How is it possible - coverage for pre-existing conditions?

Discussion in 'Politics, Religion, Social Issues' started by kobalap, Oct 30, 2018.

  1. kobalap, Oct 30, 2018
    Last edited: Oct 30, 2018

    kobalap macrumors 6502

    Joined:
    Nov 30, 2009
    #1
    It seems that election season has Trump republicans talking about coverage for pre-existing conditions.

    Honest question - how can we have coverage for pre-existing conditions without the individual mandate? I mean, wouldn't a woman just sign up for health insurance a month before having her baby and then stop paying for her health insurance about 6 months after?

    It seems to me that coverage for pre-existing conditions without the individual mandate is just another way to tax the rest of us for bums who don't want to take personal responsibility and keep up with their medical insurance.
     
  2. BaldiMac macrumors 604

    BaldiMac

    Joined:
    Jan 24, 2008
    #2
    As the evidence repeatedly shows... Republicans have no health care plan.
     
  3. yg17 macrumors G5

    yg17

    Joined:
    Aug 1, 2004
    Location:
    St. Louis, MO
    #3
    We could try a single payer system, which works in almost every other ****ing modernized country in the world.
     
  4. s2mikey macrumors 68020

    s2mikey

    Joined:
    Sep 23, 2013
    Location:
    Upstate, NY
    #4
    Yes, they would. Then, they would drop the coverage shortly thereafter. Think... if your auto insurance or homeowners worked this way. So damned convenient. Id milk it too. House burned down? Sign up for homeowners insurance, cash check, rebuild house, drop coverage. YeeeeHaw! :)

    So we cant really do that unless its heavily monitored/regulated/policed. That there would make it costly and have tons of red tape.

    In order for health insurance to become affordable and reasonable, the first thing we must do is get all the middle men and "hands" out of the pot. Of course, no one with said hands in the pot wants to do that. You also have a bunch of people that never make anything of themselves(I mean like total do-nothngs, not those that work and dont make a lot) who are a complete drain on the system and add nothing in return.

    Then, we have to start using insurance for BIG things again versus every little visit. I remember as a kid when I got weekly allergy shots. We paid 100% out of pocket for that directly to the doctor. It was very reasonable, says my Mother. Nowadays, that same thing would be "covered" by insurance but the ACTUAL billed out cost would probably be like $300 bucks. That in turn makes everything cost a crapload of money. You'd have a $25 buck co-pay at the most. Im just using that as one example but there are many things that could and should be out of pocket and people should be able to use pre-tax payroll dollars to help pay for them. Again though, good luck getting those that are milking the system for $$$$ to give up the golden goose. Ya know?

    Health insurance CAN be fixed. But far too many people benefit from the current system of milking it and skimming off the top for lack of a better phrase.
     
  5. vrDrew macrumors 65816

    Joined:
    Jan 31, 2010
    Location:
    Midlife, Midwest
    #5
    Well, I give you credit for acknowledging an issue that Republicans have been avoiding, like the plague, for most of the past eight years.

    In a private insurance market, which the ACA is, the system relies on three "legs", as it were, to keep the whole system stable.

    Firstly, there is the individual mandate. This means that younger and healthier people sign up for health insurance, even though they don't think they'll need it. This increases the pool of participants in the pool, and makes premiums for all participants reasonable.

    Then there are the subsidies. Which make health insurance affordable, even for those with very low incomes.

    Lastly, there is the prohibition on so-called "medical underwriting." In case you don't know what this was, it was a practice whereby, when applying for an individual health insurance policy, companies would make you fill out a very lengthy health questionnaire. You had to list pretty much every medical interaction you'd ever had in your life. And, if you subsequently needed medical services, insurance companies had people whose job it was to use any discrepancies or inaccuracies in that questionnaire as justification to deny you coverage.

    Those are the three vital parts of a Government-regulated private insurance marketplace. Take any one of them away, and the system falls apart. That's not death panels and socialism. It's simple behavioral economics and the way the free market works.

    Without a mandate, younger and healthier people won't participate. Without the subsidies, neither will the poor. Without the prohibition pre-existing conditions, then people with them won't be able to participate. And they'll ultimately pass on their medical expenses in the form of un-reimbursed care.

    The alternative to this admittedly complicated system would be single-payer. But that probably was too much like socialism for the Democrats of 2009 to pass. Which is why we ended up with the Mitt Romneyesque ACA. And we've been getting Republicans scorn and fearmongering ever since.

