No, amending it won’t work. They deliberately designed it to ensure that it wouldn’t.
Allowing people to buy insurance with pre-existing conditions remains as economically insane as when it was first proposed. There are better ways to deal with this than effing up the insurance market. And 26-year olds are supposed to be adults, though that’s just stupid, but not as economically harmful.
[Update a few minutes later]
And yes, live by reconciliation, die by reconciliation. Have it on his desk to sign on his first day.
Regarding pre existing health conditions;
What do we do about the millions who lost their health coverage due to Obamacare? Many of them had, or now have, health conditions.
I’m one of them. I lost my policy due to Obamacare (it was terminated – so much for being grandfathered in). I did not buy Obamacare (it’s utter garbage, as well as very expensive) and I refused to pay the tax penalty (they neglected to put in an enforcement mechanism).
Because of a pre existing condition that developed while I was covered by my old plan, I can’t get coverage like I had even if they nuke Obamacare and it’s insane regulations. Frankly, I’m not happy about that, but I’d prefer it to not killing Obamacare.
Regarding my above… yes, I’m angry, and have been for a very long time. The Democrats rammed Obamacare down our throats, KNOWING they were lying on their promises (to name just one: If you like your current plan, you can keep your plan. Period!”).
I therefor submit this modest proposal to Republicans: Make it right with those of us who were screwed over by Obamacare, and will thus, through no fault of our own, be screwed over by the preexisting conditions issue when Obamacare is gone. You, Republicans, didn’t cause this… but you should make it right. It wouldn’t even cost the treasury a dime. The precedent has already been set (Citizens harmed by 9-11 given the right to sue Saudi Arabia). So why not do the same for those of us harmed, in some cases for the rest of our lives (due to being unable to get back the policies Obamacare robbed us of).
How? Give us the right to sue the Democrats responsible for this for damages and compensation, collectively and individually.
It’s not only the right thing to do, it might even change some Democrats’ minds on tort reform.
Prior to Obamacare in WA, it was illegal to deny coverage to people with pre-existing conditions as long as that pre-existing condition had existed for over a year. This was to prevent gaming the system with people picking up insurance for a month when needed and then dumping it.
Also, not all pre-existing conditions are equal. Just because someone has one doesn’t necessarily mean they wouldn’t get health insurance.
@ wodun,
I’d probably have no trouble getting insurance on the old market, I’d just have to pay more.
What I had, and the liars took away from me, was a high deductible policy, basically catastrophic coverage. It cost me 1600 per year, and I’d had the policy for over a decade before my diagnosis (Type 2 diabetes). I’m very well controlled without meds (low carb diet, and avoiding putting on any surplus pounds), no complications, but this makes me high risk in the eyes of an insurance company. I’m angry because it was Obamacare’s diktats regarding coverage that caused my insurance company to cancel that policy family, thus taking away insurance I was happy with and had maintained for many years – I’d done what I was supposed to do.
I’m *not* asking for subsidies, or even my old policy back (and know the latter can’t happen). What I do want from Republicans, when they repeal Obamacare is loud and often acknowledgment that the fraud committed by the Democrats badly hurt millions of people like me, and that pain is for the rest of our lives (higher premiums than if we’d be allowed to keep the policies we had).
I’d also very much like the right to sue the Democrats involved for fraud, because it was fraud.
I’d be very happy if I could find something like the WA policies you mention. I have no trouble at all getting travel insurance without a preexisting condition premium (just via purchasing it well in advance) so that would be ideal – but I’m not holding my breath. 🙂
If you want insurers to provide coverage for pre-existing conditions, then you have to have additional government funding, coming out of taxes. That’s how it works in the Netherlands. People are free to choose their insurance company, companies have to accept all customers and there is separate funding for chronic patients, so insurance companies can still make a profit serving them.
