There Are No Pre-Existing Conditions
Medical CareEither all conditions are Preexisting Conditions or there’s no such thing.
It’s more than semantics. The idea of what medical conditions insurers should be allowed to not cover is the heart of our healthcare crisis. For an Insurance company, not covering preexisting conditions is no where near as effective or efficient as imposing lifetime limits, ramping up copayments and deductibles or allowing insurers to base premiums on health status and setting up high-risk pools. It’s been relatively ignored, because a lot fewer dollars are involved, but having the young, relatively well, among us not have insurance, is the flip side of the preexisting condition game and also works out well for the insurance industry. It all goes together. Everything that works out well for Insurers works out very badly for US.
The way we’ve come to understand diseases is first to think that diseases exist. Maybe people don’t just get struck sick or possessed or cursed. Maybe things that look different have the same roots and maybe things that look the same have different roots. Not all germs cause fever. Not all infections respond to antibiotics. Even things that look like they spring out of nowhere, like automobile accidents, burns and gunshot wounds, have roots and preexisting causes.
Categorizing something a Preexisting Condition is an arbitrary matter as is any given insurer’s decision not cover any given diagnosis, service or patient. Most commercial insurers will pay for speech therapy if your child has had a stroke but not if the speech issues are “developmental”. To get therapy more and more patients have had strokes. What I and many researchers believe to be true about most developmental disorders but haven’t yet proven is that that they are brain injuries more like strokes than not. We know that autism isn’t caused by emotionally unavailable mothers, but if it was, should having an emotionally unavailable mother be classified as a Preexisting Condition?
The number of hours my staff spend arguing about why Dick or Jane isn’t doing so good in school is a large number that gets larger every year. I am no longer allowed to tell parents the truth when their children don’t really care much about school and that that isn’t all bad. Sitting upfront, watching less TV and reading aloud at home might help. It was a $15 visit, no copayments, no deductibles, no lifetime limits. Now after many letters home, parent teacher conferences, core evaluations, thousands of dollars of NeuroPsychiatric testing and arguing about who should pay for the NeuroPsychiatric testing, everyone has autism, ADHD, oppositional-defiant disorder executive function issues, impulse control disorder and a partridge in a pear tree.
As opposed to the natural scarcity of gold, oil and other natural resources, our current scarcity of medical care is artificial and being manipulated. What doctors, nurses and hospitals actually do has boiled down (degenerated) into a useless, very expensive, arbitrary way to sort patients, diseases, tests and therapies into, we pay for this we don’t pay for that, categories. The diagnosis and treatment of disease is an inconvenient regrettable appendage.
Many doctors and nurses, when we can afford it, pay money and fly to third world places like Honduras and Haiti where we can diagnose and treat patients for free. It’s a good and noble thing to do but also a welcome chance to get away from arguing about preexisting conditions. What’s getting lost in our current debate is that most doctors and nurses went to nursing and medical school so that we could do good and noble things. If we wanted money we would have studied money. If you’re doing medical care for money, especially primary care, especially pediatrics, especially if you’re interested in developmental, behavioral issues, you probably suffer from oppositional-defiant disorder and maybe a few other mental health conditions.
Money is more trouble than it’s worth. HMO’s, managed care, pay-for-performance models and the highly imperfect ACA all tried to pay doctors and patients to be better doctors and patients. The results have been mixed, mostly bad, because it’s a fool’s errand. Doctors and patients make mistakes but are mostly doing the best they can.
Figuring out who has what and what should be done about it is something doctors, nurses and hospitals have always done and always will do imperfectly. It’s not what insurers and politicians went to school for and the results of letting them run the show speak for themselves. Not good.
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