Health Insurance and “Pre-Existing” Conditions
In an effort to help increase understanding of why insurance companies do some things, let’s take a closer look at some issues. A good place to start seems to be pre-existing medical conditions, something I can speak about with some authority, because I happen to have one.
A good analogy (not perfect, because no analogy can be perfect) is that of the church or work potluck. You may know it by another term depending on where you grew up, but what I am speaking of is a gathering where everyone brings food of some sort, and then the group eats from what is brought. This analogy works well because in health insurance, a group of people (I’ll call them the members) put money into a big pool, which is then used to pay for the medical expenses of the members of the group. (Unlike what some people seem to believe, insurance companies don’t have a huge orchard of money trees in some hidden underground greenhouse.)
The rules of a potluck (usually unwritten or unspoken, but still real) are that those that don’t bring a dish to the table don’t eat from the table; it’s simple fairness. Unfortunately, there are those that will try to eat from the table even though they haven’t brought anything. The same thing happens, unfortunately, in health insurance; people without coverage will try to sign up only after their doctor tells them they have a serious condition.
In order to combat this, most reputable companies (and I’ve been covered by several) will have what’s called a “waiting period”–in my personal experience, it averages about 90 days–before the insurance will cover treatment for any pre-existing condition. Agan, I’ve run up against this myself, and it does not–I say again, does not–mean that you can’t get treatment for the condition, it just means that you have to pay for it yourself.
This may, on first glance, seem unfair, but what the insurance companies are doing is making sure that people put some money into the pool (bring a dish to the table) before they take money out of the pool (eat from the table). Again, it’s simple fairness, or, as Joe Biden might say, they’re making sure everyone has skin in the game.
Of course, there are some difficulties, but the best way to solve most of them is simply through education. If we make it a point of personal responsibility for employed people to make sure that they have coverage before they develop a serious medical condition, it would solve a large portion–if not most–of the problems people are having with pre-existing condition waiting periods. After all, you don’t buy homeowner’s insurance only after you have a fire, you get it before the fire. I am leaving out the poor and disabled, because they’re already covered under existing programs, such as Medicaid. There’s still a difficulty with those who become unemployed while they have a serious medical issue, but that shouldn’t require a complete government takeover to fix.
In short, if you get coverage before you get a condition that might be called pre-existing, then you’ll have brought your food to the table, and when the time comes, you can eat from the table. It’s really that simple.