Who should pay the costs of treating pre-existing conditions has been a contentious topic of debate among the political class for some time. Regardless of how one comes down on this question, however, it is important to keep definitions tight and analytically correct. In a Wall Street Journal op-ed, Dr. Craig Blinderman perpetuates the erroneous and illogical idea that it is possible to insure against pre-existing conditions. (“Insurers Are Still Denying Treatments for Pre-Existing Conditions,” op-ed, Aug. 23) To point out this fallacy, I submitted a Letter to the Editor to the Journal, which it published today under the title “You Can’t Insure Illness That’s Already There.” Click on the link to read it.

To fit within word count limits, the Journal slightly edited my original submission, which I reproduce below.

—————————————————————————————————-

Sloppy language clouds public policy debate.  Regrettably, Dr. Craig Blinderman carries on the rhetorical error that has become endemic in discussions of healthcare policy ever since the passage of the Affordable Care Act.  (Op-ed. 8/23/2017)  Dr. Blinderman asserts that an achievement of the ACA was its “prohibition on denying insurance coverage to patients with pre-existing conditions.”  The statement is a non sequitur.  By definition, it is impossible to insure against something that has already happened such as a pre-existing condition.  One can only insure against matters that have not yet occurred, but for which a reasonably knowable (actuarial) probability of future occurrence can be assessed.

Although in a compassionate society it may be morally sound to care for people with known medical needs and who otherwise cannot afford treatment, to speak of insurance coverage of pre-existing conditions does violence to the precise use of language and camouflages the actual policy argument being advocated.  In fact, what Dr. Blinderman wants is the socialization of the costs of caring for people with pre-existing conditions. That is, he wants the taxpayers to pick up the tab.  As a moral issue, such a policy may be justified, though reasonable people can disagree.  Honest debate, however, requires calling a spade a spade. 

Theodore A. Gebhard