On Prexisting Conditions

[Boom Sound 416]

So, I understand the ACA for the most part I think.

The Need to cover pre-existing conditions so millions aren't left with bankruptcy as a path to Medicaid. Right?

And for profit insurers will go broke covering those with pre-existing conditions unless we add those who don't purchase insurance (and are relatively healthy) to the rolls to essentially pay or offset those new costs.

Do I have right so far? (no sarcasm intended)

Ok. And single payer is, well, just what it says - an all in, all out govt backed insurer. Right?

So why not just create a single payer for the uninsurable. Those folks who go to the various for profit insurers who then get predicitably denied do this time and again and eventually cross a threshold deemed uninsurable by the govt and then pay a (i guess) means tested fee for single payer insurance. So if the person makes 200k a year they would pay X% and be givien a single payer insurance card from the govt. no co-pay (as it's already paid via the fee) and the dr bills the govt.

Is this crazy or naive or on the horizon?

[Taitertots]

1. Single payer for sick would be a handout to the insurance corporations

Making the healthy pay corporations to not cover them when they get sick.

[Warren Stupidity]

2. It's a horrible idea the insurance companies would love.

They would dump everyone with anything into the government program and only insure healthy people.

[Boom Sound 416]

3. How?

Let's say you get a job, your first job at the place you might work for the next 30 years, you get insurance after probation, you get sick, you put in the claim.

Same scenario, but the insurance company deems condition pre-existing, you file a grievance with HHS or state equivalent, you win, coverage remains.

You lose, you keep your employer provided coverage for other illnesses, family, etc, but you got to the fed as an uninsurable for this type of treatment and you don't go broke or die paying medical bills.

[elehhhhna]

4. ACA makes coverage of preexisting conditions a leagl requirement

or do I not understand your q?

[Boom Sound 416]

5. are you referring to the scenario above or OP

Absolutely it is, but the whole thing is predicated on covering PEC's and doing so with a for profit industry.

[Warren Stupidity]

13. People change jobs on average every 5 years.

Your example is an outlier. The net effect of your proposal would be that most of the unhealthy people would be in the public program and the private insurers would have most of the healthy people. So either the public program would be ridiculously expensive or taxpayers would pick up the tab for this mess. Meanwhile the private for profit insurance industry would make out like bandits, insuring mostly healthy people. Insurance works when everyone, healthy and unhealthy, is in the same pool and the costs are shared across that pool.

[SoCalDem]

6. Insurance only works when EVERYBODY spreads the risk

I do not live in a firetrap, but MY fire insurance premiums pay for people who DO have fires..

The reason why large group policies have worked relatively well for as long as they have, is because the RISK is spread out.. The 50+ers who will NOT use maternity care are paying their share for the 20-somethings who might.. The 20-somethings are "paying" for the 50-something guys who develop prostate cancer. The 20-somethings who may not go to the doctor very often, have care AVAILABLE to them IF they have a car/motorcycle/skiing crash, or if they have a sports injury, and by the time THEY are older and have other health care issues, the people younger than they are, will be in the place they are now. The assumption is that as older folks retire OUT of the plans, the costs are constantly being moderated.

The fly in the ointment, is when companies merge, downsize, stop the hiring/retirement conveyor.

[Boom Sound 416]

7. Agreed. That IS the model

For the entire industry across all other industries. But fire traps only burn once. Yes, they will burn, but they don't burn for 65 years constantly needing treatment.

That's the fly in the ointment. Hell, keep the mandate. As someone who didn't have insurance through my late 20's until I got married and had a family. Now I get it. And I should have had it then for both safety and the pay-in, because I sure am taking from it now.

That said, just remove those with PEC out of the system and exclusively for that ailment. As far as general medical treatment: song remains the same. You are still a payer-in and a receiver-of for all else.

maybe it's just naive

[SoCalDem]

9. Once you start separating out certain groups of people, you weaken the system

and strengthen the "other-ness" of people "not like you and me", and in doing so, you open them up for cuts here and there, and over time, elimination from services.

This is the problem we currently have..in spades.

As long as "some people" are deemed to be lesser-thans, it's easier to discount their worth.

Already, smokers have been carved "out of the norm"..and the next carve-out will be weight (count on it). They are not "pre-existing conditions", but will be treated as such. And once the weight issue is attached, what comes next? athletes?

I can tell you, as the Mom of an athlete, we used a LOT of healthcare for our intrepid young guy who participated in soccer, football, basketball, golf, tennis.

For a good group plan to operate, it needs to the BLIND to the proclivities of the participants.

Insurance is ALL about actuarial tables..A National healthcare policy would assume that EVERYONE has some "bad habits/issues" and the system is about delivering healthCARE to people...not INSURANCE.

We are doing it bass-ack-wards in the US.

[Boom Sound 416]

11. probably quite closer to reality

than my example

[Ms. Toad]

8. And where do you think the money comes fromfor that scheme?

The taxes we all pay. If taxes are going to pay for the care for the sickest among us, they ought to pay for care for all of us rather than letting the insurance companies skim the profits off of low risk patients.

[Boom Sound 416]

10. exactly

we all pay taxes, therefore we are all paying in on this program. those of us who need it, have it even if we don't know we need it yet

[Ms. Toad]

12. Not with the insurance companies still in the mix.

If we're moving to single payer, it needs to be for everyone - not rigged to give the insurance companies more profit at a lower risk.