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Great explanation. Even many PA types should be able to comprehend this article. <g> intercst, for all his stock picking brilliance, probably will not comprehend this article which is puzzling because the guy purports to be a degreed engineer.

Mike

http://market-ticker.org/akcs-www?post=212796

If you have a "pre-existing" condition then you're not buying insurance.

Remember what insurance actually is: A small payment made to someone in order to obtain pooled risk against an unlikely but catastrophic event that one either cannot or chooses not to reserve against on one's own.

By its very nature insurance is a negative-sum game. That is, if you take all the bad outcomes that happen across the insured population and sum their costs, the cost of the insurance purchased by that population must exceed the sum of the costs. It cannot be otherwise or the insurance company will cease to exist as it will make continual losses and eventually run out of capital.


As such if the catastrophic event already happened you're not negotiating for "insurance"; you are now trying to lay off the cost of mitigating the damage that has already occurred on someone else ex-post-facto.

The common word for that attempted act is theft.


Consider the rest of your life. What would you say to someone who demanded to be able to buy fire insurance on his house while the house was on fire? Or someone who demanded the ability to buy auto insurance covering both liability and property damage after he got into a wreck?

You'd laugh at either of those attempts, and with good cause.

So why don't you laugh at someone who argues that after contracting cancer or HIV someone should be able to buy health insurance to cover the cost of that cancer treatment or HIV?

It's the same issue, yet one is quite-properly regarded as nothing other than an attempt to reach into other people's pockets and pay for your consensual decision to either live in a house without insurance or drive a car without having coverage while the other is demanded as a civil right!

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The left spends its days trying to convince voters that everyone can live better at everyone else's expense. The problem is that much like a perpetual-motion machine, this cannot work. So, it's a political shell-game.

Now, specifically with respect to pre-existing conditions, I think that health care coverage should be portable and people should be able to get coverage for conditions that are beyond their control. I would not want anyone to have to choose between caring for their child with a genetic defect or condition, and being able to feed their other children. However, many health problems are the result of bad choices, and I don't want to subsidize those. It's a tough issue, no doubt, but IMO, calling it 'theft' in all cases is using too broad a brush.
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The left spends its days trying to convince voters that everyone can live better at everyone else's expense. The problem is that much like a perpetual-motion machine, this cannot work. So, it's a political shell-game.

Now, specifically with respect to pre-existing conditions, I think that health care coverage should be portable and people should be able to get coverage for conditions that are beyond their control. I would not want anyone to have to choose between caring for their child with a genetic defect or condition, and being able to feed their other children. However, many health problems are the result of bad choices, and I don't want to subsidize those. It's a tough issue, no doubt, but IMO, calling it 'theft' in all cases is using too broad a brush.


It's definitely not "theft." At best, it could be fraud if the pre-existing condition is required to be disclosed (by either the insured or a doctor) and wasn't.

It kind of reminds of those who call a fractional-reserve banking system "fraudulent." It's not fraudulent unless the bank intentionally deceives people into thinking that their deposits are backed by 100% reserves.
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If you have a "pre-existing" condition then you're not buying insurance.


Of course no insurance company will ever be able to make money if they take people with pre-existing conditions and other companies can select and skim those people who are perfectly healthy.

The classic republican solution to this is mandating coverage for everyone (the so-called individual mandate) the classic liberal solution is universal coverage.

On the conservative side, the individual mandate prevents people from only purchasing insurance once they get ill.

On the liberal side, universal coverage allows everyone, sickly and healthy, to be covered. No one chooses to be in poor health (granted some do indirectly by smoking or becoming obese) and I dare say very few people think, wow I hit the lottery, I got in an accident that caused me to be in the hospital and rehab centers for 4 months incurring a $1 million dollar bill that the government now pays.

I, personally, think Universal coverage is the obvious best solution. However, I can see where the conservative idea of an individual mandate could work. Clearly, the fantasy that you can provide for pre-existing conditions without having somehow forcing everyone to be covered would never work. (The plans that took pre-existing condition people would cost much more than the plans that did not. No healthy person would sign up for these plans because they cost more. The plans would have to pay out tons of money for every person that signed up; the costs for these plans would spiral up until no one could afford them.)

Charles
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I, personally, think Universal coverage is the obvious best solution. However, I can see where the conservative idea of an individual mandate could work. Clearly, the fantasy that you can provide for pre-existing conditions without having somehow forcing everyone to be covered would never work. (The plans that took pre-existing condition people would cost much more than the plans that did not. No healthy person would sign up for these plans because they cost more. The plans would have to pay out tons of money for every person that signed up; the costs for these plans would spiral up until no one could afford them.)
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You also have the option of direct intervention, as we do with the genuinely disabled in providing them income protection.

There are other options such as a pool of undesirables that are shared across all insurance companies by mandate as a cost of doing business

There would seem to be a lot of ways of actually addressing this issue.
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A agree with the original poster that people cannot buy health insurance after they get sick (the buy home insurance when the house is on fire scenario).

However, current health insurance rules and regulations may force a person to change insurance companies by changing jobs or moving to another state. These people have been insured and should not be penalized with a condition developed while insured because of a forced change of insurance.

John
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JoKingMe wrote: However, current health insurance rules and regulations may force a person to change insurance companies by changing jobs or moving to another state. These people have been insured and should not be penalized with a condition developed while insured because of a forced change of insurance.


The Health Insurance Portability and Accountability Act of 1996 (HIPAA; Pub.L. 104-191, 110 Stat. 1936, enacted August 21, 1996) was enacted by the United States Congress and signed by President Bill Clinton in 1996. It was sponsored by Sen. Nancy Kassebaum (R-Kan.).[1] Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs.

