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.

Twelve Things the G.O.P. Should Do to Replace Obamacare

1. Make the federal government adhere to its constitutionally enumerated powers, and simplify and roll back federal involvement in health; by repealing nearly the entirety of the Patient Protection and Affordable Care Act (Obamacare).

2. Reduce limitations on coverage of health insurance subscribers, by keeping the Obamacare provision that allows young adults to stay on their parents' health insurance plans until the age of 26.

3. Put health insurance providers on an equal playing field with consumers, by allowing health insurance providers to deny coverage, and to change the price of coverage, on the basis of pre-existing conditions.

4. End the punitive and unnecessary enforcement of the "individual mandate"; repeal the individual health insurance purchase mandate, and repeal the fine ("tax") on failing to purchase insurance plans.

5. Make it easier for people to keep their health insurance when they move to a new state, by allowing health insurance plans to be bought and sold in any state, as long as the plans fit the requirements set by the state in question.

6. Make it easier for people to keep their health insurance when they lose their job, by ending the tax credit for employer-provided health insurance, or make tax credits equally applicable to all.

7. Allow for long-term planning of health care expenses, by expanding health savings accounts (H.S.A.s); allow people to save unlimited amounts of money in H.S.A.s.

8. Provide income relief for health care workers by repealing taxes on the income of doctors and nurses, and other workers providing health care services, whether they work at hospitals, religious charities, or other enterprises.

9. Make medical devices more affordable for hospitals, by repealing taxes on the sale of medical devices, and by repealing taxes on profits from medical device sales.

10. Help decrease overall federal spending in non-enumerated policy areas; by not only curbing the growth of Medicare and Medicaid, but by refraining from allowing their budgets to grow (in terms of inflation adjusted dollars), at the very least, if not by cutting those programs overall.

11. As soon as possible, cease federal involvement in health when not directly pertinent to the health care and insurance of federal workers; and devolve most (if not all) federal health affairs to state and local governments.

12. Abolish or drastically reduce all taxpayer-supported artificial business privileges, supports, protections, and favors given by government to enterprises providing health insurance and care.




Author's Notes:

     There are probably very few Americans who agree with me on both Point #2 and Point #3. Most Democrats agree with me on Point #2 and disagree with me on Point #3. Most Republicans disagree with me on Point #2 and agree with me on Point #3.
     I support allowing in all cases; that is, allowing young adults to stay on their parents' health insurance plans until they're 26 years old, and allowing health insurance companies to deny or charge for coverage on the basis of pre-existing conditions.
     The position I take is non-ideological, I take my position without regard to its effect, and with my position I intend to benefit no particular class or type of people. If Obamacare required young adults to stay on their parents' plans, or required insurance companies to offer plans that 25-year-olds can be on, I would oppose that measure, even though the effect of my position would bring about the opposite state of affairs.
     The point is to oppose more requirements and more force in health, and to support more freedom. As a parallel to what I explained above, since Obamacare requires health insurance companies to insure people with pre-existing conditions, I oppose it, because I know more freedom means more choices. Moreover, people with pre-existing conditions need care, not insurance, and you can't insure against something that has already happened.



     Additional taxes that should be reduced and repealed, in addition to those mentioned in Point #8 and Point #9, include the following: 1) sales taxes on medications; 2) taxes on profits from sales of medications; 3) taxes on sales made by hospitals; 4) tariffs and duties on imported medications; 5) taxes on the sales of ordinary non-health consumer goods that health workers and patients buy every day; and 6) the "inflation tax on savings" that dilutes the value of health savings accounts.
     Lowering taxes on health employee income and purchases, medication importation, and savings, will help increase affordability of health care and medications, improve the free flow of medicine across international borders, and increase affordability of ordinary goods by the people who provide health services, helping ensure that nurses are not struggling to make ends meet.
     Monetary reform will be necessary to "repeal" the "inflation tax" mentioned in Tax #6 above. An additional tax measure pertinent to health is to allow people to deduct health care expenses from their taxes, perhaps in addition to elder care and child care expenses. This would help return more of the taxpayers' money back to them, while increasing affordability of health care for anyone and everyone who generates income (or is dependent upon someone who generates income for health insurance).



   Point #12 should be construed to recommend the repeal of laws limiting the importation of prescription drugs from foreign countries; these laws show favoritism towards domestically produced American pharmaceuticals, and the result is that American patients pay higher prices.
   Another example of taxpayer-supported artificial business privileges is the overly lengthy intellectual property protections on pharmaceutical drugs. Government enforcement of drug patents helps give domestic pharmaceutical companies security on the taxpayer's dime; this aggravates the problems of few choices and high prices.






Final Author's Note:

     On March 9th, 2017, I changed my position on Point #2. I supported the provision of Obamacare that allows young people to stay on their parents' plans until they turn 26, because I misunderstood what the provision does. I oppose federal laws that require insurers who issue family health insurance plans to allow 26-year-olds to stay on their parents' plans until they turn 26. I oppose this provision of Obamacare, and I oppose the pre-existing conditions provision as well. I now oppose full repeal of the A.C.A.; full repeal of both of these provisions, and the five other major provisions of Obamacare, including the individual and employer insurance purchase mandates.




Written on January 6th, 2017
 
Author's Note on Point #12 Added on January 25th

Author's Notes on Points #2 & #3, and #8 & #9, Added on February 18th, 2017, based on notes from February 8th

Final Author's Note Added on March 9th, 2017