• Guest, The rules for the P & N subforum have been updated to prohibit "ad hominem" or personal attacks against other posters. See the full details in the post "Politics and News Rules & Guidelines."

10-Day-Old Baby Denied Health Care Coverage

Page 3 - Seeking answers? Join the AnandTech community: where nearly half-a-million members share solutions and discuss the latest tech.

Hayabusa Rider

Admin Emeritus & Elite Member
Jan 26, 2000
50,872
4,214
126
Well, my confusion is about the age of the child. It's not like this kid is months old, its days old. Can you sign up a child for health insurance before it is born? If not, I don't see how the parents were irresponsible. They have paid for coverage for their other two children, so it seems like they would have bought coverage for this child too irregardless of the condition. I'm not sure them failing to purchase insurance for themselves is sufficient reason for their child to be denied coverage, especially when they pay for coverage for their other two kids. That just doesn't make sense to me. I'm missing something.

I'm not saying they shouldn't have to have coverage, just that I don't see how the connection between them not buying coverage for themselves and denying coverage for their child (when they buy coverage for their other children).
It boils down to the established understanding of what constitutes "family" coverage. That would be the adults and the children. Instead of signing up for that, they elected to pay for individual coverage. Now they want to sign up someone as another individual, not add to a family policy.

Do I like the situation? No, not at all, but the parents elected to do this for whatever reason.

We need to look at the situation and define it in reality. Yes, the baby was denied a policy. No the baby won't be denied health care. The real question in this case is who will pay for it. Should the parents be held accountable for their actions? Should the insurance company be forced to take this on although there was never a contract for them to do so? Should the hospital absorb the loss? Could should it then be able to recoup expenses through tax credits or other means? Should the government do it?

Lots of questions. The one which is not an issue is if the child will be tossed out. The answer to that is no.
 

Carmen813

Diamond Member
May 18, 2007
3,189
0
76
The paperwork can be arranged beforehand, but usually the policy is not bound until afterward (I think). There is a waiting period of a few days before signing, and then coverage is retroactive to birth. Then again I've only gone through the process while having coverage, and I may have forgotten a detail or two. It could be different if seeking an individual policy for an infant who is not a rider for the parents. In that case a policy might be bound beforehand, I have no idea.

The parents were irresponsible in one regard: not knowing exactly what they needed to do long in advance. I don't fault them for not having insurance on themselves. I do think they were irresponsible to let themselves be surprised by the legalities. I would have been all over that fine print backwards and forwards by the end of the first trimester and had an agent talk me through exactly what was going to happen. By the middle of the second I would have had a short list of confirmed options, and then everything would have been cool until the big day.
See, now if that' the case, I agree they were personally irresponsible. I would have made damn sure to know the details if my wife was pregnant.

However, what should the punishment be? The child's life has been saved, regardless of the parents ability to pay. Should the parents be forced into bankruptcy? What kind of impact would that have on the child's life?

Should they be able to buy coverage for the child that will cover any conditions that arise in the future? Pre-existing conditions clauses are usually used to prevent having to pay for something new through the process of rescission. Well at least that was the way it worked 4 days ago.

I think they should have to pay something, and quite a bit, but I don't think it should financially ruin them. Then again, bankruptcy does only last 7 years.
 

Carmen813

Diamond Member
May 18, 2007
3,189
0
76
It boils down to the established understanding of what constitutes "family" coverage. That would be the adults and the children. Instead of signing up for that, they elected to pay for individual coverage. Now they want to sign up someone as another individual, not add to a family policy.

Do I like the situation? No, not at all, but the parents elected to do this for whatever reason.

We need to look at the situation and define it in reality. Yes, the baby was denied a policy. No the baby won't be denied health care. The real question in this case is who will pay for it. Should the parents be held accountable for their actions? Should the insurance company be forced to take this on although there was never a contract for them to do so? Should the hospital absorb the loss? Could should it then be able to recoup expenses through tax credits or other means? Should the government do it?

Lots of questions. The one which is not an issue is if the child will be tossed out. The answer to that is no.
There is also the possible solution of something like the individual mandate, which would have prevented this entire situation.

The argument against the mandate is that it takes away some of the parents freedom, and it does, but I'm not sure its fair for them to benefit from someone else's lack of freedom. After all, the hospital and doctors never really had a choice about whether or not to treat the child. If government pays for it, that really means taxpayers are.

I've supported the mandate as a matter of policy, but in terms of principle I'm still up in the air about it. However I read a Romney quote the other day from 2006 that is starting to push me towards supporting it in principle as well.
 

waggy

No Lifer
Dec 14, 2000
68,145
9
81
this is not a story of a evil company. this is a story of a stupid set of parents.

