Pre-Existing Conditions

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Pre-existing conditions are not covered by insurance. And they shouldn’t be either.

Please tell me why an insurance company would take such a risk. It’s not good business at all. And insurance companies, like all businesses, seek to make a profit. If one is always paying out, the profit goes away and the business goes out of business.

Are Leftists up in arms about other kinds of insurance no covering pre-existing conditions. We never hear of any Leftists demanding the coverage of a pre-existing condition on a home or vehicle.

“Hello All State? Yes I would like to get insurance on my vehicle. Oh I’ve had a wreck so it is totaled and needs lots of repairs. So it has a pre-existing condition. You can over that right?”

All State would not cover that vehicle with an insurance policy.

“Hello State Farm? Yes I would like to get homeowners insurance. Yes right now my house is burning so I will need to get it fixed once the fire is out or if the fire destroys it. Yes this is a pre-existing condition of being on fire.”

Here again State Farm would not cover this pre-existing condition. No insurance company would and no insurance company should be forced to do so either. It would cause the company to go bankrupted and out of business. Unless of course that is the goal.

Although these examples were on property the same applies to health conditions. With a pre-existing condition, there is always a payout. That is loss revenue and loss profits. That over time will lead to an insurance company closing its doors forever.

Insurance is to cover something that might happen, that one hopes never does. A payment to cover costs in the event of catastrophe. It is a risk that insurance companies take. They are betting that no event ever happens. But if one has to insure something that has already happened. Then the cost is either going to be very high to cover the outgoing costs. Or it will not be insured.

Additionally, in these debates the terms of health care and health insurance are used interchangeably. They are not the same thing at all. Everyone has access to health care. It is not a right however nor is health insurance.

I have already written on the topic of reform in our health care industry and health insurance industry. If you are interested in these please look up the previous posts on this subject and check the issues section menu as well. Reform in both are needed.

And there needs to be something to assist those with pre-existing conditions as well. But it’s not health insurance since that implies something that hasn’t already happened. What it is, I don’t know, but it should be available.

Author: bynw

Chris aka "bynw" is the site owner and primary post author. A life-long conservative Constitutionalist when it comes to politics. A believer and follower of Jesus Christ. A Linux enthusiast. And a gamer.

3 thoughts on “Pre-Existing Conditions”

  1. So in your opinion, do people with Dwarfism, Autism, Lupus, or any other long-term (life long) conditions not qualify for medical insurance? This is one where I’d have to disagree with you…a car is a physical object and can be replaced, a life cannot. We can’t expect people with these sorts of conditions to simply have to pay for all health related expenses out of pocket. If someone with dwarfism breaks their leg, it’s the same procedure to heal it as a typical person would be, so why should they be required to pay potentially thousands out of pocket for the same procedure a typical person would have insurance for? – As long as they pay their premiums, they should have access to the same insurance programs that average people do. – Now if you want to have a discussion about how our health care and insurance system is all sorts of screwed up then we can talk about that 🙂

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  2. Q: “So in your opinion, do people with Dwarfism, Autism, Lupus, or any other long-term (life long) conditions not qualify for medical insurance?”
    A: No not at all.

    Q: “We can’t expect people with these sorts of conditions to simply have to pay for all health related expenses out of pocket.”
    A: I agree, there are fixed to the heath care industry that need to be done.

    Q: “If someone with dwarfism breaks their leg, it’s the same procedure to heal it as a typical person would be, so why should they be required to pay potentially thousands out of

    pocket for the same procedure a typical person would have insurance for?”
    A: They shouldn’t. The price should be the same across the board with minor market area fluxuation.

    Q: “As long as they pay their premiums, they should have access to the same insurance programs that average people do.”
    A: As long as its covered by your insurance sure should be the same.


    Here is where the socialist change in language has been altered our thinking. Health Insurance is different from Health Care. They are 2 separate things that cannot be used interchangeably.

    Insurance is a means of protection from financial loss. It is a form of risk management, primarily used to hedge against the risk of a contingent or uncertain loss. So by definition a pre-existing condition is not covered as it is not a contingent or uncertain loss. It is a guaranteed loss.

    As the policy holder takes out insurance, paying premiums hoping that they never have to use it. The cost of the premiums are lower than the total cost of the loss to them so the expense of insurance is justifiable.

    Likewise the insurance underwriter is also looking at the risk to see if it justifies the output of the loss in case it happens. The riskier the road or if the output sum is high, the insurance underwriter may demand higher premiums or simply refuse to take the risk. Deciding that they don’t want to take that business which is well within their rights.

    To rephrase what I had written previously on this subject. Insurance should not be forced to insure anything they deem to risky.

