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I have always recognized the argument that covering pre-existing conditions in health care is analogous to trying to get home owner insurance once your house is on fire as true. Last night during the Republican debate, Trump made it clear that his health care plan would cover pre-existing conditions. This knocked my respect for the man down pretty hard. How could a man who is so successful not see how fundamentally flawed the concept was? This got me thinking about the issue more, and really thinking how people could support such an obvious fallacy. I always try to push back when my mind says "well people are just stupid" when trying to discover the root cause of an issue, because surprisingly, that is usually not the case. There are typically other factors that are not seen in the issue that are making people to push back against reality so much. What I came up with is this: Covering pre-existing conditions in health care is not analogous to getting home owner insurance when your house is burning down given one simple, but over looked, fact about the existing health insurance system. The fact is a very large portion (seems to be around 60%) of health care in the US is provided through employment-based health insurance, which fundamentally changes the pre-existing condition issue. When your health insurance is provided through, and tied to, your employer you have to remain employed with them in order to maintain your current coverage and risk management relationship. The minute (well actually several months after) you leave that job for a different opportunity, all of the money you have paid into that current risk management plan is gone. You have to restart a risk management relationship with a brand new entity that you have no history with. When you restart this relationship with a new entity it is understandable that they would want to know the risks you pose and price that risk accordingly, and they don't have the benefit of having years of payments coming in from you to help offset this risk. This leaves a lot of people with hard choices of either staying in a job they hate, or passing up an opportunity they would otherwise pursue, or to take on the risk not being able to receive health insurance due to their existing health conditions even though they have paid years into a health insurance plan. This is not how typical insurance systems work, and you can see why people would want, or even need, to have pre-existing conditions covered (given the current system). With your house, you have the option to maintain your insurance indefinitely no matter what happens with your employment. There are obviously people who would take advantage of pre-existing conditions and not pay anything into the system until they got sick which is the whole reason why ObamaCare has a mandate for everyone to pay in. Does this mean Trump is right about needing to cover pre-existing conditions? Probably not, but given the current situation, that we do have employer-based health insurance and live in a statist society where we are all chained together, covering pre-existing conditions and having a mandate is probably the most pragmatic position to hold. Trump isn't anything if he isn't a pragmatist, so I no longer find his position on this issue very surprising. However, what we need to do is end employment-based health insurance before we can have a reasonable conversation about this.