Seeing What Condition My (Pre-Existing) Condition Is In

Papa's_Delicate_ConditionIt’s impossible to read an article about Republicans’ plans to “repeal and replace” Obamacare, or about the general issue of health coverage and insurance, without encountering the phrase pre-existing condition. For example, The New York Times recently noted that a new proposal by the conservative congressional group the Freedom Caucus “would effectively cast the Affordable Care Act’s pre-existing conditions provisions aside.”

Those provisions prevent insurers from denying coverage to someone with a particular ailment, or (crucially) from charging that person higher premiums than a relatively healthier person.

My question is: Why is this referred to as a pre-existing condition, instead of just a plain condition? I do not see the difference. I go to an insurance company, and they say they cannot cover me because I have a cancer, diabetes, or some other, yes, condition. The fact that it’s pre-existing goes without saying, unless I developed it at the precise moment of submitting my insurance application. It would appear that redundancy is again rearing its head once more.

Of the two elements of the phrase, pre-existing is surprisingly older (dating to 1599, according to the Oxford English Dictionary) than condition; the OED’s initial citation for this connotation of the word is a 1946 Modern Language Notes mention of heart condition. Six years later saw the publication of a memoir titled Papa’s Delicate Condition, ultimately made into a movie with Jackie Gleason. And I would be remiss not to mention the 1968 hit by Kenny Rogers and the First Edition “Just Dropped In (to See What Condition My Condition Was In).”

The OED‘s first citation for pre-existing condition is from a 1947 article in the Reno Evening Gazette. But I found an earlier one, in The New York Times in 1930, referring to Dr. Raphael Lewy, the chief medical examiner of the New York State Department of Labor: “Lewy’s theory is that if an otherwise slight injury which would not entitle the workman to compensation aggravates a pre-existing condition or activates a quiescent malady, the workman is granted compensation for the complete damage.” (And by the way, let’s raise a glass in honor of the period when phrases like quiescent malady would commonly appear in the daily prints.)

You see the difference in how the key phrase was used then and now. Under Lewy’s thinking (which became state policy), there was no question or suggestion of a person not being able to get coverage because of the state of his or her health. In fact, a pre-existing condition (not redundant at all in this context, as it refers back to the moment of receiving coverage) actually could work to one’s advantage in terms of compensation.

The use of the phrase up through the late 1980s was consistent with this nonredundant idea: an insurance-industry term of art referring not to something that would prevent one from obtaining a policy, but to a policy’s coverage, or lack of coverage, of conditions holders had beforehand. That’s reflected in the OED definition of the phrase: “a disease or disorder from which a person taking out an insurance policy is known to be suffering, the effect or treatment of which is thus often not covered under that policy (or is only covered after a certain amount of time).”

And it’s reflected in a 1972 New York Times article on how the Pennsylvania consumer watchdog Herb Denenberg, in his investigation of  a mail-order health insurance provider endorsed by Art Linkletter,

zeroed in … on the industry’s so-called pre-existing condition clause, under which a policy holder can be denied benefits for the first two years of the policy if the illness that landed him in the hospital was something he had been treated for, or was “manifest,” in the past, even at birth.

The first Times mention of an insurance company’s rejecting someone’s application for a policy because of a pre-existing condition occurred in 1986.  Apparently such rejections became common over the next half-dozen years, as they were a focus of Hillary Clinton’s attempt at forging a new health-care system early in her husband’s administration — and the first thing she mentioned in remarks quoted by the Times in February 1993:

I mean, people who have been denied health insurance because of a pre-existing condition, who cannot change jobs because if they do, they lose the insurance for their spouse or their child, people who are laid off and lose their benefits, people who are in the 100,000 Americans a month who lose their health insurance, people who have to wait in long lines to immunize their children — I think Americans know we have a problem.

What we have now is vestigial redundancy as a result of the gradual repurposing of a phrase. As problems go, it’s a lot more benign than being rejected for insurance coverage because you have high blood pressure.

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