Health Insurance and Pre-Existing Conditions: A Blast from the Past

There is much talk about “pre-existing conditions” and their effect on health insurance.  One of the reasons that politicians find it so difficult to replace, let alone repeal the “Patient Protection and Affordable Care Act” (and how many untruths are in that title?  Every word, including “and”) is that covering pre-existing conditions is popular.  Very popular.

Here’s the problem.  It doesn’t matter how popular it is.  It doesn’t matter how many people want it.  It doesn’t matter how great the idea sounds.  Requiring insurance to cover pre-existing conditions without allowing that insurance to charge for that coverage commensurate with the extra cost destroys health insurance.

Let me break that down for you.

In statistics there’s a concept called the “expectation value.”  It’s simply the “numeric value multiplied by the probability of it happening.  It’s also the average that would happen over many, many cases.  Like this.

The probability of getting “heads” in a fair coin toss is 0.5 or 50%.  Suppose you got a dime every time the coin came up heads.  The expectation value would be $0.10 * 0.50 or $0.05.  One nickel.  Flip the coin a thousand times and you would expect to get pretty close to $50.00 averaging that $0.05 per flip.

If you have multiple things that could you simply sum up the expectation values of each of the things that can happen to get the total expectation value.  For example, a standard die can give you a number from 1 to 6 with each face having a probability of 1/6.  So for the total its 1*1/6+2*1/6+3*1/6+4*1/6+5*1/6+6*1/6 (please remember your PEMDAS, particularly the MDAS portion). That’s 21/6 or 7/2 or 3.5  Roll the die a million times and expect a total of about 3,500,000.

Well, that’s how insurance works.  Each of the things that insurance has to pay for has a cost–how much insurance will have to pay to treat it.  And each of those things has a probability of happening.  Different people will have different probabilities of various things.  A person who’s young and healthy will have low probabilities of most things.  An older person will have a higher probability of many things than a younger person.  A smoker will have a higher probability on some things than a non-smoker.  A heavily overweight person will have a higher probability of some things than a person of normal weight.  A biological male (worded so to avoid arguments some people will raise) will have a higher probability of certain things than a biological female.  And vice versa, a biological female will have a higher probability of certain things than a biological male.

Insurance, actual insurance, basically pools that.  You, as an individual, might hit the medical “jackpot” where the “prize” is a really expensive medical condition.  You don’t know that in advance.  What insurance does is allows the expectation value of many people to be averaged.  Each person pays for their risk, the insurance company invests the money in the meantime.  And by simple statistics, some people at the end will find that they didn’t have any expensive medical expenses and others will.  Some will get more in benefits than they get in premiums.  Others won’t.  But that’s okay because they were paying for the risk.  They did not know ahead of time which category they would fall into.

I don’t know about you, but so long as the premiums are commensurate with the risk, I hope the insurance company wins that bet and I don’t have any major medical expenses.

That’s actual insurance.  It’s balancing the risk that something might happen against the cost of it happening.

Of course, insurance companies don’t sit down and try to figure out each individual risk factor in each individual and calculate that against all the possible things that might affect them.  They use “actuarial tables” as a shortcut.  A person in this age range, with that weight range, of this sex, and non-smoker will likely cost so much on average.  When I first got private insurance I had to pay a bit more because I was heavier than the insurance company liked.  I was okay with that because my weight made my risk higher.  Fortunately I was always a non-smoker so I had that going for me.

It’s like car insurance for young people costs more because they’re more likely to make expensive claims.  Your particular kids might not (in which case good for you for teaching them well) but in general, that’s how it works.

But now we come to the other aspect that gets rolled into “insurance” when it comes to health.  That’s not “insurance” per se, not risk sharing, but rather analogous to a maintenance contract:  you agree to pay a certain amount and routine stuff is taken care of.  Annual exam.  Glasses.  Birth control if you use it.  Stuff that isn’t so much risk as certainty.  In this case you’re simply arranging payment in advance to cover this stuff, or most of this stuff since there’s almost always a copay (always in my experience, but there might be some plan out there that doesn’t).

