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America’s Pre-Existing Condition

| August 3, 2018

pre-existing conditions pierre tristam segal

‘Untitled,’ by George Segal.

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.

pierre tristam column flaglerlive.com flaglerlive That, of course, would be absurd, insane and unacceptable. But it’s exactly what health insurance companies used to do with people who have pre-existing conditions, and it’s what they want to do again: insure those who are well. Let those who are not fend for themselves. It’s as retrograde a reversal of what health insurance is intended to be as if law enforcement were to arrest only first-time offenders and let repeat offenders go on their way.

We’d never accept that from police chiefs and sheriffs. Why would we accept it from politicians and state government agencies? But we are.

Last month the Trump administration filed a court brief, joining 20 other states, Florida among them, in a lawsuit that seeks to throw out the requirement of insurance companies to cover pre-existing conditions. The states are actually arguing that Obamacare is entirely unconstitutional. The Trump administration isn’t going that far. It doesn’t need to. It’s done plenty to plunder the Affordable Care Act as it is, eviscerating so many of its provisions–cutting off subsidies, aborting birth control coverage, curtailing enrollment helpers and actually shutting down the Obamacare website periodically (shutting down a website?) among other gouging –that the law is already an invalid hobbling in most states. But covering pre-existing conditions had become a moral red line. Then again, moral lines are mere squares in Trump’s hopscotch, there to be hopped on the way to sadism’s plum pudding.


There are many reasons to dispute the validity of Obamacare. The requirement to cover pre-existing conditions is not among them. It is the most popular provision of the 2010 law, because it’s its most effective one. Without it, Americans would go back to the days of bankruptcy by illness, and worse. No coverage doesn’t mean no care, but it means less care, much less preventive care, and more early, unnecessary deaths. As Jimmy Kimmel famously said after his son’s emergency heart surgery last year, “if your parents didn’t have medical insurance, you might not live long enough to even get denied because of a pre-existing condition.”  Covering pre-existing conditions is also a principal  reason health insurance exists, at least anywhere civilized health insurance exists: life is a pre-existing condition. The rest is endurance. 

The point of health insurance is that it’s there when you get sick. That’s why you pay premiums for your whole life, most of it healthy you hope. And if you happen to have diabetes or cancer or had a C-Section, that shouldn’t count against you. Instead, insurers want to return to the days when pre-existing conditions, as arbitrarily defined as drug offenses, are the equivalent of a prior criminal record, there only to aggravate your sentence: not only will you get no coverage, but you’ll get blacklisted across the industry. Until 2010 when Obamacare kicked in, the United States was the exception in the developed world where insurance companies could cherry-pick their clients. It was a simple way for actuarians and annual report fantasists to minimize services and maximize profits.

But Obamacare has done nothing to dent profits. It’s been sending them to new highs. Trump’s own White House this year reported that “the stock prices of health insurance companies rose by 272 percent from January 2014 to 2018, resulting in improved profitability and outperforming the S&P 500 by 106 percent.”

Still, insurers want to eliminate coverage for those who need it most, going back to times when they could deny one in seven people for that reason. It’s part of the ideology of  greed that’s redefined the purpose of essential services. The insurance industry is not here to help you while making a decent profit along the way. You are here to help the industry make obscene profits, pouring in your premiums while you’re healthy and kindly getting out of the way when you get sick. And government should help business get its way. That’s what Florida Attorney General Pam Bondi is pushing for by joining that lawsuit. That’s what the Trump administration is hoping for by lending it its voice.

The GOP line on pre-existing condition was summed up by former New York Lieutenant Governor Betsy McCaughey when she argued that “Obamacare discriminates against healthy people who have to buy their coverage in the individual market,” forcing them to “pay the same price as the chronically ill, whose medical costs are ten times as high, on average.” Odd. I never hear that kind of wishful means-testing applied to Medicare provided to anyone over 65 at the same price, whether the recipient is an obese hedonist with sirloin bile for arteries and $5 million of care ahead as opposed to that of a svelte ascetic whose cost of end-of-life care will approximate that of dust. Totalitarian regimes used to send the bill for the cost of an executioner’s bullet to the family of the executed. Would McCaughey be comfortable sending Medicare’s bills to the family of the expensively departed?

