Rape Victims’ Hobson’s Choice

Kathy -- your leader is incorrectly worded, and in fact most of us have done both all the time, if the words are used in the correct sense. (We just haven't had the need to take HIV-related medication. You do realize, that most HIV infections arise from decisions, not through inadvertent exposure.)

If the person is taking anti-HIV medication, what would you expect the insurance company to do, ignore it?

A better example than this would have been a domestic violence victim or a rape victim that didn't involve HIV exposure, which complicates this story and can lead some away from the main issue. HIV exposure or infection is an obvious basis for rejection of insurance coverage, and taking a drug for HIV is an obvious red flag; there is no controversy here whatsoever. HIV and cancer patients are the well known people among those who can't get coverage and must pay high rates in state "assigned risk" health insurance pools. Any and all HIV exposures put one at risk; this is little different than someone known to have HIV that got it from a blood transfusion or from an organ transplant (itself making you a high-risk individual, by definition).

We've already seen that being a woman is a pre-existing condition. Having an emergency c-section is a pre-existing condition. Getting beaten by a partner is a pre-existing condition. Mamograms aren't covered in many states. Add to the list: being a rape victim is a pre-existing condition. But by all means, let's do everything in our power to keep these awesome companies who provide this wonderful service making billions.

"A better example than this would have been a domestic violence victim or a rape victim that didn't involve HIV exposure"

Or how about the actual truth here, DLS: the woman did not know if she had been exposed! She was *passed out* because she was *drugged*. She took the necessary precautions, did not develop the infection, and now she's being punished for it.

"what would you expect the insurance company to do, ignore it?"

SHE DOESN'T HAVE HIV. Holy hell.

"Or how about the actual truth here, DLS"

I, at least, insist on it, and on other things that matter, including staying logically sound and zeroing in on the real issues, rather than diverging into emotional and illogical nonsense and tantrum-throwing. Why does unpleasant truth make you and others so increasingly agitated or otherwise, well, pathological? There's a lot poor about many of you that you're exposing related to health care and health care reform (or the Dems' "reform" efforts), which I haven't failed to notice as well as respond to. [shaking head]

"the woman did not know if she had been exposed"

Are you out of touch with more than just emotional control currently? Do you know the meaning of anything these days? She was obviously exposed. The question is if she has been _infected_. That she is taking drugs to prevent the chance of infection rather than retard the progress of HIV infection that has already been established is not enough to make any reasonable insurer fail to recoil from the fact that she is taking HIV medication (something that isn't done as a routine matter). It is a red flag. Ahem.

This kind of shit gets irritating, it really does. Does anyone believe HIV drugs are taken for the hell of it?

L-A-T-E-N-C-Y

http://www.retrovirology.com/content/3/1/7

So why is it that liberal haven't gathered their wealth and made an insurance company with policies they approve of? You'd think they would corner the market in these areas. Isn't their enough liberal money out there that they are willing to gather for at least one progressive insurance company? After all, they did raise a ton of money for President Obama.

Could it be that such policies aren't economically feasible for an insurance company? If not, where is the progressive money to fund one? I don't think anyone is preventing such a venture, I for one encourage it. I believe people should put their money where their mouth is.

This kind of shit gets irritating

Yes, you do.

She was obviously exposed.

To rape. Not necessarily to HIV. Unless you have some inside information on this case that you don't want to share.

Apparently neither the woman nor the crack HuffPo investigative team know anything about HIPPA.

HIPPA limits the preexisting condition denial to only 12 months, not 3 years. Additionally, while it would allow them to preclude coverage for HIV infection for that time period, it would not allow them to deny a policy that covers other health insurance risk.

roro80 -

You win this debate hands down. Denying coverage is the problem. Period. To deny based on rape, being beaten, whatever, is immoral and inexcuseable. Those who would use actuarial excuses as they feign to rationalize this garbage on the part of insurance companies fail to understand that it is precisely these types of practices that helped form the groundswell for reform in the first place. The only people the insurance industry wants to insure are those who don't need it. It drives me nuts when my conservative friends consistently, consistently, consistently put the interests of corporations above the interests of people.

Side note. Some time back Sen. Patty Murray (D-WA) proposed an amendment to the Baucus proposal that would have required insurance companies to pay for medical costs associated with partner abuse. It was defeated. Do you have any update on that initiative? Any commenters want to take a stab at defending that vote?

I oppose the legislation coming through Congress, and have said so many times. It is possible, however, that the one thing worse than current legislative proposals is the conduct of the health insurance companies..

I think this is one of those moments that it depends how you look at people. If you look at them as liabilities or possible liabilities the insurance companies are doing nothing wrong and everything right. If you believe that people are more important than numbers then the insurance companies did nothing right and everything wrong. Some will fall in the middle and see both sides but this is the problem with having a for profit insurance industry, profit has to stay the focus and therefore care takes second place if not being totally kicked off the podium and handed an Also Ran ribbon. It is interesting from a sociological point of view though to see the classic pro-life side defend the insurance companies numbers while the pro-choice crowd chooses the people side. It makes total sense to me but the left will not understand why the lifers on the right do not join them and the lifers will be confused why the choicers care. Hint, choicers care about people but the debate is in where you define the word people and lifers will mostly trust nothing that choicers like(this dynamic works both ways but is more common in this version) plus they see any gov regulation or fix as being attached to abortion in some way(whether true or not, sometimes its true sometimes its not but they always say it is).

If she's applying for individual coverage that's not covered by HIPPA.

