Wednesday, January 4, 2017

How to Finesse the "Pre-existing Conditions" Issue

My man Kevin D. Williamson has it exactly right. How you gonna keep Obamacare down on the farm when we the people like the gay Paree of "pre-existing conditions," or being able to sign up for health insurance after we get sick?

That after all is what the "individual mandate" was all about in Obamacare. Says Kevin:
We have to have an individual mandate because we want a preexisting-coverage mandate. If insurers have to pick up the expenses for everyone who shows up at their door with lung cancer or HIV or severe diabetes, that has to be paid for. 
But, of course, the whole point of practical politics is to figure out how to let your supporters off the hook while sticking it to the supporters of the other party.

But let us step back and think about this for a moment. What is it that people really want?

People want to get health care when they get sick.

Very good. But then things get sticky.

If someone has assets, then they will want to protect their assets from the health care bills. These are the kind of people that need health insurance, and they usually get it.

If someone does not have assets, then they are not going to be that interested in getting health insurance. Why? Because if they get really sick then they are not risking their entire life savings. They can always declare bankruptcy. So why pay good money to protect non-existent assets?

However, it is clear to me that anyone that does not have good insurance, or that does not pay their bills, is not going to get good health care. That's why Medicaid patients have worse health outcomes than people of the same income that don't use Medicaid.

I've talked to health care professionals. They hate Medicaid with a passion. Not just because of the low reimbursement rates, but mainly because of the huge cost of interacting with the bureaucracy. They would rather give it away for free than deal with the government.

It doesn't matter how you slice it, the health care system is not going to "put out" for you if you don't pay your bills or you have the bureaucrats at the DMV paying for you.

Let's put it in terms of my reductive Three Peoples theory. If you are a Person of the Responsible Self then you will make arrangements to protect your loved ones and your assets in case of catastrophic illness. So you will probably buy some kind of catastrophic health insurance, and you will probably get good health care when you or yours gets sick. If you are a Person of the Subordinate Self then you will rely on the lord of the manor to take care of you. But the lord of the manor, or his modern equivalent big government, really does not care about people like you, whatever he says. So you will get pro-forma health care. If you are lucky.

Now, I don't know how things work out there in the murky world of the health care system's billing department. But I recall reading that your average hospital will usually try to enroll you in Medicaid if you show up at the ER without health insurance. So there is that.

Maybe that's the solution. Sure, we'll take care of you if you show up without health insurance. But if you do we'll enroll you in our Affordable Pre-existing Condition program, for life, and you will be taxed X% of your income to pay for it for life.

And the health care you get will probably be a very much like the care you get at Britain NHS and America's VA.

Or, you could graduate from the People of the Subordinate Self and become a Person of the Responsible Self. You will find, apart from improved health care, that you will also get a lot more respect.

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