Why on Earth should Insurance companies have to cover pre-existing conditions?

[Procrustes Stretched]

what is in here?

Health insurance in the United States - Wikipedia, the free encyclopedia

 

[auditor0007]

Some people seem to have a very strange view of what insurance companies do. They point to the problem of people who have a pre-existing condition, trying to sign up for new insurance, only to find the insurance companies won't pay for the the treatment for that pre-existing condition.

Of course they won't. That's not what insurance companies do. Whoever said they did?

Insurance is a gambling game where you bet on what will happen in the future. You "bet" that you will get sick or injured, and the company "bets" that you won't. If you get sick or injured, the company pays you the stipulated amount (paying for a portion of your medical treatment etc.), and if you don't, you pay them (premiums). The purpose is to shield you from the "shock" of suddenly and unexpectedly getting hit with huge medical bills... which is why you agreed to the contract.

A pre-existing condition cannot be insured against. It's like betting on the outcome of a horse race that's already been run - there is no "chance" involved, and no "unexpectedness" to the outcome (any more). Or like trying to get car insurance after wrecking your car.

Insurance companies are in the business of selling security - the assurance that you won't be suddenly bankrupted by huge medical bills, rehab bills etc. in the future. They do it by insuring huge numbers of people and getting them to each pay relatively small amounts (their premiums) each. They and their clients all know that most of them will never incur the huge medical bills they are worried about. But since no one knows which few people WILL incur them, they are all happy to pay the premiums, for the knowledge they won't have to pay the huge amounts if they turn out to be the unlucky ones.

Insurance companies sell safety from FUTURE possible disasters. And that's all they sell. Asking them to cover pre-existing conditions, is like asking a submarine designer to design a supersonic jet - it's got nothing to do with his business or his area of expertise, and he never volunteered to design jets in the first place, for good reason.

If you want to set up some kind of universal pool to pay for pre-existing conditions, fine, go ahead. But why drag insurance companies into it? It's got nothing to do with their areas of expertise, and they never volunteered to do it in the first place - for good reason.

Here is the deal made fairly simple. If insurance companies want to provide health insurance, then they need to insure everyone. That is great part is the reason for the mandate requiring everyone buy insurance. Insurance companies should not be put in a position where they have to cover people only when they get sick. That obviously would not work.

Beyond that though, and let me be very clear about this, insurance companies have done everything possible to stop insuring those who become too costly for them, even if the too costly only means higher risk. I had private health insurance all of my adult life, but I got sick. I have a genetic disorder that is under control, but when I moved to a different state, I was no longer able to buy insurance, even though I had been insured my entire life.

Anyway, the point is this; we need a system that offers coverage to everyone, not just the healthiest of the healthy. This is really the best argument for removing insurance companies from the equation and going with a one-payer system. Insurance companies could always offer supplemental plans for those healthy people that wanted one, like they do in the UK.

BTW, when I brought this up in the past, the fact that I lost my health insurance because I moved, a good percentage of the idiots here told me it was my fault for moving. Lot of brain dead people in these here parts.

 

[Procrustes Stretched]

Some people seem to have a very strange view of what insurance companies do. They point to the problem of people who have a pre-existing condition, trying to sign up for new insurance, only to find the insurance companies won't pay for the the treatment for that pre-existing condition.

Of course they won't. That's not what insurance companies do. Whoever said they did?

Insurance is a gambling game where you bet on what will happen in the future. You "bet" that you will get sick or injured, and the company "bets" that you won't. If you get sick or injured, the company pays you the stipulated amount (paying for a portion of your medical treatment etc.), and if you don't, you pay them (premiums). The purpose is to shield you from the "shock" of suddenly and unexpectedly getting hit with huge medical bills... which is why you agreed to the contract.

A pre-existing condition cannot be insured against. It's like betting on the outcome of a horse race that's already been run - there is no "chance" involved, and no "unexpectedness" to the outcome (any more). Or like trying to get car insurance after wrecking your car.