Thank goddess my truth is different than yours. In my truth, taking a drug to prevent a disease she didn't get shouldn't make her uninsurable, especially since she *didn't get the disease*. In your truth, she got raped, so screw her. Already been screwed once, I guess?

"Are you out of touch with more than just emotional control currently?"

You know what? If I'm "emotional" about this woman getting cut off from the ability to get health care because she was drugged and raped (again -- even thought she *didn't get HIV*), I'm actually not going to take that as an insult, much as you'd like to paint me as some silly hysterical woman. This is all just numbers on a page to someone who is statistically unlikely to get raped I guess. For many of us, it's a little more than that.

Speaking of hysterical women -- I'm hereby going to coin a term referring to men who are out of touch with the idea that there are things that are, inherently, emotional. This inability, probably related to a sociopathic lack of empathy, often causes people (particularly men) to make ridiculous leaps of what they consider logic. This term is "testerical".

"Those who would use actuarial excuses as they feign to rationalize this garbage on the part of insurance companies fail to understand that it is precisely these types of practices that helped form the groundswell for reform in the first place. The only people the insurance industry wants to insure are those who don't need it. It drives me nuts when my conservative friends consistently, consistently, consistently put the interests of corporations above the interests of people."

I think it's the normalization of the sociopathic mindset. It's unclear whether society is just rewarding inherent sociopathy more, or whether it's actually cultivating that behavior, but it seems to be on the increase. It is really really disturbing.

On Obsidian Wings they had a post about Scalia saying that there was no Constitutional right to not be executed if you are "actually" innocent but have been convicted according to due process. Some people were defending that remark as an institutional imperative, and that anyway, the executive could pardon based on "actual innocence." Recently they had a post about how the Texas governor didn't even read the evidence sent to him in that one execution case, and people were defending him not taking 5 minutes because he was probably busy, and anyway most appeals don't have merit. Plus, it's not like he did anything illegal.

I've long pointed out similar sociopathic arguments present in the torture "debate."

When justice is defined in terms of obeying the system, instead of the expecting the system to uphold justice, then that's when society gets sick on a wide level.

I watched The Boy In The Striped Pajamas recently and agree with Ebert's review:

Other than what "The Boy in the Striped Pajamas" is about, it almost seems to be an orderly story of those British who always know how to speak and behave. Those British? Yes, the actors speak with crisp British accents, which I think is actually more effective than having them speaking with German accents, or in subtitles. It dramatizes the way the German professional class internalized Hitler's rule and treated it as business as usual. Charts, graphs, titles, positions, uniforms, promotions, performance evaluations.

How can ordinary professional people proceed in this orderly routine when their business is evil? Easier than we think, I believe. I still obsess about those few Enron executives who knew the entire company was a Ponzi scheme. I can't forget the Oregon railroader who had his pension stolen. The laughter of Enron soldiers who joked about killing grandmothers with their phony California "energy crisis." Whenever loyalty to the enterprise becomes more important than simple morality, you will find evil functioning smoothly.

There has not again been evil on the scale of 1939-1945. But there has been smaller-scale genocide. Mass murder. Wars generated by lies and propaganda. The Wall Street crash stripped people of their savings, their pensions, their homes, their jobs, their hopes of providing for their families. It happened because a bureaucracy and its status symbols became more important than what it was allegedly doing.

Mikkel -

Like you, I have been following the posts on executions in Texas. But, I had forgotten Scalia's amazing (dis)logic about how it is just fine to execute innocent people as long as they had a fair trial. You may be correct that it is all part and parcel of the same mindset.

My frustration is that I grew up in a conservative household at a time when conservatives, like others, felt sympathy for human suffering. My conservative family would have been outraged by Kathy's piece; they would never have dreamed of defending the insurance company's actions. I still hold many conservative values, but when I see conservatives defending or participating in what you refer to as a "sociopathic mindset" it makes me question whose company I am keeping when I come down on the conservative side of some issues.

tidbits --

Thanks. These are the sorts of conversations that drive me up the wall.

It's funny, I find myself, rather strangely, thinking of how so many of the people in power want to keep all the rights for themselves while denying these rights to others, regardless of the reason. I think of how the right always trots out the excuse of "choosing" to be gay as a reason that gay people shouldn't have the same rights as straight people. Then we see things like this -- women being denied insurance for being women and doing what women do and being raped by men or beat by men. Clearly, women didn't choose to be women (for the most part). Clearly, I'd much rather not have to bear the burden of child birth and losing my figure and the constant second-guessing in the professional world, and being either to beautiful or too ugly or too fat or too thin, or any of the metric f*ckton of bull that comes along with being someone of my gender. This isn't my choice, yet there's still no equality of protection for me and the other women of the world. Chosen or not, there's always reason to demonize the other.

Obviously, being told that having the nerve to get raped should preclude women from equal health care makes me question the intellectual honesty of those saying this -- on this issue and anything else upon which their keystrokes choose to expound.

DLS. This post is about potential HIV infection in the context of rape. It's not about potential HIV infection arising from decisions, not through inadvertent exposure. That is why the title of my post reads, "Rape Victims' Hobson's Choice." If the reader reads that title, or sees it, or notices it, before the reader actually reads the leader, then it will become obvious to the reader that the leader is referring to possible exposure to HIV infection as a result of rape.

A better example than this would have been a domestic violence victim or a rape victim that didn't involve HIV exposure, which complicates this story and can lead some away from the main issue.

DLS. To the best of my knowledge, all rape victims must consider the possibility of HIV infection -- unless they knew the rapist personally, and/or had requested and been given, by the rapist, a doctor's report verifying that the rapist is not HIV-infected.

