How Pre-Existing Conditions will Lead to the Socialization of the U.S. Healthcare System

The current debate over Obamacare (Affordable Care Act) and its proposed GOP replacement The American Healthcare Act of 2017, is showing how difficult the healthcare issue is to solve. In fact, the debate may be revealing a different reality altogether, the only choice the US may have is to move to a single-payer healthcare system managed by the government – or to put it a simply, socialize the entire U.S. healthcare system.

The for-profit model of healthcare in the United States is failing, or already has failed many millions of Americans. While Obamacare sought to insure all Americans and reduce the overall cost of healthcare, the program has failed in both respects. In April 2017 CNBC reported, 11.3% of U.S. adults were without health insurance. At the same time, Kaiser/HRET reported the average family health care plan will cost an employer $18,142 per year, up 3.4% from 2015. CNN Money reports, “Premiums on the Obamacare exchanges are expected to rise double-digits in 2016-17.” Most recently, Aetna Health Insurance announced it would pull out of all Obamacare exchanges due to the unprofitability of the system. Many other insurance companies may follow Aetna’s as profitability erodes.  The US healthcare system is in crisis.

The current GOP administration is seeking to replace Obamacare or the Affordable Care Act with the American Healthcare Act of 2017. The legislation has passed the House and is now moving to the Senate. While many applaud the new healthcare legislation, an important question has arisen, what about pre-existing conditions?

Prior to Obamacare, insurance companies could charge more for their healthcare insurance based on pre-existing conditions. For example, someone with congenital heart failure would pay a higher premium than someone who is relatively healthy. From an insurers point of view this makes total sense. A greater risk would require a larger premium. This is certainly true for automobile insurance, people who have past accidents pay more than people with a clean driving record. Why should this not be the same for healthcare?

The question of why can’t an insurance company charge more for pre-existing conditions like auto insurers, is a matter of public policy. First, can we hold someone responsible for a pre-existing condition like we hold a poor driver? Second, at what point does the cost of health insurance for pre-existing conditions become prohibitive to an individual or employer?

While many health issues do arise from the activity of a person, i.e., smoking or over-eating, many health issues do not. It is also difficult to pinpoint the cause of some illnesses. If you smoked in your teens but get lung cancer in your fifties, should we call that a pre-existing condition? If someone had cancer and it is completely cured, should they have to pay a higher insurance premium for the rest of their lives?

As the debate continues it is becoming clear that pre-existing conditions and the right of insurance companies to charge more for them is one of the major issues. If insurance companies are given the right to charge more for pre-existing conditions we can assume health insurance costs will rise. As the cost rises, less and less people will be able to afford healthcare. Ultimately, the cost of the uninsured falls on the public through government assistance and lost productivity.

Pre-existing conditions may be the issue that transforms the debate from a profit/private to a non-profit/public U.S. medical system. We must ask, as fewer people have access to quality healthcare, what is the cost to our society? If the US were to adopt a social healthcare system what are the benefits?