Why Mandating Coverage For Preexisting Conditions Is Morally Wrong
Despite overall disapproval with President Obama’s health care law, many of its provisions remain popular. Perhaps the most popular provision in the law is one that prevents insurance companies from discriminating against customers based on “preexisting conditions.” The logic is relatively simple at first glance: people with debilitating conditions will not be able to get coverage at affordable prices unless Congress mandates that insurance companies cannot discriminate against those with a preexisting condition.
We all know someone with a preexisting medical condition, be it cancer, diabetes, or pregnancy. The fact that we all know someone who currently has or previously has had a preexisting condition is one reason why this provision is so popular. After all, it is difficult to argue with someone who uses the emotional appeal of an aunt with cancer or a single pregnant woman who is uninsured. Emotional appeals can be used to “justify” any side of any issue but they cannot prove anything. Preexisting conditions can be tragically sad and are often not the fault of anyone, be it the victim or society as a whole.
There is a very important question that we must ask before we decide whether or not such a provision is a good idea: is it appropriate to punish someone who has done nothing wrong?
This is a very serious question. If we decide that it is appropriate to punish someone who has committed no wrong, then we must not only answer why it is appropriate to punish the innocent, but who should punish the innocent and how severely they should be punished for their non-wrongs.
I do not see how any rational person who has thought about this question can decide that it is morally acceptable to punish a person who has done nothing wrong.
Therefore, if it is not appropriate to punish someone who has done nothing wrong, then we must absolutely reject the idea of Congress mandating that insurance companies not discriminate against those with preexisting conditions. The reason for this is simple: forcing insurance companies to provide “affordable” coverage for those with preexisting conditions must result in increased costs for those of us without preexisting conditions.
Insurance is a vehicle which prices and protects against risk. This is usually done by assigning people with similar characteristics to “risk pools” and charging them similar premiums. In a free market for health insurance, 35 year old male smokers residing in the Chicago area who are overweight and have type 2 diabetes are likely to be placed in the same pool and will be charged the same or a similar monthly premium. Under a system where insurance companies are prevented from discriminating against those with preexisting conditions, the previous group is merged with the group of 35 year old male smokers residing in the Chicago area who are overweight but do not have type 2 diabetes. While this will result in lower premiums for those with type 2 diabetes, it will result in higher fees for those without the disease.
In other words, while preventing insurance companies from discriminating against those with preexisting conditions sounds like a noble idea, it ends up punishing those who have done no wrong.
I am sorry if you have a preexisting medical condition, I truly am, but unless you can conclude that your preexisting condition is my fault, you have absolutely no moral right to punish me for your condition.
My article dealt with the ethics of mandating coverage. It did not deal with the economics of it, nor did it offer solutions.
There are (and have been) ways to provide care to people with preexisting conditions without forcing punishment on the innocent. There will always be tragic cases. We do not live in utopia. But let’s consider a system that minimizes the tragic cases, and to the best that is humanly possible, deals with tragic cases (on case by case basis) in a non-coercive way. A blunt/one-size-fits all “fix” destroys incentives for improvement and treats a diverse range of challenges as if they are all the same. I recommend that you read The Voluntary City: Choice, Community, and Civil Society
which contains historical examples of solutions to this type of problem.
For a reading list on the economics of health care, I suggest you check this out.
1I disagree with your article. It is immoral to leave the ultra sick to fend for themselves when the system has made the cost of healthcare completely out of reach for the average person. If we can all be charged a surcharge on our cell phone bills to pay for cell phones for the poor, too bad if there is a surcharge on insurance for those who need live saving medical care.
2So Joyce, do you believe that it is morally acceptable to actively punish someone who has done nothing wrong?
3It’s still in our best interest as a nation to cover them, bc we already offer universal healthcare through the emergency rooms. Don’t we all benefit if they (and others that are currently uninsured) receive more efficient care?
Now, if you were to argue they shouldn’t be cared for at all, then it makes financial sense, but that becomes tough for me since many of those with pre-existing conditions also did nothing wrong.
4Ashish–
“It’s still in our best interest as a nation to cover them, bc we already offer universal healthcare through the emergency rooms.”
Do two wrongs make a right? The fact that we do offer universal emergency coverage in no way justifies offering other mandates.
“Don’t we all benefit if they (and others that are currently uninsured) receive more efficient care?”
I would say no, but this article was on the morality of the issue and not the economics of the issue.
“…since many of those with pre-existing conditions also did nothing wrong”
True they did nothing wrong, and their conditions are unfair, but that does not justify punishing the healthy for these conditions. And this just deals with the conditions that are accidents of nature. What of those that are do to poor personal decisions on the part of the inflicted?
5No Problem. If you are healthy, DON”T buy any insurance. Just pay cash if and when you have a problem. Or better still, fly down here to Mexico where the free enterprise system provides doctor visits for as little as $2, and cheap medicine bought WITHOUT prescriptions.
6Well said. i personally deal with a “preexisting” condition and to be honest i’m glad that the insurance i do have doesn’t cover my treatment. Not that i believe in karma exactly but i don’t want money that was violently extracted from other people who are probably also struggling, and even if they can afford it, no, i do not have a moral right to punish them. How can anyone feel justified in that??