    You wonder why I've lost faith in the Republican Party?
     
  6. BaldiMac macrumors 604

    BaldiMac

    Joined:
    Jan 24, 2008
    #6
    I'm surprised! That's a very well thought out argument for universal healthcare.
     
  7. BoxerGT2.5 macrumors 68000

    BoxerGT2.5

    Joined:
    Jun 4, 2008
    #7
    $25 is what weekly allergy injections cost.
    --- Post Merged, Oct 30, 2018 ---
    An individual mandate is toothless if the fine is so low it's cheaper to pay that instead of paying for health insurance.
     
  8. BaldiMac macrumors 604

    BaldiMac

    Joined:
    Jan 24, 2008
    #8
    That's mostly true. There are also some cost savings that potentially offset some difference between the fine and the cost of health insurance.
     
  9. BoxerGT2.5 macrumors 68000

    BoxerGT2.5

    Joined:
    Jun 4, 2008
    #9
    What cost savings if you're a 28-35yr old that never goes to the doctor?

    They made it low because it was the one thing that would have sank it from the get go. They still had to argue in front of the SC and back track on the lie they told the american people to get around the constitutional hurdle of it being a "fine".
     
  10. A.Goldberg macrumors 68020

    A.Goldberg

    Joined:
    Jan 31, 2015
    Location:
    Boston
    #10
    You could have no mandate and cover preexisting conditions. Insurance would just be heinously expensive- even more than it is now. It would essentially become the same cost as paying out of pocket.
     
  11. kobalap thread starter macrumors 6502

    Joined:
    Nov 30, 2009
    #11
    Perhaps but it seems the very same politicians that couldn't eliminate the individual mandate fast enough are talking about protecting the pre-existing conditions clause of Obamacare.

    I'm a simple person. To me, this is either:

    A) a scam being perpetrated by crooked politicians trying to win votes

    or

    B) there is some magic that allows coverage of pre-existing conditions, without individual mandates, and doesn't saddle all of the ones who actually maintain continuing medical coverage with the burden of paying for the cheaters.

    If it is B, I'd like to know what the magic is. Maybe this is just simple math for those in the "know".
    --- Post Merged, Oct 30, 2018 ---
    That's just a different way of doing it. In the end, if you want health insurance that doesn't saddle those who play by all the rules with all the costs, you have to have some form of individual mandate.

    In the case of single payer, everyone has to pay a tax that would subsidize the system.
    --- Post Merged, Oct 30, 2018 ---
    It would be heinously expensive for those of us who play by the rules.

    And it would be comparatively cheap for those who cheat.
     
  12. JayMysterio macrumors 6502a

    JayMysterio

    Joined:
    Apr 24, 2010
    Location:
    Rock Ridge, California
    #12
    Just for hypocrisy giggles, here's a list of repubs now claiming to support coverage pre existing conditions. All the while having actually voted against it, try to sabotage it, or are still actively trying to sue it.

    https://www.motherjones.com/politics/2018/10/republicans-preexisting-conditions-obamacare-repeal/
     
  13. A.Goldberg macrumors 68020

    A.Goldberg

    Joined:
    Jan 31, 2015
    Location:
    Boston
    #13
    Well, no. You wouldn’t be “following the rules” as there would be no rules regarding mandates. You’d be dumb to pay for insurance until you needed it. As a result the cost of a procedure or service insurance would be the same as not having insurance at all because no one would be paying into the system.

    But enough with unrealistic hypotheticals.
     
  14. BaldiMac macrumors 604

    BaldiMac

    Joined:
    Jan 24, 2008
    #14
    It's silly to discuss cost savings by an insurance provider in terms of individuals. Not everyone that decides to pay the fine will avoid any sort of health care.
     
  15. PracticalMac macrumors 68030

    PracticalMac

    Joined:
    Jan 22, 2009
    Location:
    Houston, TX
    #15
    Yeup.

    And think, health care is a FOR-profit system, with many hospitals, pharmaceuticals, device suppliers, insurance, and like all on the stock market with a board of directors.

    What is the motivation for the health care industry?
    $$$$$$$$

    What about those CEO's with billion dollar incomes?

    Someone suggested a regulated system for billing expenses, I think simply a non-profit (that is all profit goes right back to the facility/services) would be better.
     
  16. Herdfan macrumors 6502

    Joined:
    Apr 11, 2011
    #16
    Same was as it does now. By only having certain windows in which to sign up, mandate or not.