There’s no risk sharing here.  The premiums have to cover the cost of these routine items completely over and above the cost of any actual risk sharing coverage.  When everybody has similar costs here, well and good.   Everyone has an annual exam, that sort of thing.

But then there are pre-existing conditions.  A pre-existing condition–something you had before getting insurance–is not a risk, but a certainty.  There are three ways to deal with that.  The first is simply not to cover the pre-existing condition.; you can be insured for other things, but things related to the pre-existing condition are on your own.  You can charge more for coverage of that condition, make it a “maintenance contract” issue, where you have a fixed payment rather than paying for each treatment, specialist, or what have you piecemeal.  Or you can raise everyone’spremium to cover the cost of your pre-existing condition.

That last one is that the PPACA does.  It’s not risk sharing like standard insurance.  It’s wealth transfer taking money from those who got their insurance before they had expensive medical conditions and using it to provide for those who waited.

And that’s the problem right there.  It provides an incentive for people not to get insurance until they have an expensive medical condition.

Consider auto insurance.  Imagine if auto insurance covered “pre-existing conditions”.  A person could eschew insurance, wait until they have an accident.  Then, while waiting for for police and emergency crews to come in, call an insurance company and get the liability insurance since it will cover the “pre-existing condition” of the accident you just had.  Then, later, when you’re ready to get your car fixed (or totaled out) you get the collision coverage and have that pre-existing condition covered.

In such a case, why would anyone do anything else?

So some people start to drop out of insurance figuring it’s cheaper to just wait until they have something that needs coverage to get it.  This just means that the costs of covering folk with pre-existing conditions is split between fewer people.  Meaning that the cost per person goes up.  The increased costs encourage other people to leave, raising the costs still further.  And so on.  And so on.  Until all that is left is people with pre-existing conditions and the premiums are such that there’s no point in having insurance anyway.

In an attempt to mitigate that we have the various mandates.  Employers must provide insurance.  If your employer does not you must have your own coverage.  But that has its own problems including the fact that it simply doesn’t work.  The fines (excuse me, tax) simply are not enough to outweigh the rapidly growing cost of insurance and it’s simply not politically feasible to raise the fines enough to do so.

And so something has to give.  Mandated coverage means that other coverages, those not specifically required, get cut back or dropped, deductibles go up to try to mitigate the cost, premiums go up to try to recover revenue.  Insurance becomes more expensive with less coverage for everyone, not just those with pre-existing conditions.

But, hey, free birth control is worth it, right?

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Continuing Ice Follies

Last Saturday I was out on the ice again. (Remember, I’m scheduling these several days out–I’ll be at LibertyCon when this posts.) First, I set a new personal best (at least counting since re-starting ice skating a few months ago after a 30+ year hiatus, and, no, it’s not like riding a bike. Proving harder to re-learn than it was to learn the first time) 36 times around the rink. Given my foot problems and how out of shape I am, that’s pretty good. Checking the size of the rink–it’s sized for playing hockey so I could look up the size from that–that comes to something just under three and a half miles. Not bad for an old fart.

In the evening session I went back and added another twenty-four laps, just over two miles to the day’s skating.  The ice was a lot choppier then and I wonder if they ran the Zamboni before the session like they usually do.  I was a bit late because of traffic–road construction–so the session was already started when I got there.  Partly because of the choppy ice and probably partly because I was tired from the level of exertion I caught my toe picks badly and took a spill.  I seemed to be fine at the time but later I had some minor issues with my left knee, so it looks like I might have twisted it a bit in the fall.  Not badly and I should be able to get back to class after LibertyCon.

But the time and distance skated isn’t really the important part, nor is the minor injury. When I was younger, I enjoyed ice skating. At least, I enjoyed it when I had the opportunity. Small town Ohio didn’t provide a lot of opportunity. The only “ice rink” the local town had was an outdoor basketball court that was flooded and allowed to freeze in winter. Yes, it was as bad as it sounds. Then, I was able to do a little ice skating when I was stationed in England at Queens Ice Club in London. And nothing since.