We work hard and make sacrifices to afford things like insurance for the family. I have a bunch of medical issues and so insurance for us is NOT cheap.

this family is fucking stupid i feel for the kids.


When my daugter was born we had 30 days to put her on the insurance (couldnt put her on until she was born).


if this bankrupts the family i don't feel for them int he slightest.
 

Hayabusa Rider

Admin Emeritus & Elite Member
Jan 26, 2000
50,872
4,214
126
There is also the possible solution of something like the individual mandate, which would have prevented this entire situation.

The argument against the mandate is that it takes away some of the parents freedom, and it does, but I'm not sure its fair for them to benefit from someone else's lack of freedom. After all, the hospital and doctors never really had a choice about whether or not to treat the child. If government pays for it, that really means taxpayers are.

I've supported the mandate as a matter of policy, but in terms of principle I'm still up in the air about it. However I read a Romney quote the other day from 2006 that is starting to push me towards supporting it in principle as well.

I have an idea. Why don't you and I and a few others who have experience as providers or are knowledgeable in such things as costs and maybe a few folks who have served as advocates sit down and look at the state of health care and situations like this. Maybe we could come up with some effective options which will help people in need and ways to best go about it. Then we could perhaps educate those who write laws and give them a basis for which to create legislation.

Sound like a plan?
 

MJinZ

Diamond Member
Nov 4, 2009
8,192
0
0
It boils down to the established understanding of what constitutes "family" coverage. That would be the adults and the children. Instead of signing up for that, they elected to pay for individual coverage. Now they want to sign up someone as another individual, not add to a family policy.

Do I like the situation? No, not at all, but the parents elected to do this for whatever reason.

We need to look at the situation and define it in reality. Yes, the baby was denied a policy. No the baby won't be denied health care. The real question in this case is who will pay for it. Should the parents be held accountable for their actions? Should the insurance company be forced to take this on although there was never a contract for them to do so? Should the hospital absorb the loss? Could should it then be able to recoup expenses through tax credits or other means? Should the government do it?

Lots of questions. The one which is not an issue is if the child will be tossed out. The answer to that is no.
The healthcare is paid for by everyone, ultimately.

Let's face it, those born with expensive illnesses bears a greater burden upon everyone. Whether it is the insurance company that takes the brunt of it, then ups everyone's rates to compensate, or in this case, probably the hospital, the credit agencies and parents that will be paying the biggest price.

But as a society, we have deemed that new born lives are worth saving and preserving regardless of their conditions, so we all must pay for the conviction.
 

waggy

No Lifer
Dec 14, 2000
68,145
9
81
The healthcare is paid for by everyone, ultimately.

Let's face it, those born with expensive illnesses bears a greater burden upon everyone. Whether it is the insurance company that takes the brunt of it, then ups everyone's rates to compensate, or in this case, probably the hospital, the credit agencies and parents that will be paying the biggest price.

But as a society, we have deemed that new born lives are worth saving and preserving regardless of their conditions, so we all must pay for the conviction.

so to hell with personal responsibility? families like the article states annoy me.

they don't keep insurance on themselves then when they find out that the child is going to be expensive they go to the insurance company "oh we want insurance ont he child. btw it has millions in hospital bills thanks!" then get pissed when they are denied?

what if the father fals down the stairs and brakes his back? are they going tot hen sign up for insurance? and go to the paper when denied? then go broke trying to pay for it?

The childs medical bills will get paid for. not by the family either.

being a parent is about being responsible. That is makeing sure the kids are taken care of. they are neglecting that with no insurance. having family insurance provides the newborn has it from day 1.
 

Carmen813

Diamond Member
May 18, 2007
3,189
0
76
I have an idea. Why don't you and I and a few others who have experience as providers or are knowledgeable in such things as costs and maybe a few folks who have served as advocates sit down and look at the state of health care and situations like this. Maybe we could come up with some effective options which will help people in need and ways to best go about it. Then we could perhaps educate those who write laws and give them a basis for which to create legislation.

Sound like a plan?
That would definitely be the ideal way to go about it :)

Actually if you want to start a thread somewhere and discuss it as an intellectual exercise I'd be game, though I'm not really sure which forum it would be appropriate for.
 

Hayabusa Rider

Admin Emeritus & Elite Member
Jan 26, 2000
50,872
4,214
126
The healthcare is paid for by everyone, ultimately.

