The Sovereign Mind

Free thought on politics and real life

Our Little Pre-Existing Condition

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I hesitate to post a picture of my son for all the world to see, but I thought it was important that you see my inspiration for this topic. Too often we talk of politics as if it’s some cold theoretical science. Once in a while, politics and real life collide and we understand why the policy debates matters at more than just a cerebral level.

On my son’s first birthday, he enjoyed his first–and probably last–birthday cake. Since he was born he has had severe reflux. After being told a hundred times that he would grow out of it, he was diagnosed with Eosinophilic Esophagitis (EE) shortly after his first birthday. The disease causes him to be allergic to many foods. The hardest part is that we don’t know which foods he is allergic to, since traditional allergy testing is not as effective for kids with EE. After his diagnosis we removed some foods we thought bothered him the most, but we didn’t see any significant improvement. Finally, as many EE patients eventually do, we took away all foods and fed him a complete-nutrition hypo-allergenic formula. The taste of the formula is horrible, which is why he needs the NG-tube so that he can get enough. After that we saw improvement in his condition. We finally got to see the little boy inside of him–the one who is not screaming all of the time. We are now trying to introduce foods one at a time, to see which ones he reacts to. So far, the only food that he can eat is pear (precious, blessed pear). My son will probably deal with this for the rest of the life, unless some miracle cure is found.

My point in sharing this is not to make you feel sorry for me or my son. I would not trade out trials for anyone else’s. Firstly, there are many kids worse off than he is. His condition is chronic, but not fatal. Secondly, as parents, it is our responsibility to teach our kids how to deal with life, with the challenges it brings. We will teach him to be strong, and not to be a victim. Lastly, I am fortunate enough to have a good job where I bring home enough to support my family so my wife can stay home with him and our daughter, and I have good health benefits. Sure, there have been times when we have disagreed with our insurance company on what is best for my son, but in general they’ve been good. For example, they agreed to cover his expensive formula, which we’re told most insurance plans will not. They would not, however, cover his portable feeding pump, insisting that we instead feed him manually (a process that requires him to sit stationary for a half hour, six times a day). So we had to turn to our secondary insurance for that: eBay.

Had my family been in less fortunate circumstances, I might have had to find a way to pay for my son’s health-care, or a costly insurance plan that would agree to pay for his needs. Saying we are “high risk” doesn’t seem adequate, since there is nothing unsure about it: my son requires expensive health care, and he probably will for the rest of his life. Doctor’s visits every-other week, expensive testing and supplies, not to mention his formula. If not for my employer-sponsored pool, what insurance company would cover us? They’d be foolish to.

With this in mind, how the presidential candidates deal with pre-existing conditions is not just one part of their health care proposal. To me, it is the foundation on which the plan either succeeds or fails. So, let’s look at each of their plans on this issue. I would love to have enough time to analyze each of their plans in full, but here is just a brief overview of how I view their plans.

John McCain

McCain’s health care plan tries to encourage a more market-based approach to health care, where individuals would be more able to choose their own coverage instead of relying on their employer. The thought is that this would make individuals more cost-conscious about their health care, which in turn would lower costs overall. The problem, though, is without the protection of a employer-sponsored pool, how is it possible that high risk patients could possibly get affordable plans on the free market. This is an example of one of the problems with the free market that I outlined in my previous post. McCain’s solution:

As President, John McCain will work with governors to develop a best practice model that states can follow – a Guaranteed Access Plan or GAP – that would reflect the best experience of the states to ensure these patients have access to health coverage. One approach would establish a nonprofit corporation that would contract with insurers to cover patients who have been denied insurance and could join with other state plans to enlarge pools and lower overhead costs. There would be reasonable limits on premiums, and assistance would be available for Americans below a certain income level.

So, high risk people would be pooled with other high-risk people and those pools would be sold to the insurance companies? Nothing about that says “affordable” to me. I appreciate the “reasonable limits on premiums”, but he does not mention how that would be accomplished. The bottom line is that I’m sure to get worse coverage at a higher rate than I am now if my employer decides to drop their plan due to McCain’s plan.

Bob Barr

Barr’s health care plan is vague, but basically amounts to having the government get our of health care and let the people buy their own. He doesn’t mention anything about pre-existing conditions, but another part of his website hints at how he would handle the problem:

Government should stop acting as the welfare agency of first resort under the guise of providing social insurance. In general, private charity should be the first resort for anyone in need. The process of welfare reform begun by Congress in 1996 should be continued to reduce even further people’s dependence on Washington. In 2007, for example, Americans gave more than $300 billion to charity, an increase over 2006 despite growing economic uncertainty. Government should eliminate regulatory barriers that inhibit private philanthropy, and expand tax deductions to encourage charitable giving.

