Excluding Pre-Existing Conditions

One of the great victories of the Affordable Care Act is that insurance companies must provide insurance to all applicants regardless of pre-existing conditions. This provision ensures that abuses such as dropping policyholders when they become sick and charging exorbitant fees for those who need health care the most - sick patients - can no longer happen. By doing so, the Affordable Care Act affirms that health care is a right that everyone should have. But this simple idea is also a remarkable one. I bring it up because I can't think of any other insurance policies that act like this. Bad drivers pay more for car insurance, renters who live in a home that's been broken into pay more for their renter's insurance (this unfortunately applied to me), and life insurance policies take into account the applicant's health.

What seems to be somewhat different about health insurance is this fascinating and paradoxical relationship that a pre-existing condition may be the reason why someone wants health care. No one buys car insurance in order to drive recklessly or renter's insurance intending to leave the door unlocked. But someone who is sick wants to get health insurance to get better. (Of course we hope healthy people want insurance in case they get sick, the concept of insurance). But I think this is one difference that makes excluding pre-existing conditions in health care particularly despicable.

The other reason is that we cannot help most of our pre-existing conditions. Someone with cancer may not, for the most part, be able to help that they got cancer. And to exclude them from getting health insurance is an evil practice that we have hopefully eliminated. But there are some factors we as policyholders and patients have control over. Should health insurance cost the same for a smoker as a nonsmoker? For a IV drug-user as a non-user? I'm not sure. Certainly these patients cost the system more, and if these are habits they can (and ought to) change, then should premiums encourage them to do so? For things we cannot help - genetics, heritage, exposure, random chance - health insurance should turn a blind eye. But should it ask us to take responsibility for decisions we make about our bodies that change our disease risks?