up to half of Americans under 65 have preexisting conditions


    As many as 129 million Americans under age 65 have medical problems that are red flags for health insurers, according to an analysis that marks the government’s first attempt to quantify the number of people at risk of being rejected by insurance companies or paying more for coverage.

    So begins an article in today’s Washington Post by Amy Goldstein.   Both that first paragraph, and the title – Government finds up to half of Americans under 65 have preexisting conditions – caught my attention when I went to the Post website this morning.

    The report is part of the Obama administration’s attempt to manage the debate on health care reform.  And the response from the other side is predictable:

    Republicans immediately disparaged the analysis as “public relations.” An insurance industry spokesman acknowledged that sick people can have trouble buying insurance on their own but said the analysis overstates the problem.

    HHS estimates a range of 1/5 to 1/2 of Americans have conditions that can lead either to outright rejection of coverage or higher premiums.  The smaller estimate is based on those who would be eligible for the high risk pools, the larger includes those with “other ailments that major insurers consider a basis to charge customers higher prices or to exclude coverage for some of the care they need.”

    You can read the article for the back and forth.

    Several things caught my attention, for example, that John McCain and some other key senior Republicans have supported the high-risk pools.  Then I remembered that the Republicans seemingly have backed off of going for outright repeal but instead want to try to parse the language of the reform act to try to peel away one provision at a time, perhaps because they are worried that individual provisions are now polling as fairly popular among the American people.

    If 129 million represents  1/2 of Americans under 65, then 1/5 of that age range would be 40% of that number, or 51.6 million.  I mention that because such a figure is substantially higher than the number of Americans who lacked any medical coverage.

    A spokesman for America’s Health Insurance Plans, the industry lobbying group, said that most currently included in the figures already have health insurance:  

    They would be at risk, he said, only if they needed to change coverage and buy it on their own. People who get insurance through their jobs are guaranteed coverage, he noted.


    My reaction to this was immediate – it is indentured servitude, because then one CANNOT realistically change jobs, is a captive of the benefits one currently has, cannot use a competitive job offer to obtain a raise or a promotion in one’s current place of employment.  Since we have already seen employers bust pension plans, shift more of the cost of benefits including health insurance to employees, what is there to stop employers from using health insurance as a further cudgel with which to beat up employees?

    I do not claim to be a clever wordsmith.  Having grown up around New York, with my next door neighbor an executive at one agency and an aunt a VP at another, had I such an ability I would probably have tried advertising as a means of making a fortune.  But I know there are people here who have such a skill, and I wonder if that spokesman for AHIP may not have just given us a gift, that we can turn his words into something that will boomerang against the health insurers?  One can only hope.

    Several other points from the article.  Republicans realize the salience of this issue, because some of them are pushing back claiming “Republicans have consistently advocated for coverage options for individuals with preexisting conditions.”  Of course, such coverage options may be unaffordable due to allowing the health insurers to charge exorbitant fees for such coverage.  That’s another area where some detail can help.

    The article cites a report released by Henry Waxman in the period 2007-2009 the four giants of health insurance denied about 650,000 coverage due to pre-existing conditions.  It also notes that 17 to 46% of of uninsured have medical conditions, depending upon how that term is defined.

    The next – and final – paragraph may carry the most political punch:  

    Such health problems, the study found, are especially common among adults ages 55 to 64 – a group long recognized as a problem spot in the health-care system, because people of that age tend to have higher medical expenses but do not yet qualify for Medicare, the large federal insurance program for the elderly.

    Now remember, the health insurance response is that people get insurance through their jobs.   As I’ve already noted, pre-existing conditions can lock one into a job.  Add to that something else –  that we are increasingly seeing older workers lose jobs and exhaust their unemployment compensation, because employers do not want to hire older workers.  Among other things, even if they are not excluded from health insurance coverage by pre-existing conditions, they are at a much higher risk of incurring medical conditions that are costly to the plan, driving up costs for everyone else.

    This age group, 55-64, is one that is very politically active.  Organizing them on health care issues can significantly change the playing field both on this issue and in general.  One has to hope that Democratic strategists understand this, at least for the short term.

    But I cannot leave this topic without raising one more issue, one not even touched on in the article.   Cannot someone consider how issues like this point ever more clearly to why single payer should have been on the table?  

    Or perhaps I can be even more blunt:  there are things in life that should be more important than maximizing profits.  As a teacher it is one reason I am so adamantly against the privatization even partially of public education.  As one who volunteers in Appalachia for free health and dental clinics, access to health care – which requires the ability to ensure the provider that s/he will be fairly compensatated – is clearly another.

    It would be possible to do using non-public insurers.  Germany does so, but Germany has strict regulation of the insurers.  In our country they get to spend a relatively small part of their profits to greatly influence the legislative and regulatory framework to continue their massive flow of profits.  Their concern is not the services provided, it is the profits made and the value of stock options.  

    That might be fine for them, but it is not for the rest of us.  

    So perhaps we can use this report as a means of serious pushback.

    Remember:  up to half of Americans under 65 have preexisting conditions



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