Grand Rounds is up at Medical Humanities Blog. Check out the post from InsureBlog about the use of prescription records in underwriting for individual health insurance policies. If you read through the post, including the article it references, you’ll undoubtedly have an opinion one way or another. It’s likely to be influenced by a lot of things. Whether you have health insurance. Who pays for your health insurance. Whether you take any prescription medications. Whether you’ve been declined by a health insurance carrier. Whether you like John McCain. Lots of variables, but however you look at it, the subject of medical underwriting on individual health insurance policies always generates strong opinions. If we want to get to a point where all Americans have access to quality, affordable health care, we have to find a way around the pre-existing condition problem. But nobody wants to pay even more for their health insurance in order to allow insurance companies to be able to cover pre-existing conditions and still make a profit. Regardless of how you look at the morals and humanity of it all, If a health insurance company agrees to take on someone who is already spending hundreds of dollars on prescriptions, and agrees to cover the pre-existing conditions along with any future conditions that might arise, it’s going to be tough for them to make a profit without pricing themselves out of the market. Here in Colorado, our guaranteed issue high-risk pool health insurance will cover people like the couple mentioned in the article InsureBlog references, but it comes with a steep price. Assuming they aren’t smokers, the Sheltons would pay a combined premium of over $850/month for a $3000 deductible policy if they lived in Colorado and wanted a Cover Colorado plan. In our current system, that’s what happens to premiums when pre-existing conditions are not taken into account during the application process.

One thing that stands out to me is how over-medicated we are as a nation. Prescriptions have become so ubiquitous that we’re starting to see it as no big deal when a person is on two or three different prescriptions. Clients tell us all the time that they are “perfectly healthy” - and then when we question them further, we get the list of prescriptions. There are lots of factors involved. We’re too busy. We don’t want to take time to actively change our lifestyles in order to be healthier - it’s easier to just take whatever prescription the doctor doles out. Doctors have to bill for huge numbers of patients in order to make a good living, and it’s faster to write a prescription, especially when that’s what the patient is asking for. We’re bombarded with advertising for prescriptions in just about every media source. No wonder that’s what the patients are asking for. Pharmaceutical reps are actively trying to get doctors to prescribe early and often. The end result of all of this is that more than half of insured Americans are taking at least one prescription medication these days. And in our current individual health insurance system, that has to be taken into account when applications are underwritten. Perhaps in the future we’ll have a system that allows for more coverage of pre-existing conditions on individual policies, without huge premium increases. But for now, we don’t. It would be in the best interest of consumers to question whether a lifestyle adjustment instead of a prescription might do the trick and also preserve their insurability.