Fr. John's Letter Archives

Enjoy re-reading Fr. John's weekly bulletin letters for the past year.

Preexisting Conditions & Health Care

06-09-2013Fr. John LettersFr. John

Dear Friends,

One of the selling points of the Patient Protection and Affordable Care Act was that anyone with a preexisting condition could no longer be discriminated against by Health Insurance Plans. Now that nameless, faceless, unelected and unaccountable bureaucrats are writing the regulations we find out that that selling point is a blatant falsehood. Insurers can in fact charge more, 30-50% more to anyone with the preexisting condition of obesity or is a smoker (I am assuming only tobacco smokers and that marijuana smokers are off the hook). The reason that insurers can charge more to smokers and the obese is that it is claimed that they utilize more health care than other people and thus cost more to insurers.

There are two reasons I bring this to your attention. First government regulators are inadvertently admitting to the principle that not all discrimination is invidious and that some discrimination is necessary for the greater good. This is one of the arguments we have used in the marriage debate. Marriage law and practice has traditionally discriminated against various forms of relationships such as brother-sister marriage or parent to child marriage or adult to minor. Likewise marriage between persons of the same gender has been prohibited like the others in order to keep strong the institution of marriage particularly since it is the best context for procreation and in which to raise children. Like the Health Care regulations this is not an invidious form of discrimination just a necessary choice in order to protect the greater good.

Whenever we hear the word "discrimination" we especially as Americans have a visceral reaction. Discrimination, for instance based on skin color or ethnic origin is clearly immoral but other forms of discrimination are based on the choices that are often necessary in order to maintain proper order or human flourishing. Thus some discrimination is inevitable when we make choices. When we do have to make such choices we have to make sure that we are not acting in an invidious or unjust manner.

The second reason I point this out is to ask why are only smokers and the obese being singled out? Don't other lifestyles add more cost to the health care system also? How about the intravenous drug user who is taken to the ER for an overdose or who goes through a rehab multiple times at great expense or needs treatment for Hepatitis C? What about promiscuous sexual behavior with repeated use of the "morning after" pill, multiple abortions, and venereal diseases including AIDS? Remember for HIV/AIDS we have expended more money than any other disease in the history of civilization even though we know well how to prevent it? In fact new cases of AIDS continue to rise; men who have sex with men account for 63% of all new AIDS diagnoses despite the fact that same-sex attracted men are only 2% of the population. Aren't these, like smoking and obesity lifestyle choices that lead to greater health risks and hence greater costs?

One of the goals of singling out the obese and smokers is to get them to change their lifestyle and thus be healthier and cost the system less. Well wouldn't that work for other high-risk lifestyles? Why the reluctance to single them out?

Also the PPACA will use an Independent Payment Advisory Board (IPAB) consisting of 15 people whose decisions will not be subject to Congressional or Judicial review. This Board will further determine what treatments are paid for and which are not. This is where the idea of "Death panels" was first expressed. This Board will be able to make judgments that would deny treatment based on age for instance. It might be determined that a 75yr old should not have a costly proceed because their anticipated lifespan would not justify it.

The goal of this type of denial of medical treatment (which is a form of discrimination) is to not "waste" money on those who might receive little or less benefit from the treatment than another healthier or younger person. The main problem with the IPAB is that no one knows what criteria will be used to make such decisions. This could clearly lead to unjust discrimination.

Love, Fr. John