Let's face it, those born with expensive illnesses bears a greater burden upon everyone. Whether it is the insurance company that takes the brunt of it, then ups everyone's rates to compensate, or in this case, probably the hospital, the credit agencies and parents that will be paying the biggest price.

But as a society, we have deemed that new born lives are worth saving and preserving regardless of their conditions, so we all must pay for the conviction.

I agree, but what is the consensus as to what's most equitable, and how is it best applied?

What reasoned approach can be taken to assure that our sense of morality is implemented properly? Who defines what that is?

Do most people even ask these kinds of questions, or do they defer the thinking to others?
 

Hayabusa Rider

Admin Emeritus & Elite Member
Jan 26, 2000
50,872
4,214
126
That would definitely be the ideal way to go about it :)

Actually if you want to start a thread somewhere and discuss it as an intellectual exercise I'd be game, though I'm not really sure which forum it would be appropriate for.

Sadly there isn't one.
 

BigDH01

Golden Member
Jul 8, 2005
1,627
73
91
The child will not be tossed out in the streets. The government will (and I believe rightly so) step in and help or the hospital will suck it up.

As I've said, when you have to stay in business you have to clearly define the rules. If the rules aren't sufficient, the insurance companies could be compelled to provide coverage, however realize that costs will go up.

It sucks for all, and there needs to be well thought out options here but the child wasn't kicked out for being sick. Rather the insurance was expected to just sign on and pay hundreds of thousands of dollars because the parents didn't want to assume the responsibility before hand.

Where is their accountability in all this?
So the costs are externalized no matter what. When Blue Cross/Blue Shield denied coverage, they only ensured their customers and their stockholders wouldn't bear the brunt of the costs. If the government picks up the tab, the taxpayers feel the burden. If not, and the parents can't pay (and mind you, their excuse for not having insurance was that they couldn't afford it), the other customers of the hospital feel the burden, and some of these other customers will be insured by BC/BS. We'll probably have the added expense of paying for the courts that this couple will be using during their bankruptcy proceedings. No matter what, someone is paying.

I guess this is what I don't understand. If we do really believe that everyone under a certain age should have healthcare, and we are willing to socialize said cost, what is the point in this market of an organization who's offering a way to distribute risk (at least up to a certain value of care)? The risk has already been externalized to other members of society. I understand that insurance companies exist to make a profit, I just don't understand why they should exist in this market if society has conceded that anyone too risky for them to cover is going to receive treatment anyway (and for that matter, anyone in the risk pool).

Functionally, in a market where hospitals could and did refuse treatment for those without insurance or money, price would be a rationing mechanism. In a market where treatment isn't rationed by price, insurance companies just don't make much sense in my opinion (at least up to some arbitrary cost of treatment that society is no longer willing to socialize).
 

waggy

No Lifer
Dec 14, 2000
68,145
9
81
personally i would like to know WHY they couldnt afford it. is ti because they just don't have the money or are they spending the money on a huge house, nice cars etc.

i don't mind helping those that really need it. i do not like to help those that refuse to make cuts to afford stuff then cry its to expensive.
 

Hayabusa Rider

Admin Emeritus & Elite Member
Jan 26, 2000
50,872
4,214
126
So the costs are externalized no matter what. When Blue Cross/Blue Shield denied coverage, they only ensured their customers and their stockholders wouldn't bear the brunt of the costs. If the government picks up the tab, the taxpayers feel the burden. If not, and the parents can't pay (and mind you, their excuse for not having insurance was that they couldn't afford it), the other customers of the hospital feel the burden, and some of these other customers will be insured by BC/BS. We'll probably have the added expense of paying for the courts that this couple will be using during their bankruptcy proceedings. No matter what, someone is paying.

I guess this is what I don't understand. If we do really believe that everyone under a certain age should have healthcare, and we are willing to socialize said cost, what is the point in this market of an organization who's offering a way to distribute risk (at least up to a certain value of care)? The risk has already been externalized to other members of society. I understand that insurance companies exist to make a profit, I just don't understand why they should exist in this market if society has conceded that anyone too risky for them to cover is going to receive treatment anyway (and for that matter, anyone in the risk pool).

Functionally, in a market where hospitals could and did refuse treatment for those without insurance or money, price would be a rationing mechanism. In a market where treatment isn't rationed by price, insurance companies just don't make much sense in my opinion (at least up to some arbitrary cost of treatment that society is no longer willing to socialize).
I realize it's obvious, but insurance exists to spread the risk among a group to lower vulnerability to financial catastrophe. Insurance companies are the vehicle by which this is accomplished.

A possibility occurs to me which is neither government nor traditional insurance.