Insurance companies are in the business of selling security - the assurance that you won't be suddenly bankrupted by huge medical bills, rehab bills etc. in the future. They do it by insuring huge numbers of people and getting them to each pay relatively small amounts (their premiums) each. They and their clients all know that most of them will never incur the huge medical bills they are worried about. But since no one knows which few people WILL incur them, they are all happy to pay the premiums, for the knowledge they won't have to pay the huge amounts if they turn out to be the unlucky ones.

Insurance companies sell safety from FUTURE possible disasters. And that's all they sell. Asking them to cover pre-existing conditions, is like asking a submarine designer to design a supersonic jet - it's got nothing to do with his business or his area of expertise, and he never volunteered to design jets in the first place, for good reason.

If you want to set up some kind of universal pool to pay for pre-existing conditions, fine, go ahead. But why drag insurance companies into it? It's got nothing to do with their areas of expertise, and they never volunteered to do it in the first place - for good reason.

Here is the deal made fairly simple. If insurance companies want to provide health insurance, then they need to insure everyone. That is great part is the reason for the mandate requiring everyone buy insurance. Insurance companies should not be put in a position where they have to cover people only when they get sick. That obviously would not work.

Beyond that though, and let me be very clear about this, insurance companies have done everything possible to stop insuring those who become too costly for them, even if the too costly only means higher risk. I had private health insurance all of my adult life, but I got sick. I have a genetic disorder that is under control, but when I moved to a different state, I was no longer able to buy insurance, even though I had been insured my entire life.

Anyway, the point is this; we need a system that offers coverage to everyone, not just the healthiest of the healthy. This is really the best argument for removing insurance companies from the equation and going with a one-payer system. Insurance companies could always offer supplemental plans for those healthy people that wanted one, like they do in the UK.

BTW, when I brought this up in the past, the fact that I lost my health insurance because I moved, a good percentage of the idiots here told me it was my fault for moving. Lot of brain dead people in these here parts.

Switzerland ditched the single payer. I keep forgetting I am supposed to rethink things.

... This year, there was an effort to change the health care system.

Not completely. There was a ... public referendum, and the idea was to have only one health company in Switzerland, which would be controlled very narrowly by the state.

This is what we call "single payer" in America.

Single payer, yes. ... We rejected it because we think if you have a single payer, which is also the only [party] who makes contracts with ... all the providers, it will be dangerous, because there is too much power in the hands of the health insurance system. We think that if there is competition between the health insurance companies, there will be a certain control among themselves; they will denounce the excesses of the others, ... and also they will try to provide better services, and so you can compare.

On the other side, the Social Democrats who wanted that ... thought that you could [have an] economy of scale if you only had one company. It is true, ... but if you compare with the disadvantages of one provider of health insurance, probably there [are] more benefits to keep the present system with competition. And perhaps we have too many health companies, it's true, but through competition the number will be reduced.

How many companies [are there] now?

Now, 90. Ten years ago there was almost 1,000.

So 90 for a country of 7.5 million people. It's a big number, I think.

It is a big number. But you must say that among these 90 companies, many belong to the same group, and for historical reasons they have kept various names or various companies with various systems. And there are what we call niche companies. ... There is a company for the sisters, the Catholic nuns of Ingenbohl. ... So there are many companies like that in a small village, mountain people who are accustomed to know each other and to help each other.

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/interviews/couchepin.html

 

[Little-Acorn]

Still nobody can explain WHY insurance companies, in particular, should be the ones to pay for medical treatement of pre-existing conditions, when pre-existing conditions have nothing to do with insurance.

Just pedantically repeating that "well, they ought to."

It's becoming clear that they are being forced to through no sensible procedure or reasons... kind of like forcing banana growers to pay for all pencils for schoolchildren. No relation exists whatsoever, to suggest that banana growers should pay for them while hair salons, shoe stores, and auto mechanics shouldn't.

