Pre-existing conditions

I've read that the Democrats are stressing this idea more in their arguments for the health bill.  Oddly, even from intellectuals, you rarely hear what is one of the strongest arguments for the bill, namely that personal genome sequencing might mean — how many years from now? — that many more people have pre-existing conditions than we currently are aware of.  Alternative equilibria are that the sequencing technology won't give us much health information, that the information will stay private (don't accept that cup of coffee!), or that we should in the meantime simply wait.  There's plenty to debate there but I'd like to see more discussion on the long-term future of the health insurance sector or possible lack thereof.

On related issues, Ross Douthat wants a smaller bill:

But even as a hypothetical, the more modest plan is instructive. Per the Journal, it would insure half as many people as the House and Senate bills – 15 million, all told – at a quarter of the cost. 15 million happens to be roughly the number of American citizens who don’t have insurance, aren’t already eligible for Medicaid or S-CHIP, and make less than 300 percent of the poverty line. Which suggests that you can do some of the most morally urgent work of health care reform without a mandate or price controls, and at a fraction of the current legislation’s price tag.

Jon Chait has an exasperated response.  First, the importance of that extra coverage, as would result from the mini-plan, he is suddenly downgrading in the grand scheme of things.  Second, and more fundamentally, I'd like to repeat, and modify, an earlier question.  I understand that the mini-bill does relatively well by "almost Medicaid" patients and relatively poorly by those with pre-existing conditions.

Compare the full bill to the mini-bill.  For the extra insurance coverage granted by the full bill, some of which goes to individuals with pre-existing conditions, how much are we paying per person for that coverage?

Much better (but harder) would be to see how much extra we would be paying for the coverage each additional person, conditional on that person wanting the insurance at the price he or she would have to pay for it

A third and related approach is to assume that consumer surplus, from the mandate/subsidy mix, is small for those individuals without pre-existing conditions.  Take the extra expenditure and divide by the number of people with pre-existing conditions who now fail to get coverage.  What is the cost per uninsured person with a pre-existing condition?

If you, as a supporter of the full bill, want to change people's minds, those are some critical numbers.  For all the work that has been put into this legislation, it doesn't seem unjust to be asking for that hitherto unprovided information.  The "it's too late to turn back now" argument doesn't much sway me.  Nor does Chait's claim that by passing the mini-bill we would be foregoing a "transformative" moment.  If the core of the full bill doesn't make sense, the entire structure won't hold up on its own.

The numbers, please.


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