Imagine a new type of corporation designed to allow a co-op. Imagine that the government or some private agency would front money to organizations in which the policy holders owns the corporation. Over some predetermined time the co-op pays back this debt in full or the shareholders are personally liable. Each member has one vote, not determined by the number of shares, preventing investors from seizing control in order to make a profit. Anyone signing up would be contractually bound to this for a period of time prohibiting "hit and run" use, where someone signs up, get's expensive treatment and flees.

This would be a non-profit organization and therefore enjoy the tax benefits, and since stock holders are the recipients of care, there is a high motivation to make it good and efficient at the same time.

What say you?
 

nonlnear

Platinum Member
Jan 31, 2008
2,497
0
76
Imagine a new type of corporation designed to allow a co-op. Imagine that the government or some private agency would front money to organizations in which the policy holders owns the corporation. Over some predetermined time the co-op pays back this debt in full or the shareholders are personally liable. Each member has one vote, not determined by the number of shares, preventing investors from seizing control in order to make a profit. Anyone signing up would be contractually bound to this for a period of time prohibiting "hit and run" use, where someone signs up, get's expensive treatment and flees.

This would be a non-profit organization and therefore enjoy the tax benefits, and since stock holders are the recipients of care, there is a high motivation to make it good and efficient at the same time.

What say you?
There are many insurance companies based on almost this exact model already. The word "mutual" really does mean mutual. ;)
 

Hayabusa Rider

Admin Emeritus & Elite Member
Jan 26, 2000
50,872
4,214
126
There are many insurance companies based on almost this exact model already. The word "mutual" really does mean mutual. ;)

Heh, true.

I was thinking of something which uses the same principle, but where the participants must have a time commitment. While there would be a risk, ultimately the performance of the company depends on proper management of resources, and the well being of those involved. A great motivator for success.
 

Turin39789

Lifer
Nov 21, 2000
12,219
5
81
personally i would like to know WHY they couldnt afford it. is ti because they just don't have the money or are they spending the money on a huge house, nice cars etc.

i don't mind helping those that really need it. i do not like to help those that refuse to make cuts to afford stuff then cry its to expensive.
It wouldn't change anything would it?
 

nonlnear

Platinum Member
Jan 31, 2008
2,497
0
76
Heh, true.

I was thinking of something which uses the same principle, but where the participants must have a time commitment. While there would be a risk, ultimately the performance of the company depends on proper management of resources, and the well being of those involved. A great motivator for success.
This sounds like something Ron Paul was crooning on about quite some time ago when dinosaurs roamed the earth. Term policies for health insurance, based on the term life insurance model. You must be crazy to think like that old bat!
 

waggy

No Lifer
Dec 14, 2000
68,145
9
81
It wouldn't change anything would it?
yes actually it would. If the parents are wasting money on buying BMW's and a 4k sq/ft house instead of doing the right and responsible thing then i won't shed a tear as they are forced to pay for it.

im not saying don't treat the child. The child will get whatever care it needs. paying for it will be done by donations, write offs from the hospital and doctors, etc.

i get pissed that people waste money on non-essentials then cry that things that are a essential are to expensive then want others to pick up the cost.
 

MJinZ

Diamond Member
Nov 4, 2009
8,192
0
0
I agree, but what is the consensus as to what's most equitable, and how is it best applied?

What reasoned approach can be taken to assure that our sense of morality is implemented properly? Who defines what that is?

Do most people even ask these kinds of questions, or do they defer the thinking to others?
The most equitable is usually the least deviant of the usual path, which as we have determined as a society to be the insurance company which takes the brunt of it.

So health insurers in turn, distributes the costs to everyone who uses health insurance (which should be almost everyone) by adjusting their rates, this creates the least amount of additional stress on a single entity, which I think is the appropriate solution to society's decision to save babies with conditions.

Since in this case, the path has deviated from its usual course, the insurance company wants to back out, but the hospital must treat. So whoever is directly involved with the parents and the hospitals will end up stuck with the bill or the effects of bankruptcy.
 

Hayabusa Rider

Admin Emeritus & Elite Member
Jan 26, 2000
50,872
4,214
126
This sounds like something Ron Paul was crooning on about quite some time ago when dinosaurs roamed the earth. Term policies for health insurance, based on the term life insurance model. You must be crazy to think like that old bat!