I enjoyed it, but getting back into it, it’s been more chore than pleasure. My feet hurt (arch problems I didn’t have back then). Falls hurt more, and are more injurious than they were back then. (I don’t _bounce_ like I did when I was younger.) And it was just simply harder. In fact, if I didn’t have the memory of it being fun, and the understanding that if I could get through the difficult stretch and regain my basic skills it could be again, that encouraged me to persevere in practice (and actual classes for the first time in my life–I was self taught before).

Well, today, I was out there on the ice. The first few laps I spent time practicing particular skills we are working on in the classes, get that done while it’s fresh. After that, however, I mostly just do “round and round”, just skating and two-foot glides, rebuilding the easy balance I used to have.

And I realized something as I was out there going around. I was grinning. Big, split my face wide open grin. I was enjoying myself. Yes, it was still work (and I had to take breaks every so often to catch my breath), but it was fun again, or rather “fun” had finally passed “work” in basic skating.

And that, right there, is a significant milestone.

Snippet from a new WIP

I’ll be at LibertyCon when this goes up.  I’m currently working on a sequel (which actually looks like it will be the next two volumes actually) to The Hordes of Chanakra.  But the next project once I finish that is slated to be a sequel to Alchemy of Shadows.  Here’ a snippet of the opening scene for that:


ALCHEMY IMPRISONED

CHAPTER ONE

Jason Gillespie of the DEA was annoyed.  I knew that.  I could see it in his face.  And, from his perspective he had every right to be.  I sighed and waved down at the half dozen devices on the table between us.

“They’re difficult to make.  They take time.  Give me another week and I’ll have some more.”

We sat in a small diner near one of the local universities.  I had just finished a lunch large enough to raise the eyebrows of my waitress.  I may be only about five foot three inches and just over a hundred pounds but when I am actively working alchemy I need to eat a lot.

Gillespie picked up one of the devices, a small flare, only instead of typical pyrotechnics it contained an alchemical invention of my own, Tru-Magnesium.  Lit, it was bright enough, brighter than a normal magnesium flare, but its real secret was in the alchemical Tru-Light that it emitted.  This Tru-Light is the only thing I have ever found that can harm, that can kill, the creatures I know only as Shadows.  They have chased me for more than two hundred seventy years.  And for most of that time all I could do was run.

“Look, Adrian, I can appreciate that you want to keep your secrets, but this is a matter of national security.”

I did not roll my eyes.  He was not exaggerating or using empty words as authority.  He was speaking blunt truth.  I simply nodded and he continued.

“If you could just give us the formula, we could make it ourselves and you could go back to your own life.”

I frowned at that. “You want me to just give it to you?

Gillespie raised his hands in protest. “Not give, no.  We could pay you handsomely for it.  You’d be set for life.”

I successfully suppressed the urge to chuckle.  He did not know just what “for life” entailed for me.  Instead I shrugged.

“You certainly don’t mean to tell me that you haven’t had them analyzed, do you?”

Gillespie did laugh. “Reports from three different laboratories.  All of them were utter nonsense.  There is simply no way what is in this thing–” He tossed the flare up and caught it. “–can do what we’ve seen them do.”

I nodded. “That’s part of it.  It’s not something I can just tell anyone.”

People think of alchemy as a kind of primitive form of chemistry.  It’s not.  Sure, in alchemy I manipulate chemicals but the results have nothing to do with the atoms and the bonds of ordinary chemistry.  Instead the manipulations are a way to connect to something other.  Call it magic, if you will.  A chemist could repeat every one of my procedures, every distillation and composition, exactly as I did and they only would produce piles of wet ash.  Without the secret of the Philosopher’s Stone that’s all they would ever produce.

And that secret, I would give to no one.  I dared not.