    As for the mandate, how well did that work? Are you saying every person who was supposed to have insurance did? Of course they didn't and just paid the penalty. Nothing really changed in regards to pre-existing conditions.
     
  17. AlliFlowers Contributor

    AlliFlowers

    Joined:
    Jan 1, 2011
    Location:
    L.A. (Lower Alabama)
    #17
    The US military has successfully managed single payer healthcare for a long, long time. Why not just expand that to civilians, charge a fee to "join" and allow the military to continue administering the "plan."
     
  18. BoxerGT2.5 macrumors 68000

    BoxerGT2.5

    Joined:
    Jun 4, 2008
    #18
    You really want to use the VA healthcare system as the example of what things should be? Have you been in a coma the last 5yrs? If anything the VA is a glaring example of how the federal government could **** things up. It is literally what someone would point to as an example of a failed universal healthcare system. When people talk about wait times and individuals not getting the care they need in other countries systems, they point to the VA as a current example in the US.
     
  19. AlliFlowers Contributor

    AlliFlowers

    Joined:
    Jan 1, 2011
    Location:
    L.A. (Lower Alabama)
    #19
    I'm not talking about the VA. I'm talking about the military itself. The VA is a separate entity, and should probably also be run by the military.
     
  20. diamond.g macrumors 603

    diamond.g

    Joined:
    Mar 20, 2007
    Location:
    Virginia
    #20
    I ma not sure military hospitals would be ready to deal with civilians. Nor am I convinced civilians would want military officers seeing them. (culture differences)
     
  21. AlliFlowers Contributor

    AlliFlowers

    Joined:
    Jan 1, 2011
    Location:
    L.A. (Lower Alabama)
    #21
    They would have to bring in civi doctors, civi nurses, techs, etc. It would just be a conversion of the financing behind medical care.
     
  22. diamond.g macrumors 603

    diamond.g

    Joined:
    Mar 20, 2007
    Location:
    Virginia
    #22
    Good point.
     
  23. kobalap thread starter macrumors 6502

    Joined:
    Nov 30, 2009
    #23
    Hey, that's a terrific non-answer. Let me restate my question - you are welcome to try and articulate a cogent response.

    If we institute a policy or a law that guarantees coverage of pre-existing conditions, how would that work without a mandate for everyone to maintain healthcare coverage? Example of a predictable issue is a young, otherwise healthy woman. Why would she carry health insurance until there is a compelling medical event? Such as getting pregnant.

    I think your argument might be, if there are fixed windows only to sign up for health insurance, well, there is about a 9 month indicator that tells a woman that they will need health insurance to offset the costs of delivering a baby.

    One might also argue that the woman would be risking huge expenses if she has an unexpected medical event (falls and breaks her leg). For something like that, one cannot wait until the window for healthcare insurance sign up is open before seeking treatment. Except there is another law that would force health care providers to treat her irrespective of her ability to pay - EMTALA.

    It seems to me that if you guarantee coverage for pre-existing coverage and you do have a mandate, that is license for bunches of people (young and/or otherwise healthy people) to forego health insurance because anyway, they will get coverage when they need it. Which is really another way of saying that everyone else will carry the costs on behalf of the cheaters.

    To be clear, I am not an advocate of an individual mandate. Or a single payer system. I am simply asking, from a taxpayer's perspective, how do we make this work without a) saddling the conscientious people with disproportionate amount of the expense or b) adding to the national debt?
     
  24. BoxerGT2.5 macrumors 68000

    BoxerGT2.5

    Joined:
    Jun 4, 2008
    #24
    If the average cost of health insurance is $4200 a year for a single individual you make the penalty (ie...tax ;)) for not having health insurance for 12 consecutive months $4200. 86% of those 26-34 don't carry insurance, they make up 12% of the population. Do the math; you end up with $168 billion dollars of available healthcare dollars sitting there waiting to be plucked.
     
  25. kobalap thread starter macrumors 6502

    Joined:
    Nov 30, 2009
    #25
    I see. So instead of making them sign up and pay for insurance, you tax them the same amount if they don't. Out of curiosity, is it really the semantics that is important to the opponents of the individual mandate?

    Could Obama really have improved the healthcare system in the US if he called it a tax as opposed to a mandate? Would all the Republicans in congress and all the "Joe the plumbers" have been lining in support of Obamacare at that point?
     

Share This Page

52 October 30, 2018