The point is that unless we’re ready to tax butter, sugar, carbs, girths and couch potatoes and raise armies of government pantry raiders and dossiers on every American’s eating and exercise habits (something corporations and governments are doing to excess as it is with their intrusive and baseless wellness programs), it’s not up to us to judge whose care will cost more and why anymore than it’s up to a faceless insurance company to decide who is worthy of coverage and who isn’t. If it’s big government you’re worried about, you’re barking up the wrong call center. Your insurer’s presumptions are the death of you–assuming you’re not lucky enough to be on Medicare, in which case you can be a hypocrite to your clogged arteries’  content and bitch about those younger moochers and cancer losers at the other end of the health care scale.

You think I’m exaggerating? This is the assurance I got in this month’s “newsletter” from my insurer, Florida Blue: “Before you get certain types of care, we ask your doctor to consult with our medical team to discuss and agree on the course of treatment.” A medical team that has more in common with shareholder value than tongue depressors will decide my fate. And we were once worried about mythical death panels. No mystery why that type of company would dance on the graves of clients whose pre-existing conditions it wishes it could shed.

Eliminating coverage for those with pre-existing conditions is no different than applying the principles of Shirley Jackson’s lottery to human beings. You know the famous story you read in high school: when your number is up, it’s your turn to die. Granting insurers the power to decide whom to cover lets them play god with your health’s lottery. It’s cruel enough you might have been dealt a bad hand. It should be criminal to let insurers deny you coverage and brand you a loser on their balance sheet. Instead, Trump, Florida and 19 other states want those crimes to be permissible business all over again.

This country has a pretty sickening pre-existing condition and it doesn’t even know it.

Pierre Tristam is FlaglerLive’s editor. Reach him by email here or follow him @PierreTristam. A version of this piece aired on WNZF.

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26 Responses for “America’s Pre-Existing Condition”

  1. Agkistrodon says:

    Why is it that people from Countries with socialized medicine, e.g. Canada, come to the USA in mass for health care and most surgeries?

  2. Michael Cocchiola says:

    The common theme of Republican thoughts and actions on healthcare in America is that you are completely on your own. If you can’t afford health insurance, that’s your fault. You should have worked harder. If you have a pre-existing condition, bad genes and worse luck. Why should “I” have to pay for your misfortune? There is no “we” in the Republican thought process.

  3. A Concerned Observer says:

    Okay, this story has pulled at the readers heart strings for sick people that can’t pay for the medical attention they need. Well, just bring the issue into the light of day. Insurance companies are for profit companies. They have employees to pay, infrastructure to pay for, stockholders that expect dividends on their investment and yes, those greedy, money-grubbing executive salaries to pay for. On the other hand are healthy people that don’t, at the moment, need medical treatment. Those people are betting they will need medical treatment at some future time while the insurance companies are betting they won’t, or at least, that they will collect enough premiums to more than cover what their actuary tables indicate they will have to pay out. Most of the time, the insurance companies win that bet, if only by a little, and they can even make some more profit if they gamble on the stock and bond market. That’s business, that’s life. “What’s life? A magazine. How much does it cost? It cost 20 cents. But I only got a nickel!.. That’s Life!”

    Now look at someone with an already diagnosed medical condition that will cost them no small fortune. They expect to obtain insurance and have their bills paid for by the insurance company. Guess what? The insurance companies already know up-front that they will pay out large sums of money before collecting any premiums; not a sound business practice. The cold hard fact is that the insurance companies must take in more than they pay out to stay in business.

    Now there is Medicare and Medicaid. Medicare is funded up-front from many years of those pesky FICA payments we’ve all been paying throughout our working life. It too must take in more money than it pays out to remain solvent; a questionable trend at the present. Medicaid pays out for medical coverage for those that have paid in nothing. Not a good business practice at all. Who pays for that? Taxpayers, of course. Everyone must get one fact clearly in their mind. The United States government cannot give anything to anyone without taking it away from someone else first and remain solvent. We are now in a TWENTY TRILLION dollar deficient. That is a mind boggling $21,000,000,000,000 dollars. Twenty trillion seconds equals 634,196 years!

    So, let’s give everyone free medical care and be done with it.

  4. mark101 says:

    Amazing, if you don’t like it here in the United States, please seek a home life in any other country of your choosing.