I am sorry that you feel this is "not a good example." It's the example that was at hand. It comes from a news article. I didn't make it up. It actually really happened. So it *is* an example, even though you judge it to be a bad example. If it happened to this particular rape victim, it could conceivably happen to another rape victim.

That, at least, is the assumption on which I proceed.

Thank you for your contribution.

Try not to get frustrated, roro. See my reply to DLS? So how calm and even my tone is? :-|

Ayn Rand and Anton LaVey's work and ideas have many similarities and they have heavily impacted our nation. I think LaVey did it better but I also think he was being more honest and well thought out but thats just me.

This term is "testerical."

I love it!

You're certainly a calmer person than I, Kathy. One of my frustrations is that people like DLS are so far removed from reality that they can't see how very, very WRONG they are. Being expected to talk dispassionately and calmly about things that are inherently *emotional parts of people's lives* is one of the things that bothers me about certain types of discourse. It's like men like DLS can't see that we're not talking about some philosophical possibility of right and wrong, we are talking about you and me and *people*. It's not just politics, it's not some mathematical excersize, it's people and their lives. The sociopathic lack of empathy displayed in the idea that emotion should be entirely left out of everything seems to have been picked up by mikkel, tidbits, and TMSF at pretty much the same time as me, so it's good to know I'm not alone in thinking that this move by the insurance company was wrong and cruel.

But these things do need to be tackled from many angles, so you keep your awesome, calm demeanor, and I'll keep on loudly and passionately tilting at these windmills. :-)

Profit vs punishing a rape victim for being raped. If I had that choice, I would leave the business. But then again, I am not a sociopath.

Oh, I'm not calm at all. Not at all. I just don't want to see an email from Dr E in my Inbox. :-)

I totally get what you're saying. I was actually making an attempt at dry humor -- trying to be very arch, you know -- with what I said to you. It doesn't always come across well on a computer screen (even with Mr. Straight Face.) :-)

Got it. :)

I think it's more just that movements get wrapped up in themselves. I take a pretty taoist view of history, with things ebbing back and forth, and what is "best" has no answer because it is entirely contextual. When a society has swung too far to one side, then the opponents tend to cluster and form coherent arguments and ideologies to gather around and push back...and if they succeed then it will appear that their ideology is enormously successful, in large part because it was just restoring "balance." Then as that success provides a feedback loop, it gets more and more cherished and likely to push too far in that new direction. When that happens then the truisms that the ideology is built on don't work anymore and people start floundering, insisting that we just aren't living up to the values enough and we must sacrifice our mindset to be more pure. It's that fealty to that system that produces the justifications of behavior we're talking about.

This happens all the time in all sorts of sociopolitical systems, so there is nothing unique to modern day conservatives.

I have been wary of using the term sociopath because it's such a loaded word and I didn't want people to think that it was an ad hominem just because I disagreed with the position. However last week after reading Obsidian Wings, a blog that used to be a place where people had reasonable disagreements and came to be productive in trying to understand each other, I changed my mind. They were locked in these asinine battles in thread after thread where some person would come in and provide a (quite civil) sociopathic argument and the people were twisting themselves in knots about it. They knew that something was wrong but couldn't express it because the person was playing by the posted rules. The tone had been so intellectual for so long that when confronted with an argument that couldn't be attacked intellectually but was so morally wrong, they were defenseless.

I had been seeing that sort of moral relativity more and more in the media and political arguments, but that really solidified it for me.

I agree with you strongly Leonidas. In fact, I've long planned on starting a non-profit insurance consortium with certain characteristics I won't get into now. I am absolutely convinced that it is feasible based on my knowledge of the different facets of the business and if I get enough money or influence to do it I will.

Oh I should note that it wouldn't work if it couldn't operate across state lines so current regulatory situations would be problematic and in that area what the conservatives want would be better for my idea.

Hi mikkel --
I really appreciate this line of reasoning. I think what it comes down to is that, when we try to analyze situations that have inherent emotional value and consequences while specifically ignoring emotion, you come up with the wrong answer. Every time. We can't analyze things like love or attraction or fun or hurt feelings or fear or violence or death on a purely "logical" basis because we come up with (ironically) totally illogical answers, answers that go against so much that is good about being a human being. The story in the original post is just such a situation.

As far as making choices with one's sexual habits.... So why would an HIV positive person be excluded from health insurance when a rape victim shouldn't be.... just because of "choices"? (The assumption being that HIV positive people made a choice to become positive and it's OK to deny them coverage because of their "choice".)

We all make choices and some of us are luckier than others. Sometimes people make poor choices and end up with "unwanted" pregnancies (look at all the abortions). Some people make poor choices and end up with sexually transmitted diseases such as gonorrhea, syphilis, or (heaven forbid) HIV. I think everyone deserves health insurance. I think almost everyone has made some sort of mistake, and most people have been lucky enough to "dodge the bullet".

I know a guy who's HIV positive because a condom broke. Talk about a horror story... His partner (they'd been dating 6 months) had not been tested in a long while and both thought they were negative.... But they still used condoms just to be safe. It was a surprise when they both found out they were positive. Should they be denied health insurance because of the choices they made and the unfortunate accident that happened? I was raised not to judge people. It's more important to protect and help people in their times of need. Judging people, or believing that someone is "more worthy" of insurance because of certain actions that they took (or did not take) is not compassionate. The US can use a little less judging and a little more compassion in many areas.