So, since insurance companies have no reason to pay for pre-existing conditions... who should?

 

[Bfgrn]

I could agree to something that worked best for everyone. That is why I am against obamacare, or Romneycare for that matter.

Canadian system works pretty well. They're more satisfied with it than Americans have been under our system. Still to be determined if we'll like ACA. The major problem with the situation, as I see it, is that we've still got insurance companies involved. When you have a situation where everybody's going to eventually need benefits, it's going to be rife with corruption when the profit motive's on the line.

There is something that tears me on the issue.. Gov't cant run shit
I like the idea of EVERYONE having coverage(as long as they pay for it) but, damn man, they just cant seem to run anything. I am all for small gov't, but somethings the gov't has to run. The healthcare thinggy is just scarey. What if a gov't started a one-payer and sold it privately with guidelines?

Medicare is much more cost effective and efficient than private health insurance.

 

[auditor0007]

Some people seem to have a very strange view of what insurance companies do. They point to the problem of people who have a pre-existing condition, trying to sign up for new insurance, only to find the insurance companies won't pay for the the treatment for that pre-existing condition.

Of course they won't. That's not what insurance companies do. Whoever said they did?

Insurance is a gambling game where you bet on what will happen in the future. You "bet" that you will get sick or injured, and the company "bets" that you won't. If you get sick or injured, the company pays you the stipulated amount (paying for a portion of your medical treatment etc.), and if you don't, you pay them (premiums). The purpose is to shield you from the "shock" of suddenly and unexpectedly getting hit with huge medical bills... which is why you agreed to the contract.

A pre-existing condition cannot be insured against. It's like betting on the outcome of a horse race that's already been run - there is no "chance" involved, and no "unexpectedness" to the outcome (any more). Or like trying to get car insurance after wrecking your car.

Insurance companies are in the business of selling security - the assurance that you won't be suddenly bankrupted by huge medical bills, rehab bills etc. in the future. They do it by insuring huge numbers of people and getting them to each pay relatively small amounts (their premiums) each. They and their clients all know that most of them will never incur the huge medical bills they are worried about. But since no one knows which few people WILL incur them, they are all happy to pay the premiums, for the knowledge they won't have to pay the huge amounts if they turn out to be the unlucky ones.

Insurance companies sell safety from FUTURE possible disasters. And that's all they sell. Asking them to cover pre-existing conditions, is like asking a submarine designer to design a supersonic jet - it's got nothing to do with his business or his area of expertise, and he never volunteered to design jets in the first place, for good reason.

If you want to set up some kind of universal pool to pay for pre-existing conditions, fine, go ahead. But why drag insurance companies into it? It's got nothing to do with their areas of expertise, and they never volunteered to do it in the first place - for good reason.

Here is the deal made fairly simple. If insurance companies want to provide health insurance, then they need to insure everyone. That is great part is the reason for the mandate requiring everyone buy insurance. Insurance companies should not be put in a position where they have to cover people only when they get sick. That obviously would not work.

Beyond that though, and let me be very clear about this, insurance companies have done everything possible to stop insuring those who become too costly for them, even if the too costly only means higher risk. I had private health insurance all of my adult life, but I got sick. I have a genetic disorder that is under control, but when I moved to a different state, I was no longer able to buy insurance, even though I had been insured my entire life.

Anyway, the point is this; we need a system that offers coverage to everyone, not just the healthiest of the healthy. This is really the best argument for removing insurance companies from the equation and going with a one-payer system. Insurance companies could always offer supplemental plans for those healthy people that wanted one, like they do in the UK.

BTW, when I brought this up in the past, the fact that I lost my health insurance because I moved, a good percentage of the idiots here told me it was my fault for moving. Lot of brain dead people in these here parts.

Switzerland ditched the single payer. I keep forgetting I am supposed to rethink things.

... This year, there was an effort to change the health care system.