The problem isn’t insurance. It’s the cost of health care itself — insurance costs are only a symptom. The cure: standards based medical practice. We have medical associations that have defined Best Practices in each of their fields — they already exist. We need to formalize those existing Best Practices by having NIST qualify Standards Providers in those medical organizations and transition Best Practices into American National Standards, agreed to by members of those medical associations, the insurance industry, and any other interested parties. Congress should then build those Standards into law, requiring that any malpractice suit show how a doctor deviated from the Standards before being able to bring a lawsuit. This removed the “deep pockets” lawsuit problem from the equation. (Worried about upcoming and experimental treatments? The government and the profession already have protocols, which can be codified into the body of Standards so that doctors involved in clinical research will be covered.) This removes some of the risk of practicing medicine competently, so doctors don’t have to cover their asses with unnecessary tests just to satisfy some collection of expensive popinjays the Plaintiffs find when the outcome is less than perfect. Malpractice law then becomes fact-based, not opinion-based, because the arguments were already made during the Standards development process. With doctors having risk-adverse ways of practicing their craft, especially with the growth of checklists in emergency medicine, this improves patient outcome as well. The existing doctors can handle more patients, too. Insurance companies don’t have to haggle over claims when the medicial professionals all practice to the Best Practices Standards. There is a final benefit: medical boards in hospitals and in government can force out of practice those who demonstrably don’t follow the standards. Better outcomes. Eject the incompetent. Lower costs for all. Win, win, win. The only losers are those lawyers who specialize in medical malpractice tort — the ambulance chasers can find other work. I’m told that the Republicans (and Democrats, for that matter) had this plan proposal in hand during the Obamacare debates. And ignored it. I’m also told that President-Elect Trump received something like this summary at https://www.greatagain.gov/ — let’s see if Trump ignores it like all the politicians did seven years ago.
There are several obvious problems here. First, how does it reduce costs? You only mention malpractice lawsuits. That’s not the only cost inflator to medical care and most malpractice is already doctors making mistakes, namely, not following existing standards.
Second, you create death panels. Those who make the standards are deciding who lives and dies. Standards are also an effective way to create cartels since market constraints and complexity can be built right into the standards. This, I should note, has already been done with restrictions on who can practice medicine and to what degree.
Finally, standards encourage risk avoidance behaviors at the expense of the patients. Doctors won’t be protected when they make a warranted deviation from the standards or work in situations where standards can’t be followed (eg, field medicine). Doctors need to have considerable latitude to exercise their judgment. That’s a key thing which has been removed over the decades and which standards don’t replace.
This is a contributor to the cost. But the major driver of the cost is that we pay our health-care professionals close to twice as much as they do in Europe. Doctors, nurses, OTAs, lab techs, all of them. And that isn’t going to change nohow – see the Doctor Fix in Medicare. Politically impossible and no one even tries.
All the ones pushing Obamacare were blathering about “bending the cost curve”. Eventually they found out that it couldn’t be done, and they moved on to blathering about other things.
Reconciliation: this Congressional gobbledygook has always been beyond my comprehension. Can this be used to actually get rid of all those laws, or do they remain on the books but with no funding? Not sure what would happen.
And everyone knows by now that something is going to be done to help the ones who didn’t buy insurance and then got very sick. What is that something, and can I presume that it can’t be done by reconciliation? Maybe work with the Democrats on that one, but when – for political reasons and perhaps humanitarian you need that in place before ACA coverage goes away.
We’ll see. None of it sounds as easy as “Repealed!” ought to sound.
“Insurance” is a big part of the problem, in so far as it insulates consumers from direct costs of their choices, breaking necessary market feedback. The huge deductibles of zero-care would actually help here if consumers were able or insistent to comparison shop, but other elements of the structure make that impossible.
Yes, ‘insurance’ as opposed to insurance is the problem. Insurance is a market driven solution that works as close to perfection as is possible. ‘Insurance’ isn’t insurance, but is instead a mob driven solution which means it works for some by harming others more.
The huge deductibles of zero-care would actually help here if consumers were able or insistent to comparison shop
This is true but instead they just don’t spend any money because premiums eat up all the extra cash.
Also as you allude to, it is hard to comparison shop. It is extremely hard to even speak to someone at the time of your appointment about what they charge for any given treatment.
Regulating that customers have to be the middlemen between providers and insurers could also affect this situation. Make it illegal for insurers to bargain with providers too. Then rather than providers being responsive to just a few customers (insurance companies) they have to be responsive to millions of customers. The same is true in reverse.
We need to end medical monopolies. Trump can do this as president. The fact that the democrats did not is testimony to their desire to control the market rather than help people.
This is why you don’t EVER want the smartest guy in the room to be your president. There are many issues that need to be discussed by the legislature. The presidency shouldn’t tell then what to do but hold them to principles.
Next there is the meaning of word distortion. Health care is one service. Insurance is another service. Insurance works best when it’s a pure market issue with some exceptions. Pre-existing conditions are one of those exceptions that could but probably would not be addressed by a market solution. So that’s where a govt. program might be workable, but only as an entirely separate issue that has as little impact on the normal insurance market as possible.
Forcing a market driven insurance policy to included pre-existing conditions is like forcing companies to provide launch insurance after the rocket blows up. That’s not insurance.