I've had health insurance all my life. What if I lose my job tomorrow and can't get health insurance because I was just diagnosed with cancer? (Thankfully I don't have cancer.) Even though I've paid (or my parents paid when I was younger) for health insurance all my life, it doesn't seem right that I should suddenly be denied coverage when I need it the most. Basically my health insurance has been just that- as insurance in case I need it some day. But if I need to buy private insurance, I want to know that I can be able to afford it. After all, what have all those decades of my paying for health insurance (and not using it) actually done, other than line shareholders' pockets with profits?

Oh, and I'm shocked that the insurance companies would treat this woman (or anyone) this way. To me that's the problem with insurance companies- protecting profits. Otherwise how else does one explain their behavior?

The problem is that the Democrats have coopted the "won't someone pleaaaaaase think of the [children,poor,women etc.]" as synonymous with their policies and there is a genuine frustration with people that care about those things but disagree with the policies that it's like that. In turn that causes a backlash against that rhetoric, which in my opinion, causes a backlash against the actual substance at some point.

For me the most frustrating thing about the health care debate is that it feels like one side just doesn't give a flip about people and the other side is like "we have to help everyone" without stopping to analyze whether the proposals actually do. So many times I've been talking with people that have been emotionally manipulated to support the Democratic proposals and I point out all the flaws and how their concerns will most likely be very poorly addressed...and they get it, but they don't *get* it. By that I mean they don't see anything wrong with my points intellectually, but outside they go back to the support emotionally.

This is frustrating enough to me and I am rather ideologically aligned, I can understand how someone that isn't could be so reflexive although I think it can lead to bad places.

I have a feeling the situation is not being reported accurately and I don't trust stories that are only anecdotal with no statistical or historical backup. That while she may not be covered for issues that arise out of her being raped she certainly could get coverage for other conditions that may happen. That insurance companies treat hiv as a pre-existing condition, well why wouldn't they? It makes no sense at all for a for profit company to take on a policy where they know they are guaranteed to lose money. While I don't agree I understand why people want a single payer system and that this would be situation that calls for such a system, I don't get the anger for private companies that act like private companies. They should be charities instead? Really come on.

"it feels like one side just doesn't give a flip about people and the other side is like "we have to help everyone" without stopping to analyze whether the proposals actually do"

This might be the best summary sentence I've seen written about health care here at TMV.

"The problem is that the Democrats have coopted the "won't someone pleaaaaaase think of the [children,poor,women etc.]""

I don't disagree with this, but I would say that each side has co-opted the same statement for different causes.

Mikkel -

You said, "For me the most frustrating thing about the health care debate is that it feels like one side just doesn't give a flip about people and the other side is like "we have to help everyone" without stopping to analyze whether the proposals actually do."

Thank you for putting into one sentence what so many are of us have been trying to express about the health care debate.

Geez roro -

I just posted my comment in reply to Mikkel, then went down the thread and saw that you already said it. Please stop this practice of pre-empting what is likely to be my only cogent thought of the day. :-)

EEllis - Agree with much of what you say. The purpose of a company is to provide a service at a profit. If the company, or companies, are unable to provide that service at a profit, non-profits or the public sector step in to see that necessary services are available. We see this often in areas including reseach, exploration, construction of port facilities, highways, national weather service, mass transit, disaster relief and public universites to name a few.

If, as you point out, health insurance companies cannot provide the service needed and do so at a profit, you have just made the best argument I have heard to date for a single payer health care system.

I agree about the excellent succinct summary quoted from Mikkel.

The thing is though that I see that even here in this thread, among those of you who are agreeing with Mikkel. While it's perfectly understandable, human, noble, and moral, to want everyone to be able to purchase health insurance coverage even if they have a preexisting condition (or a known high risk factor or history), at some point logic has to kick in to realize that such a policy is really prepaid healthcare which will definitely come at a high cost. And contrary to what some would like to believe, the insurance companies aren't raking in profits at a high enough rate that they can just take less profit at the end of the day in order to pay out on such a healthcare plan- they would in fact raise the rates for every other consumer, to a very large degree, if forced to cover everyone for all preexisting conditions.

That's why the current Dem plans are so illogical- it's impossible to expand coverage to the degree that people are demanding (out of sympathy) without greatly increasing the amount that we will spend collectively for that coverage- and there's not nearly enough savings (even if it was rational to think that someone is going to be able to capture all of the potential savings) to be found in administrative waste, unnecessary testing and procedures, increasing the pool of healthy contributors (especially since many of the additional healthy policy holders being added will need to be subsidized) and/or 'excessive profits'. So, any claims that healthcare reform is about a net reduction in cost are completely false if the other goals of said reform are kept intact.

It comes down an iteration of the old adage: list three goals like 'universal coverage', 'choice and access to any desired or needed medical treatment', and 'cost reduction'. Pick two, because you can't have all three.

Or, more rationally, perhaps, we should think about ways to combine mulitiple approaches to partially accomplish each of the three goals. But that would mean accepting some limits on the 'universal coverage' goal, even though that offends moral sensibilities. It offends mine as well, so I wouldn't suggest that people with preexisting conditions shouldn't have access to healthcare at all- but I think that type of access shouldn't be thought of as part of a health insurance model but should be accounted for in a different manner (some other avenue for subsidizing costs of healthcare for people in high risk pools.)

@@If she's applying for individual coverage that's not covered by HIPPA.@@
So, you know a lot of "health insurance underwriters" that are self-employed?

While the article is devoid of any substantive background facts, if she is going to claim she was an insurance underwriter, then she should certainly have the basic knowledge that you can go under COBRA for 18 months and then go HIPPA as a group enrollee thereafter and never lose a day of continuous coverage.