    I haven’;t had any issues with my health insurance, zero, had, cancer check,,2 knee replacements check, cataract surgery check, gall bladder removal check. NO issues with my insurance. Blue Cross.

    If people are so backwards to believe anything this Upside-Down Pinocchio of a President is saying are delusional.

  5. BMW says:

    I must say, you are consistent in your loyalty to everything liberal.

    The Affordable Care Act was one of the worst written pieces of legislation to ever come out of Washington. Instead of sitting down and addressing problems like unleashed litigation, securing preexisting condition coverage, fraud, etc., the entire system was turned upside down and opened gateways for billions of dollars of fraud via unlicensed rehabilitation clinics, sober houses and an unsurmountable growth of people who could pay but joined under the umbrella of Medicad. The ACA was written in the most discriminative fashion with respect to age. By the time someone is in their late 50’s, securing healthcare eats up a large percentage of their income. For example, my policy INCREASED $1,000 per month in 2017, forcing me into the ranks of an HMO with extremely high deductibles and a reduction in doctor options. As a self-employed individual, the extra $12,000 per year would have meant an additional untaxed income of nearly $16,000 to cover the increase. So while you are throwing out a bunch of ‘what is and isn’t fair or just’, how is age discrimination fair to a 59 year old person who maintains a healthy lifestyle of exercise and diet? If the government can discriminate against age, why not give those of us who take care of ourselves a little financial break, too? I’d gladly submit to an annual drug test and agree to a fairly devised cholesterol and weight standard. This picking and choosing of blatant discrimination is not fair and the ACA should be dismantled and rebuilt with common sense, good judgment and a little fairness incorporated.

    In the meantime, you may want to stop by Publix, tissues for your tears are BOGO thru Wednesday.

  6. mausborn says:

    It is pretty funny, but also sadly pathetic at the same time, that many Trump supporters STILL don’t know that the ACA IS Obamacare. Seriously, they cheer at repealing Obamacare, but they don’t even know that the healthcare they currently have IS Obamacare. Idiots cheering for their own demise, yep, that is a true Trump supporter. Since Trump’s so clueless, just rename O-Care “Trump-Care”. His base too stupid to know the difference and Trump can brag how he replaced “failing O-Care”

  7. Stranger in a strange land says:

    The basic tenants of being a Christian is to take care of those that are less fortunate. The purpose of insurance is to spread the financial risk of a catastrophe among as many as possible so that when catastrophe strikes it doesn’t lead to financial ruin. Many medical disasters are as random as winning the lottery. A baby born with a defect, a thirty year old being diagnosed with colon cancer. That is why we should ALL be willing to pay for health insurance that covers EVERYBODY. Because there, but for the grace of God, go I. One way or another we are paying for EVERYBODY’S care. Are uninsured and indigent people dying in the parking lot of emergency rooms after their condition gets so bad it requires an ER? No, they get the care. We all pay either through taxes or, the insured pay through inflated hospital bills that factor in un paid care costs. We, or our employers then pay higher premiums to cover the inflated bills. The fact is, if these people have insurance that allows care before it becomes critical, the over all cost is less.
    Unfortunately, rather than looking at how other countries handle health care and putting a national health program that picks the best practices of other countries, we had to cobble together a plan that satisfied the financial interests of Insurance companies, Hospital corporations, Pharmaceutical companies, Medical professionals, etc. etc.. Basically, big money groups with lobbying money. That is the way things work here (or, often don’t work). If you care about others, if your religious beliefs say take care of your brothers and sisters, support universal health care. If you are selfish, and want to protect your nest egg from disappearing due to a health crisis in your family, support universal health care. If you are concerned about the fiscal health of the country, support universal health care. The US spends the most per person on healthcare of any developed country. https://www.pgpf.org/infographic/infographic-us-healthcare-spending?gclid=EAIaIQobChMI-vOi-MzT3AIVgcDACh3u6glsEAAYASAAEgKvSvD_BwE

  8. Anonymous says:

    @Agkistrodon…hate to burst your alternate reality bubble, but the US isn’t even in the top 10 for foreigners visiting for medical reasons.If fact about 10 times as many US citizens travel abroad for medical purposes that travel here from foreign countries.

    https://www.medicaltourismmag.com/top-10-medical-tourism-destinations-world/

    According to Patients Beyond Borders, approximately 900,000 Americans went outside the U.S. to find medical treatment last year and the number has been rising consistently over the last decade.

