Saturday, November 12, 2016

Trump wants to cover pre-existing conditions, probably with a reinsurance concept well known in business

CNN has an interesting perspective by a medical doctor, Ford Vox, on Trump’s views of health care, here.. Ford describes Trump’s “alternative reality” and notes that conservatives expect not to pay anything for health care until something happens – that is, they object to paying for other people’s health care, on the ‘take care of your own” idea.

FEE ‘s Jeffrey Tucker notes that “the election became a referendum on Obamacare” but undoing it is anything but simple.

Here’s my take. You can go back to what we had before, but add portability across state lines, and coverage on parents’ policies until 26. For pre-existing conditions, you set up a reinsurance pool that is partially federally owned, and possibly supported by a small payroll tax.  That means that individual and group premiums don’t have to cover pre-existing conditions or pay for “anti-selection” – the public has to cover this in large part, Bernie Sanders style.

Of course, what counts as a legitimate pre-exisiting condition becomes a political football.  Inherited conditions like juvenile diabetes.  Behavior-related conditions -- whether connected to sex (including HIV), obesity, or cigarette smoking, gets testy and maybe nasty.

Remember, anyone, no matter how healthy, can get hit by a drunk driver or step on an unexploded land mine in Central Park.  Insurance needs to cover this, fully.

Update: Nov. 20

Vox has a rundown by Sarah Kliff of the leading Republican "a better way" plans (7 of them). which tend to help younger workers more than the old and sick.

Update: Nov. 25

The Washington Post offers the "Ultimate QA about Health Care under a Trump presidency" here.

Update: Dec. 6

FEE has an article explaining the rise in premiums on Obamacare on pre-existing conditions and people with bad behaviors.  Aaron Schanzenbach writes "You now pay for your neighbor's weight problem; thanks Obamacare/"   The pre-existing conditions that are clear cut enough like juvenile diabetes could be covered the way renal disease is now.  But what's behavior-based?  What's genetic?  Is HIV infection to be treated as behavior-based?

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