If she was applying as an individual, then it was her lack of common health insurance sense for getting into that totally avoidable situation..........along with going to a bar and not watching her drink........

but then again, you'd rather try to find an excuse for her

CO -

While I generally respect your point of view, the part of your comment about "going to a bar and not watching her drink" is way, way over the top. It was not her fault that she got raped. I don't have to watch my drink in a bar. I get to use the restroom, or watch sports or talk to a friend without having to worry about what might get slipped into my drink. How is it somehow a woman's fault if a criminal distracts her and slips something into her drink so he can rape her?

Ha! I will try in the future to be more cognizant in anticipating your lone cogent thoughts, although I see you've already had another excellent one in answer to co's victim blaming. The day is still early -- I'm sure there will be more. :)

"This post is about potential HIV infection in the context of rape. It's not about potential HIV infection arising from decisions, not through inadvertent exposure."

I'll try once here, because you're better-behaved than others have been. [rolling eyes]

You misunderstand. This issue is about insurability and how it is defined, and that is affected by the decision to go on HIV medication, which is associated with HIV exposure and possible infection. The ability to determine a state of infection is made more difficult by latency. As a result (and as an excuse, if you're also willing to consider that), insurers consider HIV medication grounds for uninsurability, which is different from in fact but not in practice from actual infection, which obviously would be a pre-existing condition. It's simpler just to deny coverage to everyone taking the medication, as a policy matter.

I've not paid any attention to the "wait three years proven infection-free" or any other time period that may have a more precise and scientifically valid definition, nor any superseding legal details, because these are secondary, and moot concerning this policy and this episode. It's sufficient to note that with latency in particular, it's hard to prove a negative (which are the results one normally hopes for when testing for disease).

In addition to the childishness and worse I have seen on this thread, preceding anything I wrote plus the garbage written in response to it, all I can say is that it's been that way on threads here before, and the temper tantrum-throwing, insistence on being devoid of logic (and often of ethics or morality), and the equivalent of flailing limbs and foam emission from mouths by leftist and left-leaning people here and out in the political realm elsewhere is bad enough now (and I despite the loserism and worse directed at me, though I'm not surprised; there's a low tail on the bell curve), but is only going to get worse, as there will be both anticipation and more desperation on the left, as well as impatience and frustration. (Calm down and grow up.)

Note that this issue was an appeal to emotion that fails, and I note the timing -- looking for everything possible (out of frustration and impatience) to hurl at the insurance companies (bypassing logic and sensibility, typically) includes this episode, which was not only in Huff Post but on far-left talk radio last night. (The standard policy of deniability for being on HIV medication, all people on such medication, which is perfectly logical, was promptly snapped at as "grabbing profits off the backs of the public...")

A little (actually, a lot) less operation in HUA mode and the use of one's mind and maturity is in order for many.

"She didn't develop HIV." We don't know this, given latency. Either it didn't happen or (unsurprisingly) Huff Post didn't report it: "She was tested and shown not to be infected" should have been followed by bulletproof argumentation against the insurers that would have appealed to normal people: "The HIV medication prescription was not for infection, but as a prophyactic." Why not find out and report it, if true?

The real issue is lack of fault and external causes, which I clearly referred to in my original posting. (Any responsibility-free kind of reactive resentment against references to "fault" discredits people, morally as well as with quality of argument and argumentation.) This is similar to domestic abuse (as well as rape, which needn't include HIV exposure to still constitute a violent physical attack, obviously). Even without HIV exposure (object here of idiotic hype as well as misunderstanding), simply being attacked can lose you insurance coverage, and this is the bigger, real issue here. People are denied due to something that's not their fault, and fact arguably is not any kind of risk, certainly not a "pre-existing condition." Taking an example of this, featuring a true potential pre-existing condition (which is what HIV exposure constitutes, and which taking medication for the virus makes it especially noteworthy), and misusing it in an appeal to emotion, comes up short.

Enough, already.

"if she is going to claim she was an insurance underwriter, then she should certainly have the basic knowledge"

... including what her fellow insurers would have thought about taking HIV medication, not to mention that she should have known what standard industry policy is(!).

"The assumption being that HIV positive people made a choice to become positive and it's OK to deny them coverage because of their 'choice.'"

Hopefully you haven't joined the worst of the Herd that assumes everyone who can see the truth about this episode makes such judgments, even when many of them are, and resentment is unfounded and morally defective. People can get HIV for many reasons. Intentionally risking infection obviously is irresponsible. But what about those who didn't choose the risk? Not only this person in the story, but (as I've written) children, hemophiliacs, people who got bad blood transfusions, or transplant recipients who got contaminated organs, for example? (Something I've clearly stated but ignorantly or dishonestly missed.)

So what's the point of health insurance if the insurance companies will only cover healthy people? If the health companies will cover some illnesses, but not others, then why? Sorry if I can't just select an "approved" illness to come down with if I want to be covered by health insurance.

"While I don't agree I understand why people want a single payer system and that this would be situation that calls for such a system"

That's also where community rating can be used (with flat per capita rates), an example of neglected reform currently. (Other goals are being sought.)

CS -

Our assessment is similar in some regards, particularly in respect to the current mess coming through Congress. At the risk of becoming a member of the Society of Repetitive Redundancy, what's coming through Congress does almost nothing to address underlying costs and will not achieve universal coverage. It doesn't even meet your two out three test.