  9. Anonymous says:

    What IS “absurd, insane” is the notion that INSURANCE is something one buys AFTER you need it.

  10. bill says:

    @Anonymous

    Ill bet the vast majority of those top 10 medical TOURISM destinations are for ELECTIVE cosmetic surgery NOT live saving surgery’s.

  11. John Dolan esq. says:

    When we allow bean counters to decide which medical procedure is best for us we are doomed.
    Well, unless you go to Dr. Fruitcake on Pine Cone.

  12. Dave says:

    Anonymous why would you have insurance before your diagnosed? You must be sick to get diagnosed, and why would you have insurance if you aren’t sick? I don’t see why someone would pay for insurance if nothing was wrong with them. And if something did seem to be wrong you get insurance for the year and go to the doctor,try and cure your illness and then cancel your insurance. You dont jus obtain insurance ,pay monthly ,just incase you get sick.

  13. Mark says:

    I guess when I buy auto insurance they should fix my previous lumps and bumps.

    I guess the government is responsible to provide everything I need.

    If us fortunate are responsible to provide for the less fortunate then I should give them part of my paycheck. Why should it go too a government that cannot manage it’s money?

    I am not responsible for anything in my life.

  14. MRC says:

    Thank you Rick Scott, a former insurance company executive and whose wife is still involved with. I know what this means. I have been denied coverage in the past and wept many tears over having terminal disease states and not having insurance or have been denied needed treatment. Time to seriously clean house starting at the top and very the sake of every Floridian citizens VOTE them out! Time to drain the proverbial Florida swamp!

  15. oldtimer says:

    My question is should everyone get the same level of care ( remember congress passed Obama care but didn’t have to take it ) and if so how would it be funded

  16. Percy's mother says:

    Pierre

    Last year you wrote a piece about the cost of Obamacare and referred that the cost was becoming prohibitive, so much so that you and your family were living like “sharecroppers”.

    So why are you defending an extremely flawed piece of legislation. The deductibles are so high that Obama should really be classified as catastrophic insurance. If you have a $5000+ deductible, everything up to that point is out of pocket. So what’s so great about it? Wouldn’t something else be better. Do you really want to keep something that doesn’t work for most of the insured population? Don’t get you at all.

  17. Dc says:

    @Dave, so you’re going to purchase your life insurance policy after you die? The purpose of insurance is to have just in case you get sick.

  18. Richard says:

    ACA – Affordable Care Act was only affordable for the people who had no money to pay for the premiums or had pre-existing conditions. It was NOT affordable for all of the healthy people who did not use it that often or even needed all of the coverage that it mandated yet THOSE are the people paying the HIGH premiums for the former group. That kind of healthcare is NOT what I signed up for. I don’t mind paying for healthcare but this industry plus the RX industry have gone ballistic with greed and corruption. If those people who have strong beliefs in regards to socialized healthcare there is nothing stopping you from moving to another country where they have those FREE benefits. In fact I would bet that there are MANY people who would donate to a GoFundMe page for you to leave! Here is a link to a comprehensive list where you can make your selection. https://en.wikipedia.org/wiki/List_of_countries_with_universal_health_care

  19. Agkistrodon says:

    @Anonymous Look at your facts again, the BULK of those are for cosmetic and procedures NOT approved in the US. And for the record, if you look further, MANY of those experience bad effects from those procedures and quite a few die. I am talking about the Canadians and Europeans who come here for Cancer treatment, quality of life type care(knee replacements), and cardiac surgeries. You see if you actually read the facts, the facts trump the feelings. But you have to read the COMPLETE facts. Don’t forget in a country of over 330 million 800,000 plus or minus, is a drop in the bucket.

  20. Sherry says:

    Speaking with 11 years of professional health insurance underwriting experience, “INSURANCE” is all about “sharing the risk” of extremely expensive health care among a “group” of people. That “group” MUST contain those who “will not” require a claim pay out in any given year, as well as those “who will”. The “risk” must be spread among the “entire” group, for the insurance company to be viable, much less profitable.

