burning down to collect.
maxdancona
 
  1  
Reply Sat 8 Dec, 2018 08:39 am
@TheCobbler,
You are being silly Cobbler.

The term "pre-existing condition" when used in the insurance industry for the situation when patients buy insurance after they get sick. If people don't buy insurance... and then after they get a disease that costs $10,000 a month buy a policy that costs $1,000 a month to cover it... the insurance companies are all going to go out of business.

For the same reason you can't buy car insurance after you get in a accident and expect that it will cover the accident, nor can you buy fire insurance after your house has burnt down. When I bought car insurance, they sent an inspector over to check for pre-existing conditions. He took pictures of the car, and documented every ding that was already there... no insurance company pays for pre-existing conditions.

You seem to be missing the basic point of insurance.

There are two choices in the real world... either we force everyone to get insurance for all their lives (either through premiums or through taxes) or we all insurance companies to have pre-existing conditions. You can't get something for nothing.

2. This political use of the term "
neptuneblue
 
  1  
Reply Sat 8 Dec, 2018 10:46 am
@maxdancona,
maxdancona wrote:
The term "pre-existing condition" when used in the insurance industry for the situation when patients buy insurance after they get sick.


That's part of it, but not all of it.

My son is medically handicapped. He's had multiple surgeries to correct his condition. When I changed jobs, our insurance switched from Anthem BC/BS who covered 3 of his surgeries to Medical Mutual. Since his condition was pre-existing, they refused coverage of his handicap but insured him for any thing else. Luckily for us, BCMI picked up most of the tab of his last 2 remaining remaining surgeries.

Insurance companies do that for a whole host of illness such as diabetes, prior sports injuries, and allergies.

maxdancona
 
  1  
Reply Sat 8 Dec, 2018 11:05 am
@neptuneblue,
My complaint is the misuse of the term "pre-existing conditions" by political liberals to make a point. I actually agree with most of the political point. I still object to the misuse of the term. People should be honest and straightforward about the issue.

Your experience with your son is a good example of why free market health insurance doesn't work (assuming we care about human beings). Under the free market, business make decisions based on profits... that is how the free market works. When the product is cars, or TVs or fruit rollups the free market works very well. It isn't working for health care... and that's the problem.

1. We should have a straightforward discussion about the issues around healthcare. When either side misuses terms to make political points, it takes away from the real issues.

2. There are two options. You either allow healthcare providers to avoid covering pre-existing conditions, or you force everyone to pay for health insurance whether they need it or not. Either there are pre-existing conditions... or there is an individual mandate (although this can be taken in taxes). Someone needs to pay for health insurance.

3. There seems to be a denial among liberals that someone has to pay for healthcare. Doctors need to be paid. Janitors working at hospitals need to be paid. It costs money to develop and manufacture drugs and buy equipment. You can't ignore the basic facts of economics.

4. It is absolutely insane that we force employers to pay for health insurance. The history of this was to provide a loophole around wartime quotas when politicians couldn't agree enough to change a crazy law. There is no rational reason for employers to be the institutions that provide health insurance.

5. That we can't change point #2 demonstrates one of the weaknesses of democracy. Once an insane program is in place, it is very difficult to change it because one party or the other will block any changes (in this case both parties are guilty).

I personally think that we should provide national health care that people are forced to pay for whether they want it or not. We can take this money completely or partially through taxes. Americans will pay for health care through higher taxes or premiums. It is not reasonable to have private companies provide health care and then expect them not to earn money for themselves.

Let's be honest about what we are proposing.
0 Replies
 
 

 
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