The current system is equally offensive on both moral and cost grounds. High risk pools is an interestig idea. Something in me objects to allowing the insurance companies lap up all the gravy while the taxpayer assumes the burden of the high risk sector. I would prefer an option not currently on the table anywhere which is national Single "Payee" system, creating a national pool of 300+ million to spread costs and allow coverage for high risk, and provide (through a 5% add-on) coverage for those unable to afford coverage, while using the payee pool to negotiate pricing, set standards to reduce the necessity for defensive medical practices and reduce underlying costs.

Unfortunately, it would gore too many oxen, and the political will does not exist.

Something in me objects to allowing the insurance companies lap up all the gravy while the taxpayer assumes the burden of the high risk sector.

It's no different than what we now do with Medicare (which pays out for medical care of the known high risk groups of senior citizens as well as patients with end stage renal disease) and with the national flood insurance program. In all of these cases, it's known that the 'insured' population aren't in a true insurance pool where the cost of paying claims can be spread over the group seeking coverage- so instead, spreading the costs to the entire population of taxpayers makes more sense.

And to get past the populist desire to make sure the insurance companies aren't being given a sweetheart deal with this type of thing, you have to acknowledge the obvious- that costs are always passed on to the consumers anyway.

tidbits--in a perfect world, the flunitrazepam would not even be involved, but it is not a perfect world. If my daughter gets up and ever leaves her drink behind, I have told her to order a new one upon return......she has been doing so for the last 10 years.

Why is streets smarts "over the top"?

CS -

I say to you what I said to EEllis. You make a good argument for single payer where the taxpayer costs of high risk can be offset by the profitability of insuring the healthy in a single pool. Don't mistake this for supporting single payer, but there is a sense in which it makes more sense than giving the gravy to insurers while making the taxpayers eat the gristle.

The fact that this is similar to what we have now with Medicare is, I'm sorry to be disagreeable, not very convincing given how poorly the current system works.

The fact that this is similar to what we have now with Medicare is, I'm sorry to be disagreeable, not very convincing given how poorly the current system works.

I don't actually think the Medicare system functions that poorly though- it's just too expensive (and contrary to what many of the critics of private insurance say, part of the problem is actually that the admin costs are TOO low, which means that there isn't enough internal control over fraud and abuse.) To me, that's an argument to fix the flaws with it, and then run cost analysis to see what the additional taxpayer burden would be to add the high risk pool of individuals to that system. My guess is that although we'd still be incurring more liabilities for the taxpayers, it would likely come at a lower price tag than what is currently on the table for 'reform'.

As for a general single payer plan- although it wouldn't be my preference at all, at least it makes more sense than most of the hybrids that have been proposed. This is one of many cases where political moderation isn't actually a good thing if by that we mean taking the extreme ideological positions as a starting point and then watering them down until they're politically palatable. That kind of 'negotiation' for a centrist position often produces the worst of all worlds instead of the best.

CO asks "Why is streets smarts over the top?"

Because it is victim-blaming CO. Not everyone has street smarts, though I'm glad that you and your daughter do. The rapist is the criminal. He is not any more or less a criminal based on whether his victim did or did not have "street smarts". The woman didn't ask for it because she wore a short skirt or because she didn't have the "street smarts" to order a new drink, or because she was flirtatous or because she had too much makeup or because, because, because.

Blame the criminal, not the victim. And, just a note, there is no evidence in the story that this woman ever left her drink. She may have looked away for just a few seconds or been distracted by an accomplice. I really think you need to re-examine this instead of trying to defend it. The same logic, street sense, could be used to suggest that all women wear burkas, lest they tempt a criminal to rape.

CS -

"As for a general single payer plan- although it wouldn't be my preference at all, at least it makes more sense than most of the hybrids that have been proposed."

Ah, we have found our point of agreement.

cs I object more to the process instead of the outcome. I totally disagree that adding everyone will increase costs by definition. I was going to list the ways it could be cut but I see you did it for me.

I would also add to that that there is currently no attempt to control costs at the different levels of the supply chain, which is another issue, and that Rand has projected that if we have a mere 4% annual efficiency increase in productivity (primarily due to better IT infrastructure) then it would save $500 billion-$1 trillion annually in 10 years. That is more than enough to insure everyone that isn't currently. In fact on a prior post I pointed out a Kaiser study that says it will only cost $80 billion more than what is current spent (so in 10 year dollars plus overshoot, let's say $150 billion...still far below the savings projected by Rand).

Now you may argue that insurance companies aren't responsible for all that and can't fix it all, and I agree. But they do have an extremely major part to do, both in moving towards that direction and patient education.

I don't think that for profit companies should be forced to do charity (although I do think that critical areas like this need lots of nonprofit competition) but I also believe that they have a moral social obligation to try to be as upstanding as they can be. At the very least, that is developing a personal relationship with a patient or prospective and making decisions based on that, instead of looking at them as an actuary would. It's not just in this, banks that did the former turned out alright, even lending subprime, while those that did the latter are in awful shape.

A good amount of stories that get people upset are based on stupidity that I will call sociopathic because it shows no empathy. I love the definition of empathy that it's being emotional enough to put yourself in another person's shoes while being objective enough to analyze the situation. A lot of times their behavior isn't empathetic in that they don't care, and they are either going back on their word or they are denying something for a reason that is no good.

If they started being more empathetic and explained how they can't afford to take on high risk people due to systemic factors, explained those and tried to be leaders in changing it, then I believe that vast majority of people would understand their position. However the current feeling (which is correct) is that they are just out to screw you over and it's only when they are legally forced to do something -- or someone has reams of time and knowledge to fight them on their footing -- that they begrudgingly cough up.

