Pre-existing Condition clause: The True Evil of Health Care

A lot has been written lately about health care reform and whats needed to change the system. While I wouldn’t mind a universal health care system, I think that level of change will be a generation or two in coming. Like the Civil Rights Movement (which is still waging a war with hatred), health care reform will take place slowly, over the course of many years.

That’s the nature of social reforms, and health care is nothing if its not a social reform. Injecting change into such an industry is time consuming and labor intensive, as we’ve all seen from the endless debates taking place in cyberspace and on the twenty four hour news channels. The endless droning of talking heads, with small, eight second interruptions for sound bites, is more likely to put one to sleep than lead to any real changes.

And I don’t think a massive overhaul is necessarily the best thing. I would be satisfied paying for health care if the two following points were addressed:

1) Make it illegal, across the board, for insurance companies to deny anyone coverage due to any form of pre-existing condition. This would include any ailment, be it cancer, AIDS, or dog bites (I’ll explain why I mention this in a bit) or yeast infections.

2) A limit on prices companies can charge is put in place to prevent private companies from gouging consumers. Further, this price is derived on a sliding scale format with no more than 10% of a families total income devoted to health care. If a universal option is taken completely off the table, this should be a balancer to the Private Sector Overlords who decide who lives and who dies.

As with government, some form of checks and balances MUST be in place for a workable health care system.

A Dog Bite a Day Keeps the Insurance Company From Paying (‘Cause It’s a Pre-Existing Condition)

Back in ’07, I took my wife out to eat on her birthday. We went to a nice restaurant and enjoyed an excellent meal. When we returned home, I noticed our two dogs were getting rather aggressive with each other. We headed out to the dog pen to bring them inside when they started going to town on each other. It was bad. The worst fight they’ve been in since we had them.

I tried to separate them and in the process got bit on my right hand. Once I got them apart, I headed to the ER with my wife and mother. I got in pretty quick, as dog bites are treated as being rather important, and I got treated.

Near the end of our stay in the ER, I filled out the reams worth of paper work that accompanies any ER visit, including insurance forms. We paid the co-pay, and went home.

A few weeks later, I got a letter from the insurance company stating I was not in their records as being covered. Our coverage was through my wife’s employment, so she talked with the insurance company and finally convinced them that a) I existed, and b) was covered since they were taking it out of her check every two weeks. The agent she spoke to said everything was fine.

Six weeks or so later, I received a bill from the ER doctor (since they are all subcontractors now) for $650.00 (or so; I don’t remember the exact amount), and a letter from the insurance company saying that my dog bite was a pre-existing condition and they don’t cover pre-existing conditions.

Now, anyone who is at all intelligent will realize that a dog bite is not, in any way, a pre-existing condition. It defies the laws of common sense to even think that and any rational being should see that.

Yet the insurance company was adamant. I had to pay out of pocket for the ER visit AND we still had to pay our premiums for coverage we didn’t even receive!

So, as I see it, one of two possibilities needs to happen:

1) Full Universal Health Care for everyone, regardless of any other factor to ensure what happened to me doesn’t happen to someone else;


2) Tighter regulations on insurance companies and a complete removal of the pre-existing condition clause from all levels of policies offered by ALL insurance companies. No exceptions and no loopholes.

Combined with option two, above, a across the board reduction of costs to the consumer by, at minimum, 90% so that everyone has a real chance at coverage.

Otherwise, it will be business as usual and some faceless nameless murderer in a suit will decide if you get to live or die.

Organized, legal murder for the sake of the almighty dollar.

Opinions, discussion, and rebuttals (so long as you are civil) are welcome.

About WonderGoon

WonderGoon is seeking enlightenment and questions everything.
This entry was posted in Business, Politics, Social Observations and tagged , , , , , , , , , , , , . Bookmark the permalink.

5 Responses to Pre-existing Condition clause: The True Evil of Health Care

  1. Mike says:

    As with most things, I’m on the fence on this issue….however, this time it’s not because I see this as a blown out non-issue.

    The main problem is that the insurance system as it exists now is complete and utter crap designed by rich folk to steal from everyone else in the name of being humane. The only possible worse institution in the U.S. is the banking system’s use of Mortgages. The only reason it’s used is because like Mortgages, you have no real alternative.

