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Comment by cschneid | Hacker News Reader

Please refer to my post below that starts out with "Insurance companies are not money piñatas". Explain why a planned pregnancy is a candidate for an insurance payout?

(not that I don't think pregnancy should be covered, just not by an insurance company, but by a morally based public plan without the profit motive, or insurance model).

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actually I think a profit-based insurance model is the problem. you cannot take care of shareholders and patients at the same time.

but since you have a profit-based model, excluding planned (or unplanned for that matter) pregnancies from coverage is the same problem as excluding pre-existing conditions. insurance companies cherry-pick the risk pool to increase profits - they only want to give insurance to people unlikely to need it.

for private insurance to provide any social value, you need a large risk pool that includes healthy and high-risk patients, and the insurance companies must be required to actually cover people who need medical care.

the healthy can't be allowed to opt out, and the insurance companies can't be allowed to decline coverage to anyone in the group.

your last line is basically a public plan like I suggest, except run by the private sector, with direct payments instead of taxes. We basically agree on the shape of the solution, if not the specific implementation.

But expecting insurance companies as they currently exist to pay for pre-existing without that kind of tradeoff is like crashing your car into a pole, then walking down to state farm and being like "ohh, I need car insurance, full coverage, and pay for my repairs. I don't expect my rates to be different because of that though".

And really, a planned pregnancy is mostly a pre-existing condition. I wonder why there aren't any supplemental policies for complications though. Something that wouldn't cover the expected stuff, but would cover real medical complications.

I suspect those plans don't exist because the premiums would have to be so high to make it profitable that it would make more sense financially for most self-employed couples to have one spouse get a job with a group plan that has to cover you even if you decide to have kids.

Pregnancy might be something that's by choice, but that practically everyone will go through. Do we really want a society where only the rich can afford to have kids?

Profit is not the problem. For a site about startups/building businesses, that's a rather bizarre argument - ie this is asking how can anyone can care for their customers and their bottomline at the same time? (so is that an argument for effectively nationalizing everything?)

This assumes that the alternative maximizes efficiency - and can you honestly say that about how the US government administers Medicare? Look at education - sure it's not "for profit" if you ignore the ever increasing profits that accrue to teachers' unions.

Besides, despite all the handwringing over those profit maximizing bastards at private healthcare insurers, guess who is the largest denier of healthcare claims? http://biggovernment.com/ptuohe/2009/10/05/ama-endorses-larg...

Insurance companies care for profits and customers both now, as an example, through copays for prescription drugs. Drugs that tend to ensure the health of the patient are sometimes free and sometimes $40 or more for name brand drugs that do the equivalent of a $5 copay generic. The Insurance company takes a hit on the drugs with no copay, but they tend to reduce the lifetime cost of health for the insured by keeping them healthy.

Anti-inflammatories for example. Inflammation is bad stuff, so keeping it down keeps you healthy. You often need only a prescription to get free anti-inflammatories with certain health insurance plans.

Of course that tactic will also be quite strategic in a single payer system.

EDIT (from your linked article): In short, the AMA is endorsing a plan whose closest existing example is the most frequent denier of claims. How the public option exemplifies “delivering care to patients” is unclear.

Maybe more claims should be denied. Maybe insurance companies pay for things because the patient wants it and the doctors think it is unnecessary. Or perhaps medicare pays more overall even though it denies more claims. We don't know what the ulterior motive is, and the article implies there is one.

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