• Words fail, mandate edition

    I swear, I’m not picking on Senator Santorum. But I can’t let this one go by without posting. Evidently, he was recently speaking in New Hampshire, and said:

    “There’s a reason that people who don’t have health insurance right now, who want to sign up for health insurance are stopped from getting insurance on a preexisting condition,” Santorum said. “So if you have cancer, and you’re not insured…then you want to get health insurance, right? Because it’s really expensive [to get cancer treatment]. Imagine if the government said you can get health insurance, and the insurance company can’t deny you because you have cancer.” Santorum asked the class if anyone disagreed with that, and one student spoke up: “Wouldn’t that drive the insurance companies out of business?”

    “If you don’t have to have insurance until you’re sick,” Santorum explained, “why buy insurance?… How much would insurance be if only people who needed insurance bought it? The whole point of insurance is: healthy people buy it, sick people buy it, and those who are healthy support those who are sick…. But if insurance is only sick people buy it, well guess what’s going to be the cost of insurance. That’s why there’s a preexisting-condition clause.”

    Um… what? Now I recognize that it’s possible that this was taken out of context, and it’s possible that Senator Santorum meant something else, but he seems to be making an argument that right now, people with pre-existing conditions can’t get insurance. So we need a pre-existing condition clause. And it seems that he’s then saying that if you have a pre-existing condition clause you can potentially have an adverse selection/free rider problem. So we need an individual mandate.

    And then you have the Affordable Care Act. Which part does he want to repeal?

    UPDATE: A couple of you have asked me if it’s possible that Senator Santorum is saying that getting rid of pre-existing condition refusals is what’s going to create adverse selection. Based upon his former speeches, I get the sense that he accepts that insurance costs more for sick people, and that he feels that people should have thought ahead and bought insurance before they got sick. But if that’s the case, then he’s offering no solution for people who lose their insurance after they get sick. Maybe they got laid off. It happens, especially when you’re really sick.  They are, of course, unable to get policies even though they’ve been responsible citizens.

    Moreover, as I said in the comments, that second paragraph seems awfully close to a defense of the individual mandate.

    UPDATE 2: Another commenter says that he thinks Senator Santorum is worried that covering only sick people would bankrupt private insurance companies. Yes. That’s why the ACA has the individual mandate. Nevertheless, you’ve almost convinced me that Senator Santorum wasn’t defending the ACA (although if I was running against him, I can totally see you you could put this in an ad and say he was). You have almost convinced me that what he’s saying is that we should continue to allow insurance companies to tell people who have pre-existing conditions (there are many tens of millions of them) that they either can’t have insurance, or that it should be very expensive. If that’s the case, I’d like to hear what Senator Santorum thinks people who have pre-existing conditions, but who have been fired recently, should do to regain insurance. I’d like to know what he would tell young adults with pre-existing conditions who are leaving their parents’ plans and unable to get their own should do.

    It’s entirely possible to be a good and responsible citizen and get screwed in the current health insurance market we have. What do we do for those people?

    AEC

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    • He’s saying insurance companies should be able to deny coverage on pre-existing conditions, otherwise there will be selection problems. The pre-existing condition clause *stops* adverse selection in the argument he’s making.

      I don’t agree with him but you’ve mischaracterized his position here.

      • If I’m doing that, I want to know.

        Read that last paragraph again and tell me where you get that he’s saying insurance companies should be able to deny coverage on pre-existing conditions. It seems like he’s defending the individual mandate.

    • Aaron, I think the commenter js is right. Read it carefully: “There’s a reason that people who don’t have health insurance right now, who want to sign up for health insurance are stopped from getting insurance on a preexisting condition … How much would insurance be if only people who needed insurance bought it? The whole point of insurance is: healthy people buy it, sick people buy it, and those who are healthy support those who are sick…. But if insurance is only sick people buy it, well guess what’s going to be the cost of insurance. That’s why there’s a preexisting-condition clause.”

      The reason you think he’s defending the individual mandate is because in your mind the problem is obvious: People with pre-existing conditions have no access to insurance. Santorum doesn’t think that’s the problem. He see’s the problem as: Insurance companies might go bankrupt treating sick people.

      So whereas your solution is a mandate, his solution is a preexisting-condition clause. You value different things.

      • I’m with you right up until your last paragraph. But I tried to address this and some emails I’ve gotten in Update 2.

        • ” You have almost convinced me that what he’s saying is that we should continue to allow insurance companies to tell people who have pre-existing conditions (there are many tens of millions of them) that they either can’t have insurance, or that it should be very expensive”

          I know this position is anathema to you, but there are a lot of Randians out there who are perfectly fine ignoring the dreadful outcomes for the unlucky. Bill Clinton once caricatured this viewpoint as: “I want to help you. I really do. But you know, I just can’t”

          For example: just yesterday I heard someone criticizing Medicaid. One of his complaints about Medicaid was the patients were highly litigious, non-compliant and had poor health outcomes. To him, that was a REASON to stop supporting Medicaid. If you encounter a difficult problem: give up.

          I don’t mean this to be depressing, I just want to point out what we’re up against here. It’s not simply a lack of understanding on Santorum’s part, it’s a complete disagreement between priorities.

    • I’m going to guess that Republican thinking is along the lines of: there SHOULD be pre-existing condition exclusions and aggressive rating by health status, weight, smoking status, and other health characteristics that voluntary health behaviors can affect. If we don’t have those sort of things, then people have the incentive to get sick. I assert that this is their framework based on talks I’ve attended (just for the sake of interest) at places like Cato and AEI.

      Santorum then brought up his daughter’s congenital condition. Most likely that was just an oops on his part – there’s no great way to solve that under a pure version of the framework above.

      However, congenital conditions do present a problem for this stance. He said, “She’s going to be very expensive to the insurance company. That cost, while not the whole cost, is passed along to us…. I’m OK with that.” To be consistent, it would be best if Republicans addressed how anybody is supposed to be able to afford the whole cost of having a serious disease. Or do they think we should be spreading those sorts of costs at all? If they would spread the costs, to what extent? Why is it that I should be subsidizing your daughter at all – after all, you’re fairly well off, perhaps you should just deal with the full cost.

    • The issue being debated is based on the assumption that access to care = major medical insurance policy. I agree that is usually the case. However, the system doesn’t have to be “one size fits all” to achieve the end of access to needed care. Kare360 can help patients with pre-existing conditions gain access to affordable care. We zoom out to see what options fit the patient’s situation best, even if they can’t afford a high-risk pool premium or don’t qualify for the new pre-existing policies.

    • If Senator Santorum is worried that covering only sick people would bankrupt private insurance companies, then individual mandate in the ACA is really bad idea. If we agree that society has an obligation to provide health care to these people who are uninsurable then why is it a good idea to spread these costs over the individual insurance market? This group of people has the smallest number of people to spread the costs over and are arguably the most price sensitive. Milliman forecasts that in Ohio the individual insurance premiums are expected to go up by 55% to 85% excluding health care inflation and all of this increase is due to cost shifting. A very likely scenario is that the individual insurance market will collapse and we will once again be looking for a way to pay the health costs of the uninsurables. A more reasonable solution would be to spread the uninsurable’s health care costs over a much larger population and scrap the individual mandate.

    • I think you’ve got it with Update 2. He’s intending to defend insurance companies rejecting people with pre-existing conditions, but to people that value human life over corporate profits he’s really doing a pretty good job of defending the individual mandate.