“I’m sorry,” I said as the silence started to lag. “I can’t tell you how to make them, not won’t, can’t.  I’ll try to increase my production of the Tru-Light flares.  That’s the best I can offer you.”

“You’re not holding out for more money are you, Adrian?  Because I’d really hate to think you’re holding the nation hostage.”

This time I did roll my eyes.

“I’ve been fighting Shadows longer than you have.” Okay, I’d been running from Shadows, but he did not need to know that. “This is the best I can do.  I’m sorry.”

He stood up and dropped a few bills on the table to cover the cost of the food. “I’m sorry, too, Adrian.”

As he left, I wondered what he meant by that.


In the meantime, you can find Alchemy of Shadows itself here:

Paperback: $10.99
Kindle: $2.99
Kindle ebook free with purchase of paperback from Amazon

I was born in the year 1215 in a small town in Westphalia As a boy, my parents apprenticed me to the famed alchemist Albertus Magnus. Under his tutelage I grew to adulthood and learned the mystical secrets of alchemy including the manufacture of the Elixir of Life. I have gone by many names through the centuries.

I was already centuries old when I encountered the creatures of darkness made manifest that I know only as Shadows. They have chased me down through the years for reasons I have never understood.

Light was the only weapon I had against these Shadows, light that could drive them back but not harm them. And so I ran. Every time the Shadows caught up with me I fled to a new identity, a new life, until inevitably they found me again. At long last, with nowhere left to run, I had to find some way to fight the Shadows, not just for myself, but for the people I had come to care about.

My name is Adrian Jaeger. This is my story

Thrilling Heroics: A Blast from the Past

As a reader I’ll forgive a lot if you give me some thrilling heroics in your story.  Doesn’t matter if it’s a book, a TV show, a play, or an audio presentation.  Give me excitement.  Give me derring-do.  Give me reason to cheer.

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Add in a love story, and you’ve got me hooked.

Sure, you don’t need to have fast-paced heroism, and clear heroes and clear villains, to involve me in a story.  I can and do enjoy methodical thought pieces.

But, to be honest, it’s just easier to bring me in with heroes and heroics.  Give me someone to root for, someone to boo, a threat faced, a challenge overcome, and I’m happy.

Does this mean that you can skimp on deep character development or involved world building.  Eh.  Not really.  Well, maybe a little but only a little.

The key there is thrilling heroics.  They can’t be thrilling if I don’t care about the hero, about those threatened, about even bystanders along the way.  They can’t be thrilling if I don’t believe the hero, and the villain, would act the way they do.  You can get away with less depth in lesser characters because by definition they don’t do much and we only need enough to fit what they do.  If the cab driver is just taking Our Hero from the airport to the hotel we don’t need to know that he washed out of law school, went on a month long bender that broke him up with his fiance and ended up in rehab before finally starting to put his life together and getting a job driving taxi (at least he’d never had a DUI even while drunk out of his mind).  But we have to believe that Our Hero is going to charge through machine gun fire into a burning building for someone he hardly even knows.  So you’ve got to have your character developed enough that when that happens we believe it.

Likewise with world building.  I’ve got to believe the threat.  And I’ve got to believe the actions available to the character.

A good example of that is the series Buffy the Vampire Slayer.  In a group devoted to discussing the series someone made the comment that it was strange that Buffy and her friends (collectively known as the “Scoobies”) didn’t use cell phones to keep in touch and coordinate their actions.  However, when the series was made, particularly the first few seasons, cell phones were still high end items and not in common usage.  I didn’t have my own cell phone until the third season was out.

So if your characters have cell phones (which here is a stand-in for whatever bit of worldbuilding might affect the plot) then either have your characters use them when appropriate or give them a good reason not to.

So, develop your character.  Develop your world.  Hell, put in a “message” if that’s what you want.  But wrap it up in something for me to care about.