    Just as bakers shouldn’t have to bake a cake for an event they don’t want to celebrate. Just as restaurants shouldn’t have to serve members of the Trump Administration if their politics offend them. I am a firm believer in that businesses have the right to refuse services to anyone. And in a capitalist market you can find yourself out of business if you refused too much and too often.

    Of course there are limits on that too. But that is a topic for another post since we are dealing with health insurance and health care here.

    A pre-existing condition is a catch all phrase. It is invoked by insurance companies when the payout is too high over time, because the condition is chronic and requires continuous health care expenses. It can be birth defects or it can be other acquired conditions. And is also usually invoked when attempting to acquire health insurance because the individual is not covered under a current policy. It has also be used to drop coverage of someone as well if they develop such a condition.

    I believe that dropping someone’s health insurance due to developing a chronic condition is morally wrong. The risk was taken. Anyone can develop something. From either an accident the requires multiple surgeries and therapy, to lupus, fibromyalgia, or even cancer. Yes this may mean that premiums may increase for continued coverage.

    And since most health insurance is employer based, because the pool is larger. Pre-existing conditions can develop due to changing jobs. You might be covered for it because you work for employer X but change employers and attempt to get new insurance and you cannot because the pool is too small and the premiums too high.

    Today we have a multiple issues within health care itself as well as health insurance. When health insurance started out, it was meant to cover catastrophic events that occurred. Not every day medical expenses that it covers currently. Both industries are linked together and both are in need of major reform.

    The last reform attempt, the Affordable Care Act, only sought to destroy the private insurance industry as its goal to bring about one payer government controlled health care and health insurance. This is something that is not wanted. There are many cases in nations that have “universal health care” where everything is ran by the government through taxation.

    The government is the provider of care and the government is provider of the insurance. People are denied coverage and care because the government deems the person too high of a risk. If the person seeking care wants it they have to either go out of country, usually the United States or sometimes even 3rd world countries, where they can pay out of pocket for medical procedures that they can’t get at home. And others die because the government denies them.

    Health care is a service industry. But unlike any other service industry, the prices are not known in advance. You cannot shop around for health care services. Prices are widely different depending on where one goes for care, some of the inflated costs of health care stem from the physicians having to have malpractice insurance due to lawsuits and the risk of lawsuits if something goes wrong with the care. This drives prices up because the consumer pays those premiums for the physicians. Hospitals and other care providers need to have their rates posted. Consumers should know them ahead of time and shop around unless of course its a life or death situation, but many times it is not.

    Also health care providers have a range of rates for every procedure. Just like hotel rooms have those cards on the inside of the door saying what the maximum rate is per night stay. We just dont see these rate cards from our health care providers. They submit the maximum rate to the insurance company for payout. Which the insurance company generally pays 70% to 80% of it. Sometimes we as the consumer have to pay the rest in our deductible or sometimes we don’t.

    In the health insurance industry. Prices of premiums of any risk is determined by the available pool of policy holders. Insurance companies are locked to small areas. Unable to offer the same overages across state lines due to state regulations. Somethings are better regulated by the States others are better regulated at the Federal level. Insurance is one of those things that should be regulated at the Federal level. Thus opening the doors of commerce for the insurance industry. Premium rates drop drastically due to larger pools of policy holders and payouts can also become larger as well.

    On top of that is the aforementioned lawsuits against physicians for malpractice when it is not that need to be curtailed too and decrease the cost of malpractice insurance rates. But with wider pools available those rates too will drop. But the courts need to toss out the friviless cases in our sew happy society.

    I have mentioned before that something needs to be in place for someone to be able to afford health care even if they have a pre-exisiting condition. But, by definition, it’s not insurance.

    If an insurance company wishes to cover it and the consumer agrees to pay the required premiums then a deal is a deal. But an insurance company should not be forced to cover it.

    That is what the Left wants to happen so the private insurance industry becomes destroyed and is replaced by the one payer of the government who can also refuse services and then have no other options.

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    1. My wife had a pre-existing condition called breast cancer. Doctor removed a small lump when she was 18. Many years later she was diagnosed with breast cancer and I remember thinking about the socialized medicine debate. I was well aware that this could be like going to the post office if we were under socialized medicine. Thank God we were covered with a private plan. Before we could say anything, dozens of appointments were scheduled and their attitude was “ let’s get on this immediately.” The care could not have been matched by social medicine. My wife always felt confident in the process. Several years later we had the debt paid off and it definitely impacted our credit score. Follow up care was scheduled for us with constant reminders via phone and other. I’m pretty sure that with socialized medicine, my wife would not be here today.

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