Wednesday, January 11, 2017

In Defense of Allowing Denial of Coverage on the Basis of Pre-Existing Conditions

Written on January 11th, 2017
Edited on January 25th, 2017

          Health insurance companies should be free to deny subscribers coverage, and raise the prices of premiums, on the basis of pre-existing medical conditions.
     It may sound inhumane to advance this position, but it only seems cruel when we forget that insurance is supposed to insure against things that haven't happened yet; it is irrational to insure against getting a disease that you already have. If you have a pre-existing condition; what you need isn't health insurance; it's health care.
Taking this position seems even more inhumane when we forget that the provision of Obamacare that opposes that pre-existing conditions policy, by design, rests (in terms of implementation) on the completely illogical Individual Insurance Purchase Mandate, which was somehow found by the majority of the Supreme Court to be the most appropriate part of Obamacare. This means that once the Mandate falls, most of the rest of Obamacare falls. Moreover, the health insurance industry might not even need to exist.

It's not necessary to compel anyone to purchase health insurance, especially with people they may not want to be in the same pool with; whether that's because they have expensive conditions, or because they're older (and therefore more prone to disease), or simply because their political values - and their ideas about what health policy should look like - are different from other subscribers'. It is not only unnecessary to compel anyone to be in the same health insurance pool as any other particular person, for whatever reason; it is a violation of our constitutionally recognized freedom of, to, and from association.

Single-payer systems and public options can be made obsolete through the focused pooling of assets into voluntary health insurance cooperative plans. This idea replaces competition-destroying monopsonies (one-buyer systems; i.e., single-payer systems) with consumer-cooperative purchasing societies; market actors that can grow as large as necessary (in terms of purchasing power) in order to affect prices in a way that obtains low premium prices for all members of the pool.
The only way to justify continuing the Pre-Existing Conditions provision of Obamacare on grounds of freeing and opening people's access to trade in health insurance, is to absurdly argue that ordering someone to purchase something, is the same thing as allowing them to purchase it.
The blatantly unconstitutional Individual Insurance Purchase Mandate flies in the face of the Fifth Amendment Takings Clause, and the Supreme Court opinion that upheld it undermines everything that a logical and fiscally responsible society ought to understand about what the difference should be between fees and fines, and between taxation and theft.
The government regulates people for refraining to engage in commerce by buying health insurance. Next it tries to address the problem of people being uninsured because they can't afford it, by requiring people to spend money they can't afford to buy the insurance. It passes this off as helping the poor.
Finally, it regulates the commerce (buying the policy) because it's commerce now, even though you wouldn't have engaged in commerce unless they ordered you to buy it. Still, you're theirs to regulate, even if they only have federal jurisdiction but you can't even buy policies from other states.

None of this is necessary. Doctors' Hippocratic Oaths include pledges to help patients regardless of their ability to pay. If Hippocratic Oaths were enforceable (whether by government, or by non-state-actor contract enforcement agencies), then doctors who agree to abide by that oath would not legally be free to decide whether to turn patients away.
If that happened, and if the parts of Obamacare that violate the Constitution were repealed, then patients wouldn't need health insurance companies. Not only that, but our supposedly caring government wouldn't even force patients to trade with health insurance companies. Without the Individual Mandate, government couldn't force us to buy from these companies; and without the Individual Mandate, there would be no need for government to force companies to accept us.
          Remember, this is the same government that is limiting people's choices about what kind of medications they can try to save their own lives, taxing profits and sales of medical devices (raising prices and increasing malpractice lawsuits in the process), and enforcing medical patents for overly lengthy time periods in order to benefit Big Pharma (which makes the problem of availability of medical devices worse).
Meanwhile, the Third World suffers from disease, and Americans aren't allowed to buy cheaper drugs that imitate the patented ones, from Canada or Mexico. Figures in liberal media that "open borders is a Koch brothers proposal" so that we won't become aware of the hazardous effects that state and national borders have on the affordability and variety of consumer goods (medications and medical devices included). There are plenty of changes to health policy that would be more appropriate than six of the seven major provisions of P.P.A.C.A..

          I oppose the Pre-Existing Conditions provision because it takes away a valuable freedom - the right of the insurance company to deny coverage - without compensating them for this takings, and without allowing individual insurance companies to refuse or opt-out. If the Supreme Court had ruled the other way, this takings would be seen as the extrajudicial theft that it constitutionally is.
            Barack Obama's signature piece of legislation was a failure and a waste of public attention and money. In my opinion, about eighty-five percent of the Patient Protection and Affordable Care Act has absolutely no constitutional or economic merit to it. I believe that it has only served to make the health care and insurance industries more complicated (both for its employees and for patients); more plagued with financial and procedural problems; and less compatible with civil liberties, due process of law, the right of private property, and a federal government that enforces strictly limited intellectual property rights laws, and obeys suggestions by the framers about what kind of taxes are permissible and why.
           We should be allowing more people to buy insurance, not forcing people to do so. If young people are allowed to stay on their parents' insurance until they're 26, that's fine, because that's freedom. It would not be freedom if they were ordered to stay on their parents' plans. For the same reason, government allowing denial of coverage is a freedom, while government forcing you to be covered by compelling you to buy, is the opposite of freedom; it is command-and-control economics.

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