Now’s a good time to remind ourselves that the private sector is always more efficient and generous when it comes to caring for the less fortunate. Charities (funded by individuals who want to give), private hospitals and doctors who are willing to work with people on an individual basis… these are all valid and morally upstanding avenues that deserve more attention.
7You are wrong, I had health insurance when I developed a health condition. My premium was outrages before my condition. My circumstances have changed, and I can’t shop for another insurance because I have a now pre-existing condition. You obviously don’t know about how life can change in an instance. If you know anything about insurance, you should know they take in gross profits compared to what they actually pay out.
8“You obviously don’t know about how life can change in an instance.”
You obviously don’t know who you are talking to.
9Well if the profits are so “gross,” then why dont you start your own insurance company and operate on less profit and use that profit to provide care for people?
10While I agree that mandating coverage for preexisting conditions is wrong, I think it is misleading to ask “is it appropriate to punish someone who has done nothing wrong?”. The reason is it is possible that the person with the preexisting condition has done nothing wrong either, e.g. a non-smoker who gets cancer. So the real question is, should we punish those people a lot, or punish everybody a little?
11The difference is that “we” arent punishing the non smoker with lung cancer or the baby being born without legs. They are victims of nature, genetics, randomness, or whatever, but they arent actively being punished. If you are born with out legs you arent being punished, but if I cut your legs off I am punishing you
12America is the richest country in the world. When I see a fellow American die because he or she could not afford a surgery, it makes me wonder where our priorities are?
It is not a punishment, it is a guarantee. You pay a little more today to ensure when you develop a serious disease, you will be covered.
13Universal healthcare in emergency rooms, I noticed you didn’t say affordable. It took 25% of my tax return to pay for care for my broken kneecap, and that was ONLY because the hospital knocked of 30% off the bill, I declined some services, rented my crutches and I broke it good enough to not require surgery. I grew up with insurance, I’m from Germany, to me as a single mother not to be able to afford healthcare even wile holding a job, is a scary prospect. However, employers now keep us at part time under 24 hours to avoid having to offer health insurance. Is that better? So I guess my emotions about the whole subject are mixed.
14Also, I question some of the new diseases. Obesity, alcoholism, drug addiction and gambling for example, are CHOICES, NOT DISEASES.
As someone that’s fought genetic respiratory issues, and having had said issues make insurance both harder to attain and harder to afford as it is…I admit that I wanted something done to help insurance costs for those of us that also have done nothing wrong, but got dealt a wonky biological issue from our parent(s).
We’ve also done nothing wrong, and there’s nothing that gives us more money to afford insurance.
Given that the insurance companies have the money to shovel enormous sums into pushing for legislation that cost the taxpayers (and potential customers) anyway, I believe that they can afford to make rates more affordable, period…because if people with health issues can afford preventative care more readily, than we can have a better chance at avoiding becoming tax liabilities in other ways, such as going on disability.
I’m generally in line with Libertarian values and supported Gary Johnson rabidly…but if the only people that can get/afford health insurance are the ones who don’t need it, you’ll have millions of Americans either dying unnecessarily or having to get treatment via taxpayer-supported programs anyway.
This particular facet makes sense, at least to a degree.
15The article is deadnuts on par with what’s going on. Should someone who smokes pay more? Yes. Why? Because we know they are going to cost more to insure.
What if there was no insurance? Insurance is only a fall-back option, not care at all. It’s the means to pay for your care. So, in our capitalistic society, why would an insurance company take on someone they automatically know is going to cost the company money? They are a private organization, not a welfare program. The costs of our care could be curbed by tort reform.
This has nothing to do with how much money our country has, it has to do with fairness. If anything, the government should create a public health option that all the sick people can buy into, and it should be run at 0 deficit. But we all know the government can’t actually do that, they always end up taking extra tax money from those of us that actually pay into the system.
16“We’ve also done nothing wrong, and there’s nothing that gives us more money to afford insurance.”
Again, you are confusing the issue. I also have a preexisting condition, but I dont have the right to punish others because of it. Neither do you. The fact that you were born with an unfortunate condition does not give you the right to punish other people by raising their rates in order to lower yours.
Also, “millions of Americans” are not dying from not having health insurance. If you want to see lower rates for insurance, you might want to try pushing market reforms rather than State reforms. How about allowing insurance to be sold across state or national line? How about tax reductions for doctors, nurses, etc? How about relaxing restrictions on immigration for medical professionals? How about allowing competing agencies (besides just the AMA) to license doctors and nurses?
17But of course the government cant do this at zero deficit. Under your scenario, those who can get insurance at a profit to the insurance company will do so. How could the government be expected to run an option for the rest of people that doesnt create a deficit? It just doesnt make sense.
I would argue that in a truly free market–or even a relatively free one, there would be numerous charities (and not just fr profit entities) that would take care of those in need. We all know somebody with disabilities, or who has died of cancer, or who has a preexisting condition. We arent just going to let our friends and neighbors die because we prefer capitalism over State run systems. Read this: http://mises.org/daily/5388/Welfare-before-the-Welfare-State
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