Health, Health policy

Pre-existing condition: a palatable term for government sanctioned discrimination

We tend to think of health care as complicated.  Here’s a little secret:  it’s not.  It’s only evolved to be a complex system because we’ve made it that way.  When a physician sees a Medicare patient, an estimated 130,000 pages of rules and regulations influence that relationship. The Affordable Care Act and it’s supporting regulations are defined in over 20,000 pages.  Private insurance policies are as varied as the millions of firms offering employee health plans. Add to the mix that these coverage rules are in a state of constant revision.

Any interaction that is managed with volumes of legal-ease is bound to be one the ‘average American patient’ will not understand and with new health care proposals coming from Congress with little notice in rapid succession, it is next to impossible to comprehend how provisions buried in tens of thousands of pages may impact us far down the road.  It need not be this way.

At its core, our complex health system governs one very simple fact of life:  we get sick and need help to get better.   The devil in the details comes in how government chooses to manage this basic need of its populace.  It’s disheartening that the current health policy mentality doesn’t seem to appreciate this basic fact.

Humans are frail living creatures.  We don’t live forever.  We each die of something biological that causes our bodies to stop functioning. None of us will live our entire lives without having a single illness or accident.  Cut us and we bleed.  If we fall, our bones break. Our vision and hearing decline over time.  Our teeth rot.  And if we live enough years our hearts will eventually tire and fail.  Our cells easily mutate and multiply…cancer.  If you think of it, our bodies are so subject to ailments that it’s a wonder in ancient times we lived long enough to advance civilization at all!

Yet, this natural propensity towards illness is now given the ominous regulatory label of ‘pre-existing condition’, which has come to carry a negative connotation with penalize-the-patient policy proposals.  Don’t think illness is the natural order?  Health and Human Services analysis shows up to half of Americans under age 55 have a pre-existing condition and that number rises to 86 percent for those over age 55.  Fact is, most of us have already experiences some form of major illness in our lives and for those who haven’t, live long enough and your time is surely coming!

But alas, all is not lost!  Here comes science and medicine as the saviors of humanity.  Modern health care compensates for our physical frailties. Until this century, life was nasty, brutish and short. We now have the mind-blowing ability to have our vision corrected, repair our dental cavities, remove cancerous cells, mend a broken bone, treat a failing heart and stop a serious bleed.  Science and medicine extend not just our life, but improve the quality of that life.  That’s huge.

The rub is that life-extending scientific achievement comes with a price tag.  Our entire, complex health system is set up for no other reason than to sort out who in society can easily access these scientific accomplishments, when and how much they should pay for it.  That’s it. There is no other reason for private insurance, Medicare or Medicaid to exist…they are the more palatable modern version of ancient gladiatorial fights, with the winners (those who can access and afford care) being able to live another day.

The larger question is whether government’s rules for the fight should be applied equally to all persons regardless of age, gender, geography or any other criteria.  If we truly believe in equality, it must. To create layers of complex code which creates conditions in which only seniors, only the disabled, only the poor, only those without pre-existing conditions can access government facilitated care is contrary to ensuring the general Welfare as defined as an essential role in the Preamble of the US Constitution.

To create layers of complex code which creates conditions in which only seniors, only the disabled, only the poor, only those without pre-existing conditions can access government facilitated care is contrary to ensuring the general Welfare as defined as an essential role in the Preamble of the US Constitution.

There’s a fundamental inequity when government intervention results in a playing field in which a 68 year old cancer patient, retired with Medicare can access life-saving treatment, potentially, without paying a single dollar out of pocket but a 38 years old cancer patient, working full-time with employer sponsored insurance, cannot.  And, if the younger patient is lucky enough to survive, go back to work and pay off medical debt, they are penalized by not ever being able to get insurance again due to now having a ‘pre-existing condition’.  Such inequality created and endorsed by the federal Government via thousands of pages of regulation unintelligible to the ‘average American’ runs counter to its purpose of promoting the general Welfare.

If we accept as a fundamental starting place that we are all equal then why would this equality not apply to everything the government does, including insurance?  Otherwise, the federal Government is favoring one segment of people over another…the well over the sick, seniors over the middle aged and the young, the poor over the middle class, those who have lived long enough that the natural frailty of the human body has manifested in a “pre-existing condition” and those who have not.

To draw a line and say ‘this group is worthy of easily accessible and affordable medical care and this group does not’ is truly rather arbitrary.  It is not the federal Government’s role to divide us into segments, but rather to treat us all equally in its exercise of power.  If one segment deserves medical care, then we all do.  Few of us will escape this life without encountering an illness, accident or frailty. Any policy which does not reflect this undeniable fact is doomed to eventual failure.

Call it ‘Medicare for all’, call it ‘single payer’, call such a health system by any name you wish….but call our only fair option what it should be, an equal right to enjoy government’s promotion of the general Welfare.  That’s not socialism, it’s equality and that’s about as democratic as it gets.

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