Not completely. There was a ... public referendum, and the idea was to have only one health company in Switzerland, which would be controlled very narrowly by the state.

This is what we call "single payer" in America.

Single payer, yes. ... We rejected it because we think if you have a single payer, which is also the only [party] who makes contracts with ... all the providers, it will be dangerous, because there is too much power in the hands of the health insurance system. We think that if there is competition between the health insurance companies, there will be a certain control among themselves; they will denounce the excesses of the others, ... and also they will try to provide better services, and so you can compare.

On the other side, the Social Democrats who wanted that ... thought that you could [have an] economy of scale if you only had one company. It is true, ... but if you compare with the disadvantages of one provider of health insurance, probably there [are] more benefits to keep the present system with competition. And perhaps we have too many health companies, it's true, but through competition the number will be reduced.

How many companies [are there] now?

Now, 90. Ten years ago there was almost 1,000.

So 90 for a country of 7.5 million people. It's a big number, I think.

It is a big number. But you must say that among these 90 companies, many belong to the same group, and for historical reasons they have kept various names or various companies with various systems. And there are what we call niche companies. ... There is a company for the sisters, the Catholic nuns of Ingenbohl. ... So there are many companies like that in a small village, mountain people who are accustomed to know each other and to help each other.

Interviews - Pascal Couchepin | Sick Around The World | FRONTLINE | PBS

Switzerland never had single payer. They had a system pretty much like ours where employers provided the bulk of health insurance to their employees. Also, with their current system, insurance companies are not permitted to make any profit off of basic policies. They can only profit from selling supplemental policies. In the end, basic services and coverage are the same regardless of which company you choose to purchase from as the basic insurance is all the same and costs about the same. In the end, it's like having a one payer system for basic healthcare with the option of having supplemental insurance.

 

[Greenbeard]

Still nobody can explain WHY insurance companies, in particular, should be the ones to pay for medical treatement of pre-existing conditions, when pre-existing conditions have nothing to do with insurance.

Insurance companies are payers. Health care providers provide. Payers pay. They pool resources and reimburse providers for services that individuals alone couldn't finance themselves. If health conditions are to be treated, then obviously payers are going to be paying at least some of those costs under any arrangement.

Is the issue you're taking that you're talking about private payers instead of public payers (like Medicare or some hypothetical new public payer)? Or are you taking issue with the idea of pooling money to make sick people better?

 

[C_Clayton_Jones]

BTW, has anyone yet explained why it is insurance companies, in particular, who must be forced to pay for pre-existing conditions? When pre-existing conditions have nothing whatsoever to do with insurance?

Of course they do. Insurance companies introduced the issue into the market place

They did nothing of the kind. They introduced the idea of betting that you wouldn't get sick or injured, while you bet that you would. If you win (you get sick or injured), they pay, hugely if necessary as your policy describes. If you lose (you don't get sick or injured), they keep taking your monthly payments.

And they specifically did NOT include pre-existing conditions, for the obvious reason that betting you wouldn't ge a condition you already have, was nonsense. So they declined to do that part.

Insurance companies have NEVER dealt with pre-existing condition. Anyone with even half a brain knows that they CAN'T possible deal with those... and they know why.

So, once again:
Has anyone yet explained why it is insurance companies, in particular, who must be forced to pay for pre-existing conditions? When pre-existing conditions have nothing whatsoever to do with insurance?

Because health insurance companies are also in the health maintenance business. And in that capacity they’re being required to address pre-existing conditions, not in the context of health insurance, but in the context of health maintenance.

This is one of many reasons why we need to get private health insurance companies out of health maintenance and back to selling insurance products only.

Again, a single-payer, Medicare for all program would address this problem, allowing health insurance companies to charge what they wish for supplemental insurance, and insure whomever they wish.

 

[Clementine]

Some people seem to have a very strange view of what insurance companies do. They point to the problem of people who have a pre-existing condition, trying to sign up for new insurance, only to find the insurance companies won't pay for the the treatment for that pre-existing condition.

