Independent Investigations
A Place For Considerate Political Discourse!

UNDERLYING CONDITIONS


Doctors speak of finding the underlying condition that is causing a given set of symptoms. Treating symptoms doesn’t remove the underlying condition. As a recent example, the pain I had been experiencing in my knee was the result of gradual fraying of a portion of the cartilage that is supposed to cushion the joint. For the first year or so I treated my own symptoms with over-the-counter pain medications. For a while it worked. After a while it didn’t. A 30 minute arthroscopic surgery solved the problem for the most part. I was covered by a group insurance plan that covered most of the costs. I was lucky.

Failure to discover and treat the underlying cause of any set of symptoms can be extremely serious and possibly fatal. As a general rule, the occurrence of a given symptom or pattern of symptoms tends to indicate a fairly specific underlying condition. Most of the time, treatment involves management of the symptoms and removal of the underlying condition if possible.

There are large groups of individuals in this country who have exhibited a very specific pattern of symptoms ranging from financial and physical distress to financial ruin and loss of life. The underlying cause of these symptoms involves an inability to receive health care benefits and/or inability to pay for treatment.

There are several types of triggering events that can give rise to this inability to receive health care. With unemployment reaching 13% in Nevada, there are significant numbers of individuals and families that no longer have health care. Large numbers of individuals cannot receive health care benefits because of pre-existing health conditions. There are also large numbers of individuals who have had their health care policies cancelled by their insurance carriers. To be fair to the health insurance companies, a percentage of these cancellations are caused because individuals willfully kept portions of their medical history hidden during the application process. All are at risk.

A significant number of individuals don’t include what they consider minor issues involving their previous health care on their applications. Any individual who does not include every single health issue that they have had in their lifetime are at risk of losing their insurance. Some individuals do not have health care insurance because their income isn’t sufficient to pay the high cost of individualized health insurance. As you can see, there are many events that can contribute to the underlying condition of not having the ability to receive legitimate health care benefits.

There are significant differences in the application process for receiving health care benefits. Those who are fortunate enough to have employment that offers group health care coverage face a significantly less intrusive application process. I am covered by health insurance offered through my wife’s employer. We pay fairly low premiums to add myself to her coverage. Because I am covered in this type of plan, the fact that my knee issues were related to a previous condition didn’t matter. I had an initial “scope” procedure on my knee 15 years earlier while being covered by a group plan. When the time came for a second procedure, I was covered. However, had I been in a position where I had to purchase individual health insurance, I would have filled out a very comprehensive application listing every single medical condition that I had experienced prior to applying for the new plan. I can tell you that there is no way that I could have gotten coverage on an individual plan. Prior medical conditions experienced at a very young age would have made me uninsurable.

Insurance companies are not all that excited about insuring someone who had prior conditions. The bottom line is, if you have always been in perfect health, they will insure you. I am not sure that I know too many individuals over the age of 40 who have not had prior medical conditions. The point I am trying to make here is that there are a significant number of individuals in this country that are one illness away from financial ruin. I have heard it said that in reality, we are all only one illness away from significant financial catastrophe. The thing that is most disconcerting about this is that a very large percentage of those in this position have no idea of their peril.

The battle for health care reform in this country is being waged in large part by individuals who fall into two categories. Those that are fighting hard for reform are convinced that we must do something to change the fact that so many people are facing financial and health related ruin. There are others who don’t believe that reform is necessary or at least believe that the status quo is sufficient.

I wonder if those who are fighting against health care reform would fight reform with the same zeal if the shoe was on the other foot. In this economy anyone can lose a job. Anyone can get sick overnight. Anyone can be forced into attempting to purchase individualized health insurance. Anyone can face financial ruin as a result of health related issues.

If what we had in place was sufficient, the results would be more acceptable. The status quo is not acceptable.  Health care reform is not optional.  Both sides of the political spectrum tend to agree on the fact that it needs to be addressed.  Obviously there are very strong opinions on the “how” of health care reform.  There is very little disagreement about the “why”.  The underlying conditions are there and they must be addressed.

In my next post I am going to address the practice of insurance recision. Most will be shocked by the nature and significance of this issue. Legitimate discourse always welcome.

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