I missed that one :)

As far as crazy, mea culpa :D
 

Turin39789

Lifer
Nov 21, 2000
12,219
5
81
yes actually it would. If the parents are wasting money on buying BMW's and a 4k sq/ft house instead of doing the right and responsible thing then i won't shed a tear as they are forced to pay for it.

im not saying don't treat the child. The child will get whatever care it needs. paying for it will be done by donations, write offs from the hospital and doctors, etc.

i get pissed that people waste money on non-essentials then cry that things that are a essential are to expensive then want others to pick up the cost.
it might change an opinion, but they still aren't going to get insurance for the child. It won't actually change anything that matters to the health of the baby.

The child is still not going to get all of the therapy services that are "optional".

Sick babies are the most expensive claims I ever see. A few months in the nicu is a million dollar bill, and you aren't going to get that from write-offs, donations or bake sales.
 

BigDH01

Golden Member
Jul 8, 2005
1,627
73
91
I realize it's obvious, but insurance exists to spread the risk among a group to lower vulnerability to financial catastrophe. Insurance companies are the vehicle by which this is accomplished.
Yeah, insurance companies themselves just don't make much sense if we've already decided that risk for certain groups of people will be socialized regardless of whether or not the patient has insurance. People are then born with an implicit insurance policy from the people (government).

A possibility occurs to me which is neither government nor traditional insurance.

Imagine a new type of corporation designed to allow a co-op. Imagine that the government or some private agency would front money to organizations in which the policy holders owns the corporation. Over some predetermined time the co-op pays back this debt in full or the shareholders are personally liable. Each member has one vote, not determined by the number of shares, preventing investors from seizing control in order to make a profit. Anyone signing up would be contractually bound to this for a period of time prohibiting "hit and run" use, where someone signs up, get's expensive treatment and flees.

This would be a non-profit organization and therefore enjoy the tax benefits, and since stock holders are the recipients of care, there is a high motivation to make it good and efficient at the same time.

What say you?
I like it, it's very Proudhon-ish (aka Credit Unions). However, we still run into a single basic problem that troubles me. What if someone can't afford entry into a coop? If they walk into an ER, are they treated? What if it's a child who's parents didn't want to have insurance and now can't pay for the child's treatment?

All of the thought and debates I've had with myself and others boil down to one basic axiomatic problem.

1. There are groups of people (perhaps all) that are entitled to healthcare as a human right. Most in here would disagree, except in the case of children perhaps. Some would say that everyone is entitled, and make various arguments for it.

2. No one is entitled to healthcare and if you can't pay, you can't pay. Best of luck. I'm sure many in here would make an argument here in favor of this.

I'm going to refrain from arguing either side, and just use the premise of both to make logical conclusions.

If you accept #1 (for any particular group), insurance companies lose purpose for that group. If society has accepted treatment as a right, then society will end up bearing the cost as people without insurance will still get care and society at-large will pay for it. There's no point in smaller groups of risk pools in a society where we've decided everyone is going to get treatment (with the same stipulations in my previous post). By being in society, you've relieved your risk to some extent. And, of course, everyone is taxed to solve the free rider problem. And I like coops, but they would inevitably suffer the same question. What is the point if everyone has an explicit guarantee of treatment from the state?

If you accept #2, then I would much rather be a part of a coop. This is the scenario in which insurance makes sense. Paying a premium to distribute risk among my individual pool is rational in the face of catastrophic financial calamity or physical injury without any mandated treatment from the state. And in the case of something as important as healthcare, you'd probably find more people willing to make sacrifices to make sure this is paid.

Of course, you could have a combination of the above. Socialized medicine for children and co-ops for those over 18, etc, etc. But when I really drill down into the debate, as far as I can tell, you are left with the above. That's just how I see it anyway.
 

Turin39789

Lifer
Nov 21, 2000
12,219
5
81
The most equitable is usually the least deviant of the usual path, which as we have determined as a society to be the insurance company which takes the brunt of it.

So health insurers in turn, distributes the costs to everyone who uses health insurance (which should be almost everyone) by adjusting their rates, this creates the least amount of additional stress on a single entity, which I think is the appropriate solution to society's decision to save babies with conditions.

Since in this case, the path has deviated from its usual course, the insurance company wants to back out, but the hospital must treat. So whoever is directly involved with the parents and the hospitals will end up stuck with the bill or the effects of bankruptcy.
That is what health insurance is. It's not like they existed and just stood around and then we decided, hey you start paying for the healthcare of your members.

It is an instrument to pool risk. You pay for it in your 20's and 30's when you are healthy and not using any healthcare, and then there is money laying around for the 10 day old who hasn't contributed anything to have expensive procedures done. It is a fairly simple concept. If the people being covered are likely to cost 12 trillion dollars of the next decade, you have to collect enough money to have that on hand to pay it out and to run the operation.
 

ASK THE COMMUNITY