PRE-EXISTING HYSTERIA – Perhaps Soon to be Known as Kimmel Syndrome

Are Facts Even Important Anymore?

It’s just my opinion, but I think that if you are going to go on TV and perform a very personal rant in a very public way, please do your fellow citizens a favor and know what the **** you are talking about.

Jimmy Kimmel recently stated, “Before 2014, if you were born with congenital heart disease like my son was, there was a good chance you’d never be able to get health insurance because you had a pre-existing condition, you were born with a pre-existing condition.”

This statement is largely false – or better yet, this statement is 87% false.  Why, you ask?  Because according to the US Census Bureau, in 2013 87% of Americans had health insurance.  If parents have health insurance, a child born to the mother is covered under the parents’ policy whether or not the child has a health problem.

In addition, just because someone doesn’t have health insurance does not mean that cannot receive health care.  The Emergency Medical Treatment and Labor Act (EMTLA) of 1985 mandates that all hospitals provide treatment to anyone and everyone in need of emergency medical care regardless of the patient’s insurance status.  Moreover, this obligation applies to anyone entering the hospital through the ER, or the front door, the loading dock, or even standing in the parking lot.  Once they are on the hospital property, the hospital is obligated.

It’s called Charity Care, and last year my local hospital provided about $4,000,000 worth of it to individuals with no insurance.  Four million dollars!  Note the hospital still had to pay the doctors and nurses, and do the x-rays, and lab tests, and provide medications… and in the end could not collect a dime in fair compensation despite having performed all of that work to make people better, and even save lives.

I absolutely appreciate Jimmy Kimmel being an involved, concerned father, and he has every right to speak passionately about the challenges of that role.  However, is he a credible source for the promotion (accurately or inaccurately) of the alleged “benefits” of the ACA?  Given his entirely well-earned socio-economic success, I sincerely doubt that he bought his health insurance policy through one of the ACA exchanges.  Something tells me that his health insurance policy, just like the policies of everyone in Congress, is probably juuuusssst a bit better than that.

Modern Day “Hate-Speech” From an Old White Male

As I write, I am preparing myself for the onslaught of pejorative comments about my lack of character, intelligence, empathy and concern for my fellow man (or woman, or womyn, or genderless being, or gender-fluid human, or non-binary entity, or whatever the hell it is we’re supposed to call each other nowadays).  In 2017, my age, race and chromosomes immediately qualify me for passionate negative, invective-laden politically-correct response.

So here it is:  Unrestricted Pre-Existing Condition coverage clauses have absolutely NO business being in ANY health care legislation.  NONE!!

If your house burns down, can you then go out and buy fire insurance in order to have the insurance company build you a new house?  No.

If you crash your car, can you then go and buy comprehensive collision insurance to have the insurance company pay for the restoration of your car?  No.

Then WHY should health insurance be any different?  Not surprisingly, I’ve already had the answer to that question spit at me more than once: “Because houses and cars are things, you moron, and this is all about people’s lives!!!”  I see, how terribly foolish and insensitive of me.

So… if you die, can your family then go buy life insurance in order to have the insurance company not only pay your funeral expenses, but also provide a financial windfall for your beneficiaries?  Uh, no.

Quite frankly, the notion that anyone should be able to purchase any type of immediate “insurance coverage” for something that has already happened is absurd.  This is just one of the things clearly indicating that many of the most vocal members of American society are on the path to the complete loss of reasonable, rational thought.

The Pre-Existing Purpose of Addressing Pre-Existing Conditions

This has been a topic of serious discussion for many years.  Here’s what Pre-Existing Condition legislation was supposed to address, right up until the moment when emotion began to overrule reason.  The original intent was to protect people who were already insured by one provider, and were changing coverage to another insurance provider.  It was never intended to protect those who initially chose to not have health insurance, but now wanted it because they were sick.

Suppose you work for Employer A, who provides health insurance as an employment benefit.  During this time, you are diagnosed with a serious, expensive-to-treat medical condition.  Insurance Provider A covers your health care expenses per the terms of the policy.  Now you want to leave Employer A for a better, more fulfilling position with Employer B, who also provides health insurance as an employment benefit.  However, prior to making the change, you learn that Insurance Provider B will not cover the expenses of your specific condition, because it was pre-existing to your employment with Employer B, and therefore not their responsibility.

That situation was/is very common, and what it does is create “benefits hostages,” preventing qualified, motivated people from moving around in the job market because they need to maintain their present level of insurance coverage.   This situation is not good for individuals or society for all kinds of reasons, including limiting basic American freedoms, hindering growth and creativity, and stifling the economy, just to name a few.

KNOW The Problem Before You Try To SOLVE The Problem

One additional aspect of this that everybody (including our buddy Jimmy, and quite frankly all of Congress) seems to be missing:  In most cases, pre-existing conditions do not prevent someone from getting insurance.  Qualified applicants are typically granted the standard policy with a caveat: any pre-existing conditions will not be covered for a designated period of time, typically 6-12 months.  This enables honest people to obtain coverage for most health needs, and go forward while waiting a reasonable, defined time for the onset of coverage of the identified pre-existing condition.  Insurance companies are not unreasonable; they simply didn’t think it fair for them to immediately cover something serious that pre-dates the onset of the policy, especially for those cases in which the individual refused to purchase insurance coverage while they were healthy.

Years ago the proposed solution and rationale was that health insurance providers should, without caveat, accept insured people moving from one provider to another regardless of their health status, because those people were already part of the total insured population pool.  They were responsible enough to obtain insurance and pay premiums when they were healthy.  Over time, the number of people with expensive conditions moving between providers would balance out, resulting in no provider getting stuck with more than their typical share of individuals with serious conditions.  Simply put, every person transferring in with a pre-existing condition would be offset by a different person with a similar condition transferring out to another provider.  Given that the top four health insurance companies (Blue Cross, Anthem-Cigna, UnitedHealth, and Aetna-Humana) cover about 240 million Americans (that’s almost 75% of US citizens), basic probability alone supports this premise.

Speaking of insurance providers, we also need to understand that the primary purpose of health insurance providers is not to pay for healthcare.  Their main job is to produce positive return on investment, just like every other business in a capitalist economy.  All insurance providers must generate revenue in order to be able to actually pay the healthcare expenses they’ve promised to pay, and pay their employees, and pay all of their other business-related expenses.  For example, in 2014 Blue Cross of North Carolina paid out more than $266 million in local, state and federal taxes, and that’s just BCBS in one state!  Even the arithmetic I learned at Longfellow Jr. High was enough for me to understand that our covered medical bills far exceed the insurance premiums we currently pay.

America, Be Careful What You Demand

Mandated Unrestricted Pre-Existing Condition Coverage will ultimately bankrupt some insurance companies, drive others out of the market, and dramatically increase the cost of all health insurance.  It will eventually lead to a single-payer system run by the government.  So, if you enjoy going to the Secretary of State to renew your license, you are going to love government-run healthcare, especially when your very life – or better yet, the life of your child – depends upon it.

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Author: David Wilson

Born and raised in Flint, David Wilson now lives in Traverse City. He is a very proud husband of Shari, father of Kyle & Danielle, rider of Gitane and Specialized bicycles, Flint Northern Viking, and double-alumnus Michigan State University Spartan.