    The car insurance analogy is a great one, if looked at correctly. We cannot buy car insurance “only after” we have an accident. In fact, we all are “required” to buy basic car insurance in order to have our cars legally registered to be on the road. Yes, some people will cheat and drive without insurance. But the vast majority of us responsible citizens do our duty and protect ourselves. . . AND one another. . . by buying car insurance. We should not be making personal and legal/political decisions based on the fear of those that
    cheat. Buying car insurance to protect us against “uninsured” motorists may be prudent, but it is not required.

    Why shouldn’t it be the same for health insurance?

    Remember, the Republicans have had now over EIGHT years to come up with that “better” plan they “promised” over and over again. Where is it?

    Oh and BTW. . . Congress is NOT exempt from getting their insurance through the ACA (Obamacare):
    https://www.verywellhealth.com/is-congress-exempt-from-obamacare-4107197

  21. Agkistrodon says:

    Wow an whole eleven years. Insurance companies and those involved are like parasites. They live off other peoples fears and money. I have known many, they were all con people.

  22. Pogo says:

    @Lies, damn lies, and Republican lies

    Medicare for all is a matter of scaling Medicare to replace the corrupt and immoral status quo. Liars will speak of the cost of Medicare while willfully ignoring the obvious: Medicare for all would be replacing something – not an expense in addition to the profiteering and gouging it would replace.

    Wake up. Vote Republicans out.

  23. Anonymous says:

    @Agkistrodon .facts trump feelings? yet you posted zero to substantiate any of your blabber. People die overseas from poor treatment? Thank god that doesn’t happen in Murica…or maybe it does….

    https://www.cnbc.com/2018/02/22/medical-errors-third-leading-cause-of-death-in-america.html

    A recent Johns Hopkins study claims more than 250,000 people in the U.S. die every year from medical errors. Other reports claim the numbers to be as high as 440,000.
    Medical errors are the third-leading cause of death after heart disease and cancer.

    We pay almost double what most other countries pay for health care with mediocre results. And those “socialists” are the dummies? LMAO

  24. capt says:

    As the myth busting website Snopes points out, “contrary to popular belief, Congressional members do not receive free health care.” Instead, they choose a gold-level Obamacare policy and receive federal subsidies that cover 72 percent of the cost of the premiums.

    In short, Snopes reports that members of Congress and staff “pay approximately 28 percent of their annual healthcare premiums through pre-tax payroll deductions.” They also have access to “free or low-cost care” through the Office of the Attending Physician as well as “free medical outpatient care at military facilities” in the D.C. area.

  25. Nancy N. says:

    If American medical is so great, how do you explain that we have the worst maternal-fetal mortality rate in the western world?

  26. Bernie 2020 says:

    Obamacare was to be a basis to change how healthcare was delivered. Worts and all, it was a policy to improve and it was hugely successful… until the GOP got their hands on it to save their friends and investors. They are close to making a total reset to be back to Bush era Healthcare polices. Great Job.

    Just in Florida where the FEDS handed millions of dollars to Gov Scott and he refused to expand Medicare. it is 2018 and I still can’t get my insurance company to tell me what they cover until after I get care. Everyone reading this has had to fight with an insurance company because they decided not to cover something your licenced educated doctor said was best for you. How is that legal? Any other service from washing a car to building a skyscraper you can get estimates so you can budget but you can’t with healthcare?

    People just need to get off their high horse and realize that most of men and woman that run both parties don’t care about you and will sell you out for any campaign contribution. Very few care, it is time for us to change our country by running and voting for people that are like us not playing to us. .

    I hope Sanders keeps pushing the Medicare for all solution because it will save people lives and improve care. He is also a good man so I wish he was our president.

    Case in point I have a friend with horrible mental illness. One of the smartest most talented men I know, but without proper care he can’t function. So instead of supporting his family and working on his music and using his talents in programming and education, he is stuck in a room in his house trying to keep himself from suicide because he can’t get the help he needs. He can’t afford insurance because he can’t keep a job and when he asks for help they put him over the same red tape and al he gets is a script for Pot. If he lived in Canada or England or even Cuba, I know his outcome would be different.

    Also how many of the suicides in this county are from illness? How many of them could have been saved with just basic treatment and medication?

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