Covering existing conditions is a wonderful thing. And it is a free lunch.
Regular wellness checks, etc., while wonderful, are a free lunch. They are not insurable. You can't insure for regular, scheduled services. Because math.[1]
If you see things like this - things that are either exorbitantly expensive or defy the bounds of underwriting or both you should expect to pay other prices, elsewhere.
[1] This is insurance 101. You cannot insure against regular, universally consumed services. There is no underwriting pool there. You cannot buy an auto policy that includes regular tire replacement - and if you could, the premiums would include 100% of the tires cost (plus admin).
Insurance 201 will point out that you may be better off paying for regular, scheduled services, when you see it reduces your risk for irregular, high cost variances. To use your example, if auto insurers proved that once yearly "tire check" reduces catastrophic payouts by enough, you bet they would offer to cover them (or reduced rate if you do it, which amounts to the same thing).
"Health insurance" doesn't really work like most insurance anyway, because people. It is of course sensible to construct a system to understand true costs, but sometimes you're just going to pay them, even if the math doesn't work (although honestly, it probably works fine if your model is good enough. An insurance company won't think about the externalities that a federal government has to, for example)
I'm pretty sure most people with an existing condition would prefer not to have it at all than to cost insurance companies more and have that covered.
It's not a free lunch. They paid the admission fee with their health.
Regular wellness checkups are also not a free lunch. They're priced into the policies. You absolutely can insure against regularly consumed services, as long as the premium is enough to cover it and to do the underwriting for the unexpected expenses. Look at dental or vision insurance. The vast majority of what they cover are regular wellness visits.
Putting that aside, free wellness visits are also in the interest of the insurer. It's far cheaper to prevent disease or to treat it early than it is to deal with it later. Those savings from this so-called "free lunch" ends up right back in their pockets.
"You absolutely can insure against regularly consumed services, as long as the premium is enough to cover it"
That is called fee for service. Maybe it gets bundled with actual insurance, but it's not insurance. Regular, universal expenses are not underwritable.
Insurance is a technical term that has a strict meaning. You are absolutely correct that regular wellness checkups, etc., can positively affect the outcomes of that insurance pool, but they are not, themselves, insurable. They have to be paid for somewhere.
They actually are underwritable. Not everyone utilizes wellness visits, just like not everyone gets an x-ray, in a given year. Insurance companies can price in the expected value of wellness visits based on the participation rate.
Therefore, it fits the definition of insurance, even though the likelihood of a claim is relatively high.
Regular wellness checks are a cost savings measure because many conditions are trivial if caught early and very expensive if caught late.
What is an 'existing condition'? In my experience, it is a condition discovered while under a previous, different insurance policy. The policies for most large employers are happy to cover preexisting conditions, in my experience, while individual and small group policies are not.
And enormous amounts of money being spent in the last six months of life is also a regular, universally consumed service. Death in America is inevitably incredibly expensive and I'm not talking about the funeral director racket. Admittedly half the money is not spent in the last couple months of life.
Combined with the USA no longer being a "wealthy western nation" for a variety of reasons revolving around extreme income inequality, massive demographic changes, etc. Europe is no longer a peer. America is demographically no longer a euro nation and the long term trends indicate something vaguely "South African" in our future. A peer to the USA in 2017 or in the future, would be found in South America or Africa. Compared to those real peers, we're doing a great job in medical and educational fields. Yes we suck compared to Germans but "we americans" are not Germans, not anymore, so whats the point of that observation exactly? If our Africans are the best educated and healthiest Africans on the planet, if our South Americans are the best educated and healthiest South Americans on the planet, whats the problem exactly? Even legacy races like whites, USA has some of the best educated white people on the planet. Our averages might be dismal for various human biological differences reasons, but broken out into hyphenated-american groups, all our groups kick butt individually.
With respect to people not understanding the politics, according to the BLS there's only 100M full time employees over 25 years of age of which most but not all have bennies such as health insurance. Google claims the USA population is 319M. Pondering why the winners of a democratic election would screw over employees with bennies is like being surprised at the result of two wolves and a sheep voting on dinner.
Combining this, some of the numbers are insane. Every working person has to pay in their insurance and taxes enough money for roughly three likely incredibly expensive deaths. Very theoretically in some kind of pre-historic Egyptian sense a culture can afford a middle class lifetime income level cost of death/medical care on a 1:1 basis without creating too much of a pyramid inflation scheme. However if a nation intentionally wipes out its middle class like the USA replacing with struggling working class you can't expect each working class lifetime income to fund three middle class financial scale deaths.
The medical system has to match the economic system. Either the medical system has to be collapsed to South American or African levels, or the economic system has to be improved to Euro levels. "F you I've got mine" utterly eliminates any possibility of economic improvement, income inequality will increase permanently no matter what. That means medical care must collapse to, on average, African or South American levels. To insist otherwise is to risk sounding like one of those old people in the 70s who assumed we would never destroy our own industrial base intentionally, so surely the factories will reopen soon. I am curious what the hospital/health care equivalent is of the "rust belt" meme, because health care today is like a labor intensive assembly line factory in the USA in 1970, you may as well start counting the months until the jobs are gone and the buildings are abandoned to urban explorers, there literally is no alternative.
I'm not sure this is necessarily bad. Most lifespan improvement and quality of life improvement over the last centuries in western and formerly western countries came from civil engineers who had their glory stolen by the medical complex. Don't get me wrong, I'm sure it'll be bad, but unless we go "pol pot" on the civil engineers, we're not going back to 1800s era death rates. If we do that, then we're really doomed.
Regular wellness checks, etc., while wonderful, are a free lunch. They are not insurable. You can't insure for regular, scheduled services. Because math.[1]
If you see things like this - things that are either exorbitantly expensive or defy the bounds of underwriting or both you should expect to pay other prices, elsewhere.
[1] This is insurance 101. You cannot insure against regular, universally consumed services. There is no underwriting pool there. You cannot buy an auto policy that includes regular tire replacement - and if you could, the premiums would include 100% of the tires cost (plus admin).