To illustrate, suppose someone enrolls in a group health plan on January 1, 2006. This person had previously been insured from January 1, 2004 until February 1, 2005 and from August 1, 2005 until December 31, 2005. To determine how much coverage can be credited against the exclusion period in the new plan, start at the enrollment date and count backwards until reach a significant break in coverage is reached. So, the five months of coverage between August 1, 2005 and December 31, 2005 clearly counts against the exclusion period. But the period without insurance between February 1, 2005 and August 1, 2005 is greater than 63 days. Thus, this is a significant break in coverage, and any coverage prior to it cannot be deducted from the exclusion period. So, this person could deduct five months from his exclusion period, reducing the exclusion period to seven months. Hence, Title I requires that any preexisting condition begin to be covered on August 1, 2006.

Source: Wiki
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current health insurance rules and regulations may force a person to change insurance companies by changing jobs or moving to another state. These people have been insured and should not be penalized with a condition developed while insured because of a forced change of insurance.

That's what the federal HIPAA addresses:

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html#.UIHCRc...

HIPAA is a federal law that:

--Limits the ability of a new employer plan to exclude coverage for preexisting conditions;
--Provides additional opportunities to enroll in a group health plan if you lose other coverage or experience certain life events;
--Prohibits discrimination against employees and their dependent family members based on any health factors they may have, including prior medical conditions, previous claims experience, and genetic information; and
--Guarantees that certain individuals will have access to, and can renew, individual health insurance policies.

HIPAA is complemented by state laws that, while similar to HIPAA, may offer more generous protections.

One of the most important protections under HIPAA is that it helps those with preexisting conditions get health coverage. In the past, some employers' group health plans limited, or even denied, coverage if a new employee had such a condition before enrolling in the plan. Under HIPAA, that is not allowed. If the plan generally provides coverage but denies benefits to you because you had a condition before your coverage began, then HIPAA applies.

Under HIPAA, a plan is allowed to look back only 6 months for a condition that was present before the start of coverage in a group health plan. Specifically, the law says that a preexisting condition exclusion can be imposed on a condition only if medical advice, diagnosis, care, or treatment was recommended or received during the 6 months prior to your enrollment date in the plan.
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As stated above, some states are more generous. You can get coverage in OR with pre-existing conditions with no look-back period.

And you can always get 18 months of Cobra, continued coverage from your existing employer health plan, when you quit a job. And some states allow you to sign up for their least expensive health insurance policy if your Cobra runs out while you're living there.

--fleg
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Oops -- tele'd by that Coy woman.

--fleg
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Now, specifically with respect to pre-existing conditions, I think that health care coverage should be portable and people should be able to get coverage for conditions that are beyond their control.

Neither should insurance companies be allowed to unreasonable raise premiums or terminate insurance because an insured becomes ill. Regardless of whether or not you deem it a life style illness.

We have had carried health insurance for multiple decades. If I leave my employer, we must obtain a new policy as a "new individuals". Even though we have had insurance for decades. Pre-existing conditions weren't pre-existing when health insurance was purchased.
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And you can always get 18 months of Cobra, continued coverage from your existing employer health plan, when you quit a job.

Involuntary termination, but does it apply to voluntary?
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Involuntary termination, but does it apply to voluntary?


http://www.dol.gov/ebsa/faqs/faq-consumer-cobra.html

"Qualifying Events for Employees:

Voluntary or involuntary termination of employment for reasons other than gross misconduct
Reduction in the number of hours of employment"
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Involuntary termination, but does it apply to voluntary?

http://www.dol.gov/ebsa/faqs/faq-consumer-cobra.html#.UIHcgM...

Qualifying Events for Employees:

Voluntary or involuntary termination of employment for reasons other than gross misconduct
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I wasn't sure in our case since DW volunteered to be laid off and got Cobra. But she had to be officially laid off to get all the severance stuff. It seems she would have gotten Cobra either way.

You wouldn't think it matters as the Cobra beneficiary pays the full premium plus an administrative fee so the former employer is not on the hook. It's not like a public employee union.

--fleg
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The classic republican solution to this is mandating coverage for everyone (the so-called individual mandate) the classic liberal solution is universal coverage.

No, that's the classic socialist solution.

The classic liberal solution is to have the government less involved, not more involved.

(Unfortunately, socialists in the US have stolen the term "liberal" and applied it to a set of policies that are thoroughly anti-liberal.)
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A agree with the original poster that people cannot buy health insurance after they get sick (the buy home insurance when the house is on fire scenario).

However, current health insurance rules and regulations may force a person to change insurance companies by changing jobs or moving to another state. These people have been insured and should not be penalized with a condition developed while insured because of a forced change of insurance.


That is the law in the state of Washington regarding medical-care insurance; actually a bit more general than that - except for the "moving to another state" part.

In Washington, *by law* there are two insurance pools, the general pool and the high-risk pool. The latter cannot exceed 10% of the population.

If you are a Washington resident and *have* coverage from a Washington insurer, and are in the general pool, you are entitled to stay in the general pool even if you change insurers. That includes both employer-provided and individually-purchased insurance. And you can be uncovered for up to 90 days between policies. On top of which, if you're going for individually-purchased insurance they cannot turn you down.

If you let your coverage lapse for more than 90 days, or move in from out of state, then the insurers get to decide which pool you're in.

So you have a real incentive to get coverage while you're in the general pool, and keep coverage. On the other hand, nobody's forcing you or fining you if you don't.
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Voluntary or involuntary termination of employment

That is good to know. Given my husband's health, it means that I would be able to cover him until he is eligible for Medicare.
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