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It Should Be Criminal to Let Health Insurers Deny Coverage Based on Pre-Existing Conditions


It Should Be Criminal to Let Health Insurers Deny Coverage Based on Pre-Existing Conditions

Pierre Tristam

Imagine this scenario. Flagler County Sheriff’s deputies are arresting a man for domestic violence. They read him his Miranda rights. Then they ask him a question: Have you been arrested or found guilty of any crime before? The man says yes, he has. A couple of times. Ah, in that case, the cops tell him, you’re free to go. We don’t arrest people with a pre-existing record, only those with a clean record. Makes our life easier and we don’t have to waste time and money on you losers.


The depraved evil of the prevailing US economy…


Well shit, living is a pre-existing condition.


Until health care and human health are embraced as HUMAN RIGHTS by a critical mass of people and the governing elites of this nation, we will continue to deal with this crap on a piecemeal basis.


It Should Be Criminal To Allow For-Profit Health Insurers, period. Eliminate the middle men ripping everyone off and have a direct Medicare for all system.


Therein lies the reason Healthcare Insurance can never be sustained.


The Romans came up with the phrase “Momento Mori,” = “Remember you must die.” So following that, as soon as you are born you are dying-----so every life birth has a pre-existing condition !

I suppose Big Pharma and big medical health care companies will in the future make everyone have genetic testing to show what they MIGHT have as they apparently only want to insure healthy people. Pretty soon , no one will have health care, but then— if we had clean air, water and food, and if America at al would stop using depleted uranium, white phosphorus and agent orange ( aka Round Up) maybe we wouldn’t need health care. : )


“A medical team that has more in common with shareholder value than tongue depressors will decide my fate”.
That’s the way its been since the AMA pushed people into healthcare insurance in the 1940’s, and will remain until we remove insurance companies from the equation.


And that condition can best be described as: “Shareholder value uber alles”.


If you are covered by a group policy, some members of your group have higher health risks, some lower. On balance, the calculation is that the entire group pays enough to cover everyone. The group could be an employer, or a union of workers, etc., but it needs to be statistically large enough to spread the risk. A policy covering an individual poses a greater challenge for insurers, since presumably the higher risk individuals would be more likely to buy insurance. Hence the scheme to exclude pre-existing conditions. That is the ready excuse. In reality, excluding pre-existing is used by insurers to keep more money for themselves, regardless of the size of the paid-in pool of money.

Which is why Medicare-For-All is such a good solution to this risk problem: everyone is in a giant ‘Group’, and the risk is spread evenly, and much more cheaply. It is the only way to solve this, and many other, problems plaguing our health care non-system.


Yes. That, or a law firm. I’ve even heard doctors use the term “due diligence” when I complained to them complaining about the too-long timeline for a cancer diagnosis and treatments for my spouse.


Ugh, no. Forcing insurers to cover pre-existing conditions of course nullifies the concept of insurance in the first place. You cannot insure a calamity after the fact. You can’t insure against a fire after the fire. Life is harsh. Life isn’t fair. But no, you can’t create utopia by fiat. Forcing insurers to cover someone after payouts are guaranteed simply increases insurance rates for everyone else and makes healthcare even less affordable.


The bigger issue is that we have a human right to health care PERIOD. As for actuarial groups, risks of individual within each group constantly change for all kinds of reasons/situations and luck. Actualarianism is really a lousy way to determine weather people have access to the healthcare that they need. Also actualarianism cannot calculate for the health factor itself.

People who have access to healthcare, health education, decent food, healthy living and exercise will bring down costs overall because they are…well…healthier and contribute more to life. Actualarianism works for for-profit health parasites and not people.


But you can create a reasonable Scandinavian social democracy with universal coverage in the US if enough people wake up, search and read, and then vote (and even run for office if they are able).

I understand the issue with pre-existing conditions and private insurance - you can’t expect a company to insure people who don’t pay until something goes wrong. There was an effort to address this with the ACA (by making insurance mandatory so you’d be paying in before your problem), but most of us here feel that this effort fell way short and we want Medicare for All period. I think we will get it and you’ll just have to suck it up and complain about something else.


As long as you let the rich determine your fate…what do you expect?


It should be criminal to allow any business to profit off of the sickness, injury, or suffering of others.


You’re intentionally stupid.

If it’s an impossibility, how do the dozens of countries that enforce it have better health outcomes at lower cost that the USA?


In insurance parlance, ‘pre-existing exclusion’ means the illness you have before you started to pay for a particular coverage will not be covered. By this logic, your explanation sounds eminently reasonable, albeit cold, which is why insurers have used it so effectively for so long.

But wait, look at the end game of Medicare-For-All. Your right to health care started when you started to ‘exist’, or conceived to be a denizen of this land, hence no ‘pre-existing exclusion’. It is at once caring AND fiscally sound.


Health insurance’s first duty is to their shareholdersnot the insured. Denials, pre-existing conditions clauses etc, all exist to increase profit. Health insurance is not health care.

Obama had to pay insurance co’s to stop denying service but there’s no end to that, they want more and more of the US Treasury. Is this where our health care dollars should be spent – pacifying Big Insurance and Pharma?


Yes, this is exactly what insurance is. It may be fine for your car or house. Mind you, one is required to buy insurance for both. It’s illegal in most states to drive an uninsured automobile and no mortgage company will hold a loan on a house that is not insured. These costs are relatively minor to the owner.

Health insurance however is a major expense and where the real money is. Health care never should have been set up to be “delivered” (actually insurance is a middleman) through insurance. Insurance’s first obligation is to their shareholders – not to the insured. Denials increase the bottom line for the shareholders and do nothing for the health of the citizens of this country. And these people usually end up being treated one way or another, but then it’s on the taxpayer’s dime. How is that any better for anyone?