And God forbid you don't qualify for HIPAA for whatever reason. You're basically at their mercy then.

This isn't just health care, but corporations in general I'd add.

cs I object more to the process instead of the outcome. I totally disagree that adding everyone will increase costs by definition. I was going to list the ways it could be cut but I see you did it for me.
I don't get what I'm missing then. In all of the areas of potential savings, I haven't seen any estimates that show that we could get funding for universal coverage by implementing the changes (I did leave off a couple of other areas that are often touted- the savings on subsidized ER coverage, but objective analysis shows that that doesn't yield nearly as much as some people think- and then the supposed savings from preventative screenings, which is a very mixed bag with some forms of screening providing a positive cost-benefit ratio and others actually adding cost.)

And one thing that I was focused on, which I don't think you're really accounting for, is the high cost specifically of insuring someone with a preexisting condition. You mention the potential IT savings as being enough to 'cover everyone who needs coverage' but that population consists of two distinct groups- those who just lack insurance but are average actuarial risk individuals, and those who are at 100% risk of being high cost to insure. Are you really accounting for how much it will cost to extend coverage to all of those individuals?

If they started being more empathetic and explained how they can't afford to take on high risk people due to systemic factors, explained those and tried to be leaders in changing it, then I believe that vast majority of people would understand their position. However the current feeling (which is correct) is that they are just out to screw you over and it's only when they are legally forced to do something -- or someone has reams of time and knowledge to fight them on their footing -- that they begrudgingly cough up.

You have far more faith than I do that people will drop the 'evil corporation' meme. And frankly, although it is a nice lagniappe for businesses to go above and beyond what regulations require, I don't buy into the idea that this should be expected. Conscience doesn't exist at the systemic level, and we shouldn't operate on the basis of that expectation. Just create the regulations needed, and enforce them. If/when some companies go above and beyond that, great. Otherwise, assume that many or most will make decisions based on spreadsheets rather than a moral compass.

I have some numbers but no time to gather them for a couple days as I am leaving.

The short answer is yes..but with caveats. It would have to include systemic changes that people don't want to talk about (such as how much money is wasted on people with very poor quality of life in their final days) and the like.

That's what I meant about the process instead of the outcome, I was just scattered. There is no way to do it currently and the insurance companies can't do much about it as it is so systemic, but there is also the feeling that there is no attempt to try, and talk about what could change in order to make it possible.

I don't mind arguments like "well we can't cover people that are a high cost to insure because of this and this and this and this, that's where we should focus on seeing what is possible." I just am tired of arguments that dehumanize the people involved and suggest they use complex loopholes or not leave their drink around or accept that their financial life is destroyed because they weren't lucky and anyway, tough because I got mine [obviously you're not that type].

"So what's the point of health insurance if the insurance companies will only cover healthy people?"

They're under no obligation to cover everyone. Lay aside the future where advances in genetics will make predictability of future diseases even more prevalent, as well as the problem with the "insurance" model being applied and "insurance" being misused (the way "social insurance" is -- a stupidity!) when what is conceived and sought is comprehensive health care (typically including preventive, etc., care).

"Community rating" would address tha. That term means forming everyone into a single pool, and you can even have everyone pay the same thing, which is what I mean about having equal or identical "per capita" charges for "premiums." (This is different from "experience rating" and other risk-assessment and -distinction forms of insurance, which shouldn't be surprising to anybody given what insurance is.)

I've mentioned community rating for months, as well as other reforms that are real reforms, but neglected, because the current object of interest isn't reform, but federal takeover of health care.

* * *

"It's no different than what we now do with Medicare (which pays out for medical care of the known high risk groups of senior citizens as well as patients with end stage renal disease) and with the national flood insurance program."

Well, Medicare applies community rating to the qualifying age group that Medicare is generally known for, but the others do form a risk pool. And the "high-risk pool" is the normal alternative (and item I have written about before -- perhaps too many people simply think all the time about what they want, a magic new government solution that will be Nirvana, rather than read what people have to say, and actually realize what the facts are). Typical high-risk-pool members are AIDS and cancer patients, for example. So many of these people can't get good, cheap insurance, but they do get insurance, nevertheless; it just costs a lot (and often is limited, unless state-law minima require generous benefit packages, but then it becomes that much more expensive). Then there are other details -- for example, Blue Cross (a company notorious for being very profit-making despite its "non-profit" heritage and even nomenclature), here in Michigan, is officially the insurer of last resort (and offers individual policies, anyway, so I was able to get one without a problem, and it's pretty good, at a quite reasonable $300s per month, in fact).

Hey tidbits -- Awesome comment on victim blaming. Thought you might enjoy this post if the subject is interesting to you:

http://shakespearessister.blogspot.com/2009/10/...

ETA: Perhaps "enjoy" is the wrong word, but I think you'll find it very compelling.

I just am tired of arguments that dehumanize the people involved and suggest they use complex loopholes or not leave their drink around or accept that their financial life is destroyed because they weren't lucky and anyway, tough because I got mine [obviously you're not that type].

The problem though is that any of the types of reality based solutions you mention to limit coverage when it 'makes sense' will be looked at by the affected population as the same type of argument you feel is being made in a case like this one. It's really not possible to set an empirical formula about quality of life and end of life care because each individual and family affected will define those things differently. Ideally, more people would make the personal decisions ahead of time because once things happen it is too late to determine the wishes of the affected patient, and most people aren't very comfortable with bureaucrats of any sort (private insurance companies or govt entitities or doctors acting as agents of a hospital bureaucracy) deciding when enough treatment is enough.

