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Comment by harryh | Hacker News Reader

(My own story: I had my gallbladder out in 2004, and from that time on was denied personal health insurance for BS "pre-existing condition" reasons...until Obamacare.)

Probably you were denied personal health insurance not for BS reasons, but because the insurance companies knew they would (probabilistically) lose money insuring you. But now under Obamacare, if they participate on the exchanges, they are obligated to sell to you. So, shockingly, we see that most companies operating on the exchanges lose money doing so.

Your inability to get coverage before and the problems that Aetna is having today are very closely related.

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Well, not really. I had my gall bladder out about '08. I couldn't eat properly before it got out. It wasn't emergency, but the pain put me in the emergency room more than once. I didn't have gallstones, it quit working. It has been years since I got it out. I still have a few problems eating greasy foods (especially meat), but now generally avoid those and am mostly vegetarian. No other complications, and I have not required any sort of care for that surgery outside of that. Neither has my brother, who got his out about 5 years ago. Neither has my mother, who got hers out in 1978.

This type of thing isn't so much a pre-existing condition as much as they are "I had a health issue that was more severe than a simple infection". It isn't the same as "I have diabetes" or "I have chronic issues with x", which can cause expenses.

See #2 here: https://news.ycombinator.com/item?id=12308243

I'm actually quite curious about this.

About being rejected from buying my own health insurance, based on a surgery I'd had, I think that the question of whether it's "smart" or "dumb" for insurers to do so is irrelevant.

Especially in a modern society, that decision-making process is no more relevant than asking whether it's OK to dump toxic waste into the river, because the fines could be cheaper than processing such waste safely.

Private companies refusing to sell insurance to someone where they will lose money on the transaction is not at all like dumping toxic waste into a river.

If insurance companies can't make money (or at least break even) for a certain population then they are't a viable means of making sure care is payed for, and we need to develop alternate policies to make things work.

So it's actually very very relevant to understand the decision-making process of insurance companies in these situations.

True, but Frondo also has a point. If insurance companies can cherry-pick individuals and refuse to sell to specific individuals where the insurance company is more likely to lose money, that's... not good. It kind of defeats the point of insurance, in fact.

If Obamacare-as-a-block is business they don't want, they shouldn't have to take it. If it's a subset of individuals, I'm less sympathetic.

Indeed. Obamacare-as-a-block was specifically designed to try to eliminate this cherry picking of individuals. But it's turning out that the solution might not be adequate because insurance companies are choosing to just abandon the whole block. That's what I meant with my "closely related" comment above.

And if the Obamacare exchanges don't work, that's no good either!

As I said elsewhere, the economics of health care are very challenging.

This is a discussion the rest of the western world has had and solved in various ways over the last fifty years. The economics of health care isn't a new mystery the world has never before seen, for us to unravel here, it's a matter of policy where we're just lagging behind the rest of the west.

That's why I find these questions irrelevant.

you're suggesting the guy should throw himself off a cliff?

I'm not suggesting he do anything. In fact, I think his story is a great example of what makes the economics of health care so challenging.

I was merely pointing out a connection from his personal story to the general topic of conversation that a lot of people don't seem to realize.

When the marker they use to draw a dot on where they need to cut you during surgery costs $50, it's hard for me to believe that the problem with health care is insurance companies not making enough money. Why does all this stuff cost so much in the first place? Medical equipment prices seem so far separated from reality that it's seriously laughable, and it'd be funny if it wasn't everyone who had to find a way to afford this junk. Go look at some prices for medical equipment (where you can even find prices) and see if those prices seem reasonable to you for the equipment.

Let's find a way to fix that? This doesn't even touch how some hospitals / networks must buy from a specific vendor, or how vendors sell packages which include things the buyer doesn't need (at the same exorbitant prices).

> When the marker they use to draw a dot on where they need to cut you during surgery costs $50, it's hard for me to believe that the problem with health care is insurance companies not making enough money.

The insurance companies are the ones paying for that $50 dot. Well, after their discounts it's probably a $10 dot.

It was either Time or Newsweek a few years back which had an excellent long-form article on where health-care spending goes. As I recall, it's not the insurance companies: it's the hospitals, physicians, nurses, other staff and an army of hangers-on and middlemen.

Bitter Pill: Why Medical Bills Are Killing Us By Steven Brill Time Magazine Feb. 20, 2013. http://www.uta.edu/faculty/story/2311/Misc/2013,2,26,Medical...

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