Pre-existing conditions and viral ideas

I keep hammering at denial of pre-existing conditions because it’s a really weird talking point which has come up over and over again as a rallying cry – the healthcare equivalent of “build the wall.” Or the “rampant fraud” everyone keeps seeking but not finding in places like the food stamp program. People are, at this point, emotionally attached to the idea, in a way they can’t fully articulate.

Coverage-deniers are theoretically trying to block cheaters who only pay for insurance when they’re sick and drop it when they get healthy (so they’re guaranteed to always take more out of the pool than they put in). The classic “you always want to share my lunch, but you never share your lunch.” That’s the rationale for walling out or upcharging people who got sick during coverage gaps (but not sick people who switch insurance without a gap).

It sounds rational, but it’s covering up a more irrational fear. If the real fear is cheaters, there are other ways to penalize them – like the individual coverage mandate, which literally makes you pay for not having insurance. There are also mechanisms to make health insurance sticky, like limited enrollment periods (and massive enrollment paperwork) which mean you can’t pick up insurance just the minute you get sick or drop it the minute you get well.

In general, these things are opposed by the same people who think denying pre-existing coverage sounds fair, even though they directly address the “cheater” problem.

I figure there has to be a deeper disgust reaction underneath – maybe disgust of poverty and sickness, and a visceral instinct to bar the door against contagion. (Keep them out of my pool! Even the word pool reminds you of segregated swimming pools, the fear of contamination spread through shared water.) Maybe some of it goes back to the AIDS crisis – the gay plague – and biblical tales of God sending a pestilence to wipe out the enemies of God’s people – although God mainly sent plagues against the Egyptian ruling class, whose modern analogues would have insurance.

This is dream stuff, not logic.

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