    Insurance in general, and health insurance in particular, is nothing more than a scam. If you tried to pull the same crap in any other industry, you’d get thrown under the jail. The only reason it’s legal is because it’s so obscenly lucrative that the lawmakers have been paid off (or in some cases, the lawmakers family used the proceeds to buy that law degree). It’s one of the biggest examples of why lobbies need to be thrown out of Washington, preferably landing somewhere in the Atlantic with weights tied to their greased toungues.

    In that respect, a socialized healthcare system would be beneficial, assuming the insane leadership of this nation didn’t drop it into the laps of their insurance buddies anyway.

    On the other hand, I’ve not heard much good from the plans being considered so far. In my case, if the current proposals were to take place, I may as well go buy a shovel and start digging my own grave—I’m very overweight, and have diabetes….I’m not worth the healthplan dollar to remove a splinter.

    Ideally, I’d like to see healthcare handled somewhat like they suggest for education, with some form of voucher system. If that sort of thing were implemented, the government run medical facilities provide a price floor guaranteed to provide adequete coverage for the granted vouchered amount. The individual consumer is free to provide their own additional monies for private healthcare, getting whatever additional services they desire (elective surguries, private facilities, etc.)

    I’m sure that plan has fatal flaws as well. As Goon says, this is the sort of thing that does not get solved overnight, but over generations. My fear is that the final solution will be just that— The Final Solution, just kill the unhealthy ones.



  2. Skatha says:

    What about reducing the cost for the patient for preventative measures? If at, say, 30 I would’ve discovered I had a disease that my children could inherit. Why not allow free DNA testing to see if any of my children have it so that they could take preventative measures earlier in life to combat whatever the disease does?


    • WonderGoon says:

      Absolutely. I don’t see thing one wrong with that.

      If the focus of health care is to make sure everyone is as healthy as they can be, then your suggestion should be included in any reform package.

      But, if the focus is on making money, then such a thing won’t be put in place.

      And even if there was a nominal fee for the test, say, no more than $30 or so, I wouldn’t complain too much since the price is low and its something that could save your children’s lives.

      Thanks for commenting.


  3. awfrick says:

    Health-care reform is a nasty issue right now, but I think you’re right; people should be first, not profit. Universal health care is working well in other countries (in some cases, much better). I also think, as a humanist, we have a responsibility to help the 46 million people who have no health insurance, for the exact reason you described with your dog bite; it’s expensive and loaded with red tape.


  4. Mike says:

    The thing is, Universal (or Socialist, as some prefer) Healthcare will not reduce–much less eliminate– red tape.

    The issue will always be money, or in economic terms, resources. The money spent on anything will never be infinate. As such, some form of allocation will need to be put in place, and therin lies the problem. The systems used by other countries that are considered universal do not make better decisions, just different ones. They are still driven by an analysis of profit and loss, and they remove the option of seeking a privatly paid professional if you disagree—not that 90% of us have the resources to utilize that option now.

    Insurance as it stands now is ludicrous. It charges as much or more in a year than the average person would spend in 5—if prices were sane. Worse, it gets away with it because its playing all sides against the middle.

    Sadly, the legal lottery has insured that even minor faults within the medical industry grant huge, mindboggling payoffs—which in turn puts the medical profession at the mercy of the insurance companies to provide that coverage, driving their cost of doing buisness to crazy high levels.

    The result is that prices are not sane, and the feild has been victimized on every level from profiteering drug companies who charge more due to the “higher standards” their products must meet, equipment companies who sell standard items (for instance, $10,000 for a machine that blows warm air under a blanket) at 1000% markups (again, “higher standards” to avoid litigation), and the insurance industry that rakes billions off of every side- be it malpractice or medical.

    Universal Healthcare will not change much of that, merely change who gets to make the decisions—and usually that decision will get made by a guy in a comfortable chair who is looking at books full of faceless numbers with no medical knowlege. Tragically, that might actually help over the current situation, except that same guy will no doubt answer to people currently taking payoffs from insurance lobbiests, if not in the employ of the insurance companies directly himself.


What do you have to add to the discussion?

Please log in using one of these methods to post your comment: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.