And if you succeed in that wrapper, your prose can limp a little.  I can let the occasional lapse in other aspects pass.  I can even disagree with your message and still enjoy the story.  I’ve done it before.  I can do it for you.

So give me some thrilling heroics.  Give me big damn heroes:

And if you can throw in a love story.  That’s good too.

And if you give me that, well, that’s the kind of thing that gets me to give you money in return.

Getting Sentimental: A Musical Interlude

This one’s a little different from most of my musical interludes.  I usually put up some darker stuff–goth and metal music for the most part.  Here I’m taking a more sentimental/love song/ballad turn including some stuff from before my “Musical Awakening” of the last decade.  I’m sure there’ll be some eyerolls from some of you at some of these, but the heart likes what the heart likes. 😉

This one always gives me chills 

This is only a small part of my “sentimental” playlist, but this is a good one to finish on, I think.

Some Soul Baring

Folk who have been following this blog for a while should have twigged to the idea that I’m pretty close to an open book here.  There are some things I keep to myself (doesn’t everyone?) but on the whole I’m pretty open.

I’ve mentioned before that I grew up in the LDS church.  Sometime around my late twenties I ended up drifting away from it.  I just found that I didn’t believe too many of the core doctrines any more.  It started with Young Earth Creationism and, well, once I started picking at that thread, things started unraveling.

About the time I was going through technical training in the Air Force, there was a musical produced by folk at Brigham Young University called “My Turn On Earth”. It was a schmaltzy little piece which, in the course of its story, gave a brief precis of a number of LDS doctrines (the pre-existence of spirits, the cause of Lucifers rebellion and fall, the eternal nature of family–more on that shortly–etc.)

Mind you, back then I’d never actually seen the musical.  What I had was a cassette recording of the soundtrack (I’ve since found a recording of a performance on Youtube–and it was as nice as I imageined; one doesn’t have to believe the story to enjoy it as a story).  And, frankly, I loved the music.  Okay, this was way before my “musical awakening” and getting introduced to Goth and Metal music.  It very much had a “show tune” vibe.  Of course, they were show tunes, so that just made sense.  But, in particular one of the songs–well, more a medley of two but it’s the second part that really did it for me and can still move me to tears. (Yeah, yeah, I’m just a sentimental softie.)

To explain that you have to understand that while I no longer believe the doctrine of the LDS religion, a lot of my early emotional conditioning/imprinting/whatever you want to call it came out of it.  And the big one there was the idea that marriage and family was supposed to continue not just “until death do you part” but “for time and all eternity.”  “Heaven” in a very real sense, was simply a continuation of a loving family…forever.

Mind you, I hadn’t personally experienced that perfect family, or even a sort-of-all-right-family.  I had, however, seen it in others.   And while I recognize that seeing others vs. experiencing ones own has been described (with considerable justice) as comparing someone else’s “highlight reel” with ones own “behind the scenes”, I could still see that a good (let alone perfect) family where the people love, care for, and support each other and having that continue forever is extremely attractive, and it’s more tangible than most conceptions of “heaven” that don’t really “sing” for me. (I may joke about “Viking Heaven” offering sex, booze, and meat, but the reality is this “continuation of a great family forever” IMO has that beat hands down.)

As a side note, this is why I roll my eyes when people tell me “you can believe what you want.” You see, I can’t think of anything more appealing than that:  family, loving and caring for each other, continuing for all eternity.  That would be my heaven.  If I could just throw a switch in my head and believe the doctrines of a church that offers that, I would.  And so, whatever happens after I die–oblivion, non-existence, or some form of afterlife–remains a great unknown.

And so, not having promise (that’s meaningful to me anyway) of an “ever after” I’m left with trying to do the best I can in this mortal condition.  Of course, like everyone else, I’m hampered by all the flaws and difficulties of human frailty–and the fleeting nature of human life is no help at all.  But it’s a goal, and a high one.

