Thursday, September 13, 2012

Pre-Existing Condition Fraud

I empathize with those that find themselves with no insurance because of the dreaded "pre-existing condition" road block. I mean what to do if you learn you have a chronic expensive health problem and no buddy will let you swim into their healthcare insurance pool. I can't even imagine the fear, stress and hopelessness one would feel. Totally dependent on the charity of others and/or wiping out your life long savings.

On the other side, imagine yourself sitting in a nice clean swimming pool. The pool cleaning system has been optimally sized for the typical users who have been paying dues, and for people with a typical mix of hygiene habits that may want to join. (ie no extra cleaning capacity) How will you be feeling when a few people covered with mud ask to jump in, even though they had not been paying dues and the cleaning system is not adequate to handle this group of individuals. (ie atypical distribution)

With the above in mind:
  • Will ALL the pools need to invest in bigger cleaning systems and charge higher dues to be ready just in case these folks show up? (ie carry more cash in insurance pool due to higher risk)
  • How will we ensure that everyone is paying for the pool's cleaning system, even when they aren't using it?  (ie paying full premiums no matter their income)
  • How will we keep folks out if they haven't been paying dues consistently?
I am not sure how Obama's plan does this, however it seems the concept is causing Romney some issues... (see links below) Thoughts?

 I like the pool analogy because it hopefully removes the "excessive" profit concept from the argument.  The reality is that running a system like this will be prone to fraud (ie require fence and security guards) and will increase risk to the pools (ie more capability reqd).  Therefore most people will pay more to cover these extra costs.   On the upside, there maybe savings on the other side if it reduces bankruptcy proceedings, obtains some economies of scale, covers some of the healthcare system's buried costs, etc.

Bloomberg Romney on Healthcare
FOX News Romney on Healthcare
The American Pre-Existing
Thanks ObamaCare Pre-existing

2 comments:

  1. The way preexisting conditions are paid for is increasing the size of the pool laying off or diluting the risk. This is really a response to a preexisting problem. The fact is now, we do not deny care to people without health insurance, and so a cost is generated that someone gets stuck with. The process of sticking someone with that cost itself is expensive and distorts the marketplace in various ways, and often the person stuck with the cost has done nothing to deserve it. He or she becomes a mandatory Good Samaritan.

    ==Hiram

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  2. Actually it will dilute and reduce the individual's risk/pain/expense, and increase them for the pools. Therefore the pools themselves will need to grow.

    I think most of these good samaritans find a way to pass the costs on to their other customers. (Ie us...) Otherwise they would be bankrupt. Hopefully they will stop doing this if we are paying these costs up front.

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