It should always be about responsibility. Obama and his cohorts should be held responsible for lying about being able to keep insurance because the people that had that insurance did it the right way, before they had the conditions that they can no longer get coverage for.
Young people should be raised to understand they are responsible and not the govt. (which is just making others be responsible for them because the first lesson life should teach is the govt. is never responsible… and hardly ever accountable)
Pre-existing conditions are one of those exceptions that could but probably would not be addressed by a market solution.
Sell policies that exclude coverage for the condition in question while covering others.
I just hope that the GOP decides to take their time and come up with a good plan that will work in the long run (not just the first couple months) and be good for all.
Stop this crap of running something through the legislature in a short time just to make sure someone’s “Legacy” is what they want. Think of the country, not the President.
Require the entire medical field to stick to static pricing. You can pick your price, but you can’t bill Primera $13, Regence $50, and private pay $350 for the exact same service. Having an out-of-state ‘Blue Cross’ plan, insurance mixups mean my statements regularly show just how vast the different pricing options are. “You have no insurance?!? Pay THIS!” “Um, no, I have insurance…” “Then pay this!” “That’s the wrong Blue Cross, I don’t have the Blue Cross that’s literally next door to this building, I have one from Texas for some reason.” “Then pay -this-! And a late fee.”
This is done for a variety of reasons that will have to be paid for – but deliberately shafting private pay to the point we’re at is dumb.
The biggest thing that can be done to help is to get rid of the ‘state restriction’ law. Let every company be able to compete in every state. See what happens when they start to have to compete for people.
Hear, hear. This is exactly the sort of purpose for which the Commerce Clause was originally intended.
Eliminate the state restriction and require everyone to publish a price schedule for their services.
I like the price schedule idea a lot. Just like a restaurant
It’s really important to get the terms right:
A system which allows pre-existing conditions is NOT health insurance. It’s subsidized health care.
Now if you want to provide subsidized health care for people with pre-existing conditions, through an insurance company, then the extra cost a company MUST charge (because they will be paying out a lot more) will be paid by either:
1) Spreading the cost among all the people insured by that company or
2) The government (Feds, State).
Insurance companies use statistics to figure out the odds of healthy insured getting sick and charge everyone accordingly in order to make a reasonable profit (I’m simplifying). But once you factor in clients who have a 100% chance of needing payouts from the insurance company the FIRST DAY they are insured, then that raises the costs of doing business. A lot.
And it very well may raise the price of an insurance policy for even healthy people A LOT.
Of course, if a person with pre-existing conditions is cured, then their premiums – and everyone elses, should go down.
If you have the Feds pay for it, then the pile of money the feds will have to shell out will be huge. Now the Feds are taking over the health care costs of the sick person from the insurance company (assuming the insured had insurance; lost it; and wants to buy another policy – say because they changed jobs). The insurance company’s costs go down.
A solution will have *at least*, these attributes:
1) You have to eliminate the ability for someone to wait until they are sick before they buy health “insurance”. You have to eliminate the ability to game the system. People who choose to NOT buy health insurance when they are healthy, and then get sick, should not be in the same situation as people who have paid into a policy. You get to choose – but you have to live with the consequences.
I do not want to subsidize bad consequences of a free person’s choices.
2) Yet people with insurance who have a pre-existing condition, who LOSE their insurance through no fault of their own must be helped in some fashion.
3) There are people who legitimately cannot afford health care and for them there’s Medicaid.
4) Insurance must remain insurance.
5) Health care costs should be reduced whenever and wherever possible, in whatever liberty-preserving ways we can think of, without reducing quality of care. No death panels.
The thing about price schedules is each insurer sets them. A hospital can set a price, but the payee, which isn’t the patient, will haggle the price. And the service the hospital provides can’t be taken back, and in many cases cannot be denied. If you think it is nonsense that a baker can’t choose for whom to bake a cake; hospitals have been dealing with that situation in 1986.
Except the customer can walk in off the street, refuse to pay a dime, and they must be screened and if show some emergent symptoms must be treated like any other paying customer. I don’t know of other businesses that have to deal with that dynamic, so I think the notion they can just publish a price list like any other business misses that they aren’t any other business.
Oh, and thanks to PPACA; hospitals are actually reimbursed based on customer satisfaction. This includes getting high marks from non-paying customers. Do you run a business in which every other customer only pays to their satisfaction and that of the customers that just took the service for free? Satisfaction doesn’t mean you were cured of something that nearly killed you. Satisfaction can be based on your meal or whether you just want to be a cuss. Oh, and general experience is that the customers that complain the most: the non-payers.