And in the meantime, one can listen to this beautiful little song:

It may be horribly un-goth for me to admit (Hey, I’ve got layers! 😉 ) but there are a handful of love songs that I consider among the most beautiful and moving ever made.  There’s the Righteous Brothers “Unchained Melody.” There’s Elvis Presley and “I can’t Help Falling in Love” and “Love me Tender.” “If” by Bread.  And the second part of this one ranks right right up there with them.

Here in our love, I feel something of Eternity. (Eternity)
Looking at you, I can see right through to Eternity (Eternity)
Millions of years like pearls before us wind away.
They wind away. (They wind away.)
Millions of years like pearls before us
Yours and mine
Today.

We will go on, building upon Eternity (Eternity)
Growing with you, flowing into Eternity (Eternity)
Suddenly hours and days are spinning
Suddenly Heaven is beginning
Suddenly now the veil is thinning
In a place or two.
Suddenly now I see Eternity is you.

Suddenly hours and days are spinning
Suddenly Heaven is beginning
Suddenly now the veil is thinning
In a place or two
Suddenly now I see Eternity is you.
Eternity is you.
Eternity is you.

 

There Ought to be a Law: A blast from the past

Inspired to bring this one up from a recent article asking if Americans are “ready to legalize Prostitution.” Frankly, in most cases more problems are created by making something illegal than were caused by the issue in the first place.  Once you put people’s activities outside the law a lot of the social and even legal (after all, if they’re already breaking one law, what’s one more?) restraints go away.

One basic rule of life is that if there is a demand for something, then someone will create a supply. Making it illegal doesn’t end that. It just brings all the trappings of criminal activities along with it. We saw that with Prohibition. We see it in “Prohibition II”. And we see it in prostitution.

And so, I wrote the following on the subject of “There ought to be a law.”


Actually, in the vast majority of cases, no, there ought not to be.

Think about what “law” means.  Law means that someone from the government can come and use force on a person to make him or her comply, to submit.  Force.  And if they resist that force, the government can increase the level.

In the end, if they continue to resist, the government can kill them.

Even if you don’t have a “death penalty” on the books, it is always the end game of a person refusing to submit to the law.

And it has to be that way because without that ultimate use of force, there comes a point where someone can say “no” to your law and you have to say “okay.” At which point it’s no longer law but a strongly worded suggestion.

So when you say “there ought to be a law” you are saying “it’s worth killing people to ensure that this happens” or “to make this less likely to happen.”

That’s what “law” means.  That’s what law is.

It is the same with anything you want the government to do and to pay for.  Taxes, after all, are also laws.  Someone can say “no” to paying the tax and you send armed men to force him or her to pay.  And if he resists those armed men, they can kill him.

“The government should provide/pay for…” means “we are willing to kill someone to have…”

And it’s not even just the willingness to kill the people who break the law because the use of force occurs before any trial is held to determine guilt or innocence.  Police respond to a bad tip and break into someone’s home.  Resident, having no reason to expect the police, acts to defend himself.  And the result is the coroner has to come and haul away one or more bodies.

Someone, maybe several someones, dead because “there ought to be a law.”

This is not to say that there should be no laws and no taxes, but that we need to go into that eyes open about what it means.  Does a study on why Lesbians have a higher incidence of being overweight (an actual CDC study) really  justify killing someone?  Is it really worth killing people over smoking an unapproved plant?  And so on.

Thomas Jefferson wrote:

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.–That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed

There, I believe, is the crux of it.  To secure these rights of LifeLiberty, and Pursuit of Happiness, does justify the use of force to the point of deadly force.  Defending our nation, laws to censure those who credibly threaten the rights of others to Life, Liberty, and Pursuit of Happiness, and the minimal necessary taxes to accomplish those ends.  And no more.  Let other things be accomplished by other means, means that don’t come with the sanction to use force up to and including deadly force.

Reserve law and government for things that really are worth killing over.

Oh, and one more little thing.  Before you decide that it’s okay to kill those “other people” (you know who they are) because you don’t like what they’re doing, just remember:

Anything government can do for you, it can do to you.