Personally, I love the idea of expanding tax deductions for charitable giving, and I agree that Americans are very generous. I would love to believe that Americans would be willing to take care of each other, without the need for government. That sounds like the ideal solution, but unfortunately I can’t believe it just yet. The fact is, even with the government health programs we have today, there are still many people suffering because they can’t get affordable, quality insurance because of pre-existing health problems. Clearly, the charitable organizations are not fully up to the task today. So why should I believe that we, as a community, would all step up, if we are not already doing it?

Barack Obama

If McCain and Barr don’t do enough to help high risk individuals get affordable health coverage, Obama’s plan goes too far the other way:

The Obama-Biden plan will create a National Health Insurance Exchange to help individuals purchase new affordable health care options if they are uninsured or want new health insurance. Through the Exchange, any American will have the opportunity to enroll in the new public plan or an approved private plan, and income-based sliding scale tax credits will be AFFORDABLE, ACCESSIBLE COVERAGE OPTIONS FOR ALL provided for people and families who need it. Insurers would have to issue every applicant a policy and charge fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans offered are at least as generous as the new public plan and meet the same standards for quality and efficiency. Insurers would be required to justify an above-average premium increase to the Exchange. The Exchange would evaluate plans and make the differences among the plans, including cost of services, transparent.

I credit the Obama campaign for at least recognizing that something needs to be done about this issue, and not treating it as an after-thought, as it feels the other campaigns have. However, I feel he has gone too far in the other direction. Under his plan, patients would pay only according to what they make, regardless of their health status. This basically takes all decision making out of the hands of the free market regarding who insurance companies can cover and at what price.

The problem I have with this is that some pre-existing conditions are not preventable, but some are. Should I really be charged more to compensate for those who make poor decisions, have illegal habits, or have dangerous lifestyles? Obama loves to criticize McCain for using a hachet instead of a scalpel when it comes to the economy. To me, Obama’s plan feels like a hachet.

Conclusion

Clearly, this is not a problem that will be solved by any of the candidates. Whoever gets elected, I hope that the conversation on this issue doesn’t end. I don’t have the solution. My instincts always favor a free market solution, but on this issue I simply don’t see how the free market alone can make this work. If anyone can show me why I’m wrong, I’m all ears.

But here are some guiding principles I’d like to see discussed:

  1. A fair system would penalize people for their choices, not their health status. It’s fair for a smoker to be charged more for health coverage than a non-smoker, for example. I’d be in favor of regulation that requires insurance companies to come up with formulas to determine premiums based only on choices, and to publish their formulas so it can be independently verified that customers are being charged according to the formula. I admit though, that this is easier said than done. How would you, without bring an end to freedom as we know it, charge people who eat big-macs more than those who don’t? And how do you implement this without over-simplifying the formulas so much that they disproportionally punish only the choices that are easily measured (ie. smoking)?
  2. Insurance companies should be given a limit for how long after an application is accepted before it can be denied because of errors on the application, with the exception of lies about behavior. Insurance companies should not be allowed to deny coverage to a person after that person falls sick, just because they forgot some minor detail on their insurance application years earlier. It should be the insurance company’s responsibility to investigate the application before accepting the application.
  3. There needs to be more transparency. In the industry I work in, there are several well-respected companies who’s sole business is rating our type of service. This is an essential service to potential customers. Why aren’t there more private entities who can rate the insurance plans offered to us? They could rate them based on how well they treat those with rare conditions? What is the level of customer satisfaction? They could present their finding in easy to read reports, so customers can have confidence in what they are getting. Such transparency go a long way, in my opinion, to inspire the insurance companies to make sure they are treating their customers fairly.

I hope we can get beyond talking points and start talking about the real issues. Unfortunately, real discussion will probably have to wait until after the election, when the pressure is off and people can start thinking with a clear mind. I’ll be ready.

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Written by Mike

October 14, 2008 at 9:44 pm

2 Responses

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  1. […] I would have wondered the same thing myself about two years ago. But as a parent of a child with Eosinophilic Esophagitis, I now understand that patients with rare diseases face a unique challenge. For more common […]

  2. […] so why so much fuss over a statistic?” I would agree that healthcare reform is important, as I’ve blogged about before. But to illustrate why I think this mischaracterization (and the many that take place every day in […]


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