Except non-employer health plans rarely cover pre-existing conditions, which ultimately is what ails most people and contributes most to prolonged suffering in

Except non-employer health plans rarely cover pre-existing conditions, which ultimately is what ails most people and contributes most to prolonged suffering in quality of life. That's a bug in how the contracts are written. Things don't have to be done that way. Standard insurance pays by the treatment, but a reasonable contract would pay by the disease. In my ideal world, I'd be able to walk into Allstate and say, "Hi, I'd like an insurance policy against lung cancer." "Okay. At your age, health, and risk level, your risk level is X over six months. We offer a six month contract covering treatment plan A, averaging $Y for $XYProfit or treatment plan B, averaging $Z for $XZProfit." "Only six months? If I'm still sick after six months, my rates go up?" "Actually, $Y is the lifetime cost of Plan A. In the event you are diagnosed with lung cancer, we are contractually obligated to pay for the treatment strategy outlined there for the rest of your life." "Even if I can't keep up with the premiums?" "It doesn't work that way. This is a one time contract designed to mitigate risk over the coming six months; if you fall ill, you have no further obligation to us." "Can I change from Plan A to Plan B after I get sick?" "You can, but it'll cost you $Z - $Y. At that point, though, it's not really insurance -- more like a financing and payment plan, so the cost is much higher. You're best off selecting the level of coverage you want in advance, or arranging financing at the time." "So, if I do develop lung cancer, my acute injury contract with you is unaffacted?" "Right." "Or I could even switch to State Farm for that, and you'd still be obligated to pay for lung cancer treatment." "Right, though where synergistic treatements are possible, we offer a significant discount if you buy all your health insurance through us..." This seems to me like the omly mathematically sensible way to do it, and I find it perverse that it's done any other way. Let alone that the other way is standard practice. You buy insurance to mitigate risk. I buy a fire insurance policy that covers the cost of repairs to my house in the event of a fire. I would never buy a fire insurance policy that covered any repairs to be made within a month of the fire's occurance (after which the company might drop me or my rates might go up), nor would I expect a company to offer "insurance" that covered any repairs to be made in the current month as a result of previous fires. That would be mathematically insane. And yet it is the default case with health insurance. It mitigates the cost of this month's treatments, not this lifetime's diseases. "So . . . I need to disclose something. I'm actually shopping for lung cancer insurance because I already have lung cancer, and I can't afford the treatment." "The situation is very different, then, but we can still help you manage the overall cost of treatment. Plan A costs $Y and Plan B costs $Z, and comes with these options--" "Whoa, whoa, whoa. Those are hundreds of thousands of dollars, and you want it up front? I can't possibly afford that." "Oh, that's just the total price of the contract. Our financing department typically offers 15 to 30 year payment plans, with some risk premiums." "Paying for two years of treatment over three decades? It still looks expensive." "Yes, it's better to have insurance up front, so you can pool risk with others who match your risk profile. But even after the fact, you can still pay for predictability. You may have an easy and successful treatment, or you may suffer a costly and prolonged process followed by even a relapse. The cost to you is $Y either way." "Okay, well, so . . . not only am I uninsured and already sick, I'm also poor and don't really have any assets. You'd have be crazy to loan me money to cover even the most bare bones treatment plan. Am I just SOL?" "Well . . . we can't do much for you. At this point, you're not trying to mitigate risk, you're trying to get other people to pay for an already incurred cost. That's not insurance anymore, that's charity, and we can refer you to St. Joseph's Hospital. . ." If you want to offer universal treatment to the poor, it is a noble charitable goal -- on par with offering universal food or universal education or pursuing world peace. Establish a fund or program for that purpose and go for it. But leave the people who are buying actual insurance alone! I want a health insurance contract that is portable, customizable, and that does not give me or the insurer or the doctor perverse contractual or treatment incentives. In particular, I want a plan that actually mitigates the risk I'm trying to mitigate. I want the cost to be reactive to my personal risk level -- I don't want to pay for anyone else's health care, and I don't want anyone else to pay for mine. The lung cancer insurance cost should go up if I smoke. The cost to cover kids against genetic disease should go up if my spouse and I are both cystic fibrosis carriers. The costs in general should go down if I can pass a bi-annual athletic test. I want to be able to self-insure at whatever level I think is financially appropriate, and I want to expect to pay cash for routine or elective procedures. I don't want to be denied vaccination, required to vaccinate, or even vaccinated for free; I want to be offered a $17 tetanus shot in exhange for $4 off my monthly insurance bill. Right now, employment is insurance and health care is partly charity and insurance is partly charity and charity is largely employment. I'd love to live in a world where employment was employment, health care was health care, charity was charity, and insurance was insurance.