Preexisting

[mrissa]

I’m pretty sure I’m preaching to the choir with this, but the thing about preaching to the choir is that sometimes you get at an angle of analysis the choir hasn’t been using. I have heard a lot of “depriving people of health care is bad” arguments that are absolutely true, but not a lot of the following.

So let’s talk about preexisting conditions.

You know those commercials that tell you to tell your doctor if you’re suffering from dropsy, the vapors, or a dozen other conditions that make you think, “Shouldn’t my doctor know that already”? Under the current system, where people can’t be dropped from all insurance possibilities based on a preexisting condition, those notifications are necessary because record-keeping and institutional memory are imperfect. Your doctor should know that already, but they may now, so: probably mention it, huh.

But if you can be dropped based on a preexisting condition, it takes on a whole new meaning. “Tell your doctor if you have a history of respiratory infections”: right, so your doctor can write down “history of respiratory infections” in the course of figuring out what drug to give you for something different, and boom, there you are with that tag on you, and who knows what the consequences will be. Your doctor needs to know this stuff to figure out how to treat you–sometimes to figure out a subtle cause or contributing factor to what you have right now–but you suddenly have incentive not to tell them. Healthy as an ox, me, just this sprained ankle to deal with! Something very temporary! Oh please don’t tell them I have anything non-temporary. Please ignore the anemia. Do not test my thyroid. Forget the anxiety. I just won’t get treated for the life-altering allergies. Only deal with the condition I tell you I’m in here for. For heaven’s sake don’t run any tests because you caught a murmur listening to my heart or my blood pressure is behaving funny. That’s all the sprained ankle. Has to be. And let’s wait until whatever else there is has caused permanent damage, because that’s the point at which it’s too bad to ignore.

I’m not saying this hasn’t happened under the current system. It does. Of course it does. We should be moving away from it, not towards more.

And this is all bad enough when we’re talking about a heart condition, or depression, or, well, any of a number of things. But when we’re talking about something contagious, all of a sudden it’s more than a dangerous calculation for one person–it’s a dangerous calculation for the people around them, too. Is what you have bad enough to disclose and get treatment, or should you just cope with it and keep passing it along to others? I should not have to say that this is not a good system. This attitude often gets billed as “be a smart consumer of health care,” but in this case a stingy consumer of health care is the opposite of a smart one.

But that’s not the only thing pushing people toward dangerous medical dishonesty in the current political climate. There are lawsuits wending their way through the courts claiming that doctors should not have to treat people who have certain sexual orientations. So not only the questions that pertain to your sexual health but also the ones about the rest of your life health–“Do you feel safe in your relationships?” is one of my favorites–are now extremely dangerous. Not just for getting dumped from insurance, although let’s not underestimate the impact of that. But for being rejected for emergency treatment even if you pay the entire gigantic bill out of pocket.

Last week a family member made a Facebook post of a meme saying that while other people freaked out in favor of or against Donald Trump, he was just going to keep doing what he always did. The people who connect me to that family member each have quite large preexisting conditions that can no longer be hidden–one of them was treated on an emergent basis, both of them are in the records. And of course there’s me and my giant flashing neon sign that reads “preexisting condition.” So…”keep doing what I always do” is not actually a functional mode here for his own family. It’s certainly not a functional mode for the country.

Originally published at Novel Gazing Redux

Comments

[jebbypal]

Totally the choir here, but you know, I hope one of the ,epically shows on TV picks this up for a plot. Thinking about House specifically and his continual mantra of "everyone lies", well, duh, of course they do if they have a genetic condition that may cause them and their family to be kicked off insurance. Why would I ever tell my doctor about a family history of blood cancers if I have insurance through my employer and therefore don't need to provide a family history to get it.

[mrissa.livejournal.com]

I think that some people are thinking that if you have insurance through your employer, you're "safe": as though no one has ever been laid off, as though no one has ever had to leave their job for any reason.

Sigh.

[fadethecat.livejournal.com]

Mmhmm. I remember when I got treatment for my anxiety, via a therapist, while on my spouse's decent company-provided health insurance. When he swapped to doing contract work, and we responsibly went shopping for a new insurance plan, we suddenly discovered that we weren't even allowed to purchase several swathes of plans because my anxiety was a Pre-Existing Condition. And that was a mild emotional problem, treated with nothing more than therapy. Eliminating various types of catastrophic cover from being options to purchase with my own damn moneys. Sigh.

[mrissa.livejournal.com]

And if you had not gotten it treated, it could easily have been worse for your physical health as well as your general well-being. So. Really. Sigh.

[whswhs.livejournal.com]

You know, I don't think I can accept "depriving people of health care is bad" as an unqualified truth. That's looking at just one variable: the value of the health care. But there's always another variable: The thing you have to give up to provide health care. When you compare the badness of depriving people of health care, and depriving people of the other thing, sometimes depriving people of health care will be a net good.

My personal preference is for having such decisions made individualistically. But a collective approach doesn't avoid those issues. A few years ago I edited a British book about medical ethics that talked about the "fat and fags" movement, which calls denying health care to anyone who smokes or is overweight, other than immediate life-saving health care in emergencies. This is exactly the thing you are decrying, but apparently a majority of British doctors and a large number of British voters thought that depriving smokers and fat people of nonemergency health care was good—and they're in one of the most purely collective health care systems.

If what you mean is that not having health care is bad, and has to be traded off for other bads, then yes, that's true in any economic system. But a lot of people will use your statement as a slogan for giving health care automatic priority over other things. I don't think that leads to sound decisions; but in any case I don't think people will actually make decisions that way, whether they do so individually or collectively. But the pursuit of the illusion of doing so can lead to poorer tradeoffs than openly acknowledging that health care is only one good among many.

[mrissa.livejournal.com]

How kind of you to come in to be blithe about depriving people of health care in a post where myself and others have already talked about having preexisting conditions personally.

I am so glad to hear that the UK system is imperfect; clearly that means that we should strive for no better here.

You have been socially insensitive in more minor ways than this before, and I've just ignored you. Coming into a post by someone for whom it is not just theory to bluster in the way you have is really one step too far. I hope that you learn how to discuss this sort of thing without being a jerk, because opinions on how best to manage health care can of course vary. But I'm afraid you're no longer welcome to do that learning here; I have groaned "oh God, THAT guy" for the last time.

[rosefox]

Well said.

[teadog1425.livejournal.com]

This.

[ethelmay.livejournal.com]

"The accuracy of the doctors.net.uk survey is questionable. For one thing, the survey was a self-selecting opinion poll, or SLOP, and those are notoriously biased. Moreover, the question asked was broadly phrased: "Should the NHS be allowed to refuse non-emergency treatments to patients unless they lose weight or stop smoking?" Thus a doctor who would deny all medical care to a smoker was counted alongside one who would refuse only a lung transplant." http://wendymcelroy.com/news.php?extend.4680

[mrissa.livejournal.com]

Thank you for that useful and timely context.

[reveritas.livejournal.com]

This doesn't even make any sense.

[redbird]

I'll just leave an "Amen!" here, because my longer responses aren't cohering right now.

[mkille.livejournal.com]

I will add that pre-existing conditions bureaucratic idiocy--along with high deductible + HSA plans--were a non-trivial contributor to the eventual failure of my first marriage.