pre-existing conditions

Your logic is indisputable as far as it goes, but there are more factors to the issue:

(1) The definitions of "pre-existing condition" and the resulting exclusions are often absurd, extreme, or even nefarious. When my son was about 6, our GP made a "map" of his normal moles and birthmarks to have on file as a baseline record should anything new turn up or change. About 4 years later when we (DH and I were self-employed) were need to get new insurance, the insurance company excluded any treatment of moles or skin conditions on the basis of this "map", claiming the "pre-existing condition" escape. Insurance companies are known to dig deep through medical records to find treatments & ailments that the insured did not list on the application and term them "pre-existing conditions" and a basis for exclusion -- or worse, after the person is insured but on diagnosis of a condition, to troll records retroactively for any prior hint of the condition and refuse coverage on that basis. For instance, there was testimony at a recent health care reform hearing of a woman diagnosed with a large HER2+ breast tumor who was refused coverage based on a mammogram showing microcalcifications some years earlier.

(2) It is generally accepted that persons with legitimate, risky and likely expensive pre-existing conditions may have to be charged higher premiums or higher deductibles -- the point is to not allow outright exclusion for such conditions. And the higher premiums/deductibles can be set at a more reasonable level if more people are insured, thus spreading the risk. So the other part of the jigsaw is making it more affordable/possible for more people to have insurance in the first place -- possibly even requiring it, as many states require every driver to have auto insurance for the same reason. If more people are insured, the risk is better distributed AND more people will be getting better, more timely and appropriate health care so as to minimize the incidence of disease and/or its impact and cost.

(3) Risk has to be spread out not only over the population but time. I just checked my claim report (I'm fortunate to have very good insurance), and so far, my insurance company has been charged about $119,000 total for my treatment which started with a routine mammogram in late January. They have paid (after discounts and negotiations) about $57,000. As it happens, I've only had this plan for several years, but let's imagine I'd had it for 10, and in those 10 prior years had paid my premiums (for a family plan ~$1300/month) but rarely exceeded our out-of-pocket family maximum. So the insurance company would have made $156,000 from us -- and this year had to pay out $57,000. Sounds like a profit to me. Health care reform needs to include provisions that keep clients with the same company through their healthiest years and then on into the years when expenses climb. Again, it's all part of spreading the risk.

3) Medical costs themselves have to come down. I cannot for the life of me understand why my chemo infusion should "cost" $16,000 a pop. Or why an outpatient biopsy under local anesthesia that took all of 45 minutes should "cost" $15,000, or why 10 minutes in a PET scanner should "cost" nearly $9000! Clearly provider costs to cover uninsured patients are being recouped from the insured. Again -- insure more folks, costs will come down for everyone. And increase efficiences and upstream decision making and preventive care, etc. etc.

So -- although this is a superficial analysis and comment -- it's just to point out that there are many pieces to this puzzle and there are ways to protect insurance companies from risk, keep them solvent and profitable, while still providing broad-based reasonable, moral, and humane care. IMHO anyway!  

Yep, you're right, but there's a difference (in my book, anyway) between responsible profit making and greed. Or profit making by excluding clients or claims and profit making by increasing efficiencies and controlling costs. On the whole, our family has been treated very well by our insurance companies (the mole thing was more absurd than anything), but there are folks who have quite literally been killed by insurance companies -- by exclusion, control of treatment choices (we'll cover X drug/procedure but not Y even though X probably won't do you any good and Y will save your life), delay, or claim denial. I can't imagine how these folks sleep at night.

All said and done I really think that general coverage would be best. Insurance companies should not be allowed to hike premiums for people with a pre-existing condition because everyone (or a loved one) has a pre-existing condition one way or another. And think of all the cost of adminstering all that, insurance clerks delving into people's old medical records. It is ridiculous and degrading. Also, unlike car insurance, I think health insurance should not be a for profit business. And I also totally agree that the cost has to come done. A bag of chemo drugs is not worth more than let's say $1000 and should not have to 'cost' $16,000. It's pure theft.

Yes, but many people are not so lucky and it is not always their own 'fault'. That is why I was so happy to see something happening re: health care reform. But it will surely be messed up in the end by all the lobbying insurance companies who want to keep their golden goose...