Of course they won't. That's not what insurance companies do. Whoever said they did?

Insurance is a gambling game where you bet on what will happen in the future. You "bet" that you will get sick or injured, and the company "bets" that you won't. If you get sick or injured, the company pays you the stipulated amount (paying for a portion of your medical treatment etc.), and if you don't, you pay them (premiums). The purpose is to shield you from the "shock" of suddenly and unexpectedly getting hit with huge medical bills... which is why you agreed to the contract.

A pre-existing condition cannot be insured against. It's like betting on the outcome of a horse race that's already been run - there is no "chance" involved, and no "unexpectedness" to the outcome (any more). Or like trying to get car insurance after wrecking your car.

Insurance companies are in the business of selling security - the assurance that you won't be suddenly bankrupted by huge medical bills, rehab bills etc. in the future. They do it by insuring huge numbers of people and getting them to each pay relatively small amounts (their premiums) each. They and their clients all know that most of them will never incur the huge medical bills they are worried about. But since no one knows which few people WILL incur them, they are all happy to pay the premiums, for the knowledge they won't have to pay the huge amounts if they turn out to be the unlucky ones.

Insurance companies sell safety from FUTURE possible disasters. And that's all they sell. Asking them to cover pre-existing conditions, is like asking a submarine designer to design a supersonic jet - it's got nothing to do with his business or his area of expertise, and he never volunteered to design jets in the first place, for good reason.

If you want to set up some kind of universal pool to pay for pre-existing conditions, fine, go ahead. But why drag insurance companies into it? It's got nothing to do with their areas of expertise, and they never volunteered to do it in the first place - for good reason.

I agree.

It's funny how people have put all the responsibility for paying medical bills on the insurance companies. Imagine if no one had come up with the idea of insurance to assist people with catastrophic costs. Someone realized that people paying fairly small premuims and investing the money to make more money would help people pay the huge bills. I think originally it was meant for the big costs, much like car insurance. We don't file claims to auto insurance for tune ups or other minor things, just the big repairs in case of an accident. Yet, health insurance is expected to pay all costs, from check ups to prescriptions. Over the years, insurance has expanded because of the demand that they pay part of every single medical bill incurred.

Of course, the Big Pharms and medical supply companies know that insurance will pay for everything and then there are those people who never pay their bills. It caused prices to go up on everything for those who did pay.

Now, because so many don't have insurance and the costs have risen out of control, it's the insurance companies who get blamed for not keeping up. Even though what insurance will pay out for a hospital stay is way more than people paid in premuims in years. Not good enough and some don't believe that insurance companies should make money for making people's lives easier over the years. If they didn't exist, maybe costs would be lower, but only because there would be no deep pockets to take advantage of.

You can buy auto insurance after you have an accident and expect them to pay, yet people expect health insurance to do that.

It's big pharms and medical supply companies, and some doctors, making out like bandits thanks to insurance. There have been countless incidents of insurance fraud by these professionals. I think many bills get padded. The Dems haven't complained about them making money, but have royally bashed insurance companies.

Now, because of Obamacare, our rates will increase, yet medical costs keep rising. How sustainable is this?

 

[Vandalshandle]

For all practical purposes, there are no more health insurance comapanies. They have been replaced by HMO's which trasfered "risk" from insurance comapnies to providers, since under an HMO, the provider has agreed on a fixed reibursment, regardless of how much care they have to provide to the patient. Therefore, there is no such rthing as helath insurance companies being at risk for Pre-existing conditions. Providers are at risk.

 

[Procrustes Stretched]

Still nobody can explain WHY insurance companies, in particular, should be the ones to pay for medical treatement of pre-existing conditions, when pre-existing conditions have nothing to do with insurance.

No one has a good explanation of why health insurance should not be run by non profits.

Why must the health insurance industry be for-profit? Competition exists in the non profit sector