I do think there's a very rational line though between a real insurance model which pools against future risk and the pretense of calling it insurance when the risk has already happened. We accept that with all other types of insurance (can't call up Geico and get them to issue a policy after an accident has occurred.) That's why I think it's rational to separate out the issue of preexisting conditions and figure out a different financial mechanism to assist in paying for their health care costs.

I don't know, when people talk about the past they sound like they think they used to be different (inaccurate nostalgia? I'm not old enough to say, but it's rather broad consensus) and when I talk to foreigners they have A LOT different expectation of what corporations should do. I also felt I was too harsh in that comment in blaming corporations as a source. I think it's more that consumers have rewarded the ones that do things merely based on spreadsheets, and that what we have is largely of our own design.

The foreigners I talk to (primarily from India and Europe) are adamant that companies that try to be faceless amoral spreadsheeters lose business in the long term either because people won't frequent them as much or (perhaps more often) they make bad long term decisions for short term gain, and when they mess up there is no sympathy and they go away.

I think the memories from the past that are accurate are based on smaller, community based businesses by and large and I think that's an obvious difference. I also agree that this is consumer based- we often have traded lower prices, or convenience, or what have you, for other values during the last couple of decades.

But note that there too, the companies are still basing their decisions on their spreadsheets and that's why I say that the expectations (and basis for policy) should generally always assume that will be the case and then anything above and beyond that is just gravy.

Systemically there are things that can be done to help promote the environment in which the consumer pressures are better aligned to the hoped-for goals (helping small firms compete, and antitrust laws to prevent or correct for businesses that are too large to have those pressures on them and too faceless to have any of the personal relationships and accountability that help.) But that's still different from naively thinking that companies will just act as good neighbors because it's the right thing to do.

Yes I'm definitely not in disagreement with you about needing to innovate how to pay for costs. I am merely looking at the system wide level and arguing it should be possible in some form. The way to get there obviously is up for argument.

While it's true end of life decisions should be individual, there is a systemic bias to keep people alive as long as possible, and that greatly influences patient/family decisions. And I agree that there is no way to have an empirical formula, but a lot of cases it's just insane. I bet I could spend a week talking just to my immediate contacts and get three dozen of examples of current cases with multiple organ failure and in need of organ transplant or suffering from something that will kill them in the next few months anyway that are shuttled around from department to department ot get $100k surgery after surgery and go into more and more pain (to the point where they have to be kept unconscious basically the whole time). I do think it's an injustice that this is occurring although I have no idea how to address it. I guess addressing it at all -- without screaming death panels -- would be a start.

It goes back into my general problem with societal egoism, which in this case I think manifests as an unhealthy focus on being alive as opposed to living. I'm not saying this should be addressed politically, I'm talking about a deeper more individual and spiritual argument.

roro -

Thanks for the link. I did read it and found the perspective interesting and informative, but as you suggest, not enjoyable.

tidbits

Yes I agree with this fully. I am not really making policy arguments as much as moral ones because I have come to the conclusion that the current state of our moral bearings makes it impossible to come up with good policy. That said, I am sympathetic to the argument that extreme centralization of power (both in business and politics) has led to people depersonalizing things which in turn gives them more power which then causes more depersonalizing -- a vicious feedback loop -- and politically speaking that suggests the need to go to more localized power structures.

I will write about this more explicitly at some point as I am kicking around how to phrase things.

While it's true end of life decisions should be individual, there is a systemic bias to keep people alive as long as possible, and that greatly influences patient/family decisions.

True, but it's also easy to see how the opposite can occur in some systems and to me personally, I think some European societies have reached that end of the spectrum or are at least approaching it.

I mean there are a lot of cases where most people who aren't too emotionally blinded by closeness to a situation would agree that treatment is going too far to artificially extend a life (a 'can't define it but you know it when you see it' sort of thing), but then there are also so many cases in the gray area where you and I might easily disagree. Keep in mind that in my profession I deal with end of life/ quality of life decisions all of the time, and it's interesting to note that a financial liability toward the medical care involved certainly adds a different dimension and it's something I'm always sensitive to. In addition, of course, there's a level of difference based on animal life vs. human life and for me that's very significant because I have very different spiritual/theological views on the two.

I'm not really sure where I'm going with all of this, except I guess to say that it's all pretty complex without a neat solution.

"They're under no obligation to cover everyone."

That's right, they are under no obligation to cover everyone. One of the issues around healthcare is that more people SHOULD be covered. And what about people who pay for health insurance all of their lives but never use it (except for an occassional check-up). When they're older they inevitably experience health problems, perhaps cancer, and then may lose coverage and need to buy it on their own (especially in this day and age where thousand of people lose jobs and health insurance everyday)?

I mean what's the incentive for healthy people to have health insurance if they lose it for whatever reason and then can't get it when they actually need it?

I might as well cancel my health insurance now, save some money and not pay for others' treatments for their "approved" illnesses.

"That's right, they are under no obligation to cover everyone."

Of course, the law can be changed to require everyone to be covered (as part of community rating reform or seperately from it). Pre-existing exclusion prohibition is another reform I have listed numerous times. It gets ignored, because reform hasn't been the goal here, but government takeover.

The same is true about prohibiting recission (cancelling or reducing coverage after you get sick).

tidbits, if your point to me is there is not enough information presented for me to conclude the woman did not act with reasonable common sense at all times, I will accept that. Do I retain my doubts, yes.

No, I am not suggesting at all manner of dress or behavior affects culpability for the crime. Behavior simply affects outcomes.