Down and Out in San Diego

iVillage Member
Registered: 02-19-2008
Down and Out in San Diego
246
Wed, 06-03-2009 - 8:43pm

Poor Maggie, America is such a cruel and inhospitable place.

http://www.latimes.com/news/local/la-fi-lazarus27-2009may27,0,819761.column?track=rss

Canada's healthcare saved her; Ours won't cover her
David Lazarus
May 27, 2009
San Marcos resident Maggie Yount wasn't surprised when the letter from insurance giant Anthem Blue Cross arrived the other day. Yet she couldn't help but be frustrated.

"Some medical conditions, either alone or in combination with the cost of medication, present uncertain medical underwriting risks," Anthem informed her. "In view of these risks, we find we are unable to offer you enrollment at this time."

In other words, no health coverage for you.

Yount, 24, finds herself in that cloudy area in which a "preexisting condition" makes her too great a risk in the eyes of money-minded insurance companies. And so she's being excluded from the system.

"It looks like I'll just have to be very, very careful about everything," Yount told me. "But what kind of way is that to live your life?"

If that were all there was to it, her story would still be worth telling as the Obama administration embarks on an ambitious effort to reform the woefully dysfunctional U.S. healthcare system.

But Yount's tale runs even deeper.

In November 2007, she was rushed to the emergency room after a drunk driver crashed into her car on a Nova Scotia highway.

Yount awoke from a coma four days later. She had suffered a brain injury in the head-on collision. Thirteen bones were broken, from her leg to her cheek. The other driver was killed.

Yount, a Canadian citizen, spent three months in a Halifax hospital, receiving treatment and rehab that must have cost a small fortune.

"I have no idea how much it cost," she said. "It's not something I've ever needed to know."

So who paid the bill?

"The government of Canada."

The United States is the only industrialized democracy that doesn't have a government-run insurance system. Under such systems, universal coverage is provided through tax revenue. There are no premiums, co-pays or deductibles.

It's not a perfect system -- people often end up waiting for nonessential treatment. But it won't leave you destitute if things go bad. Basically, you're covered. For everything.

In Yount's case, that ended when she moved to San Marcos in northern San Diego County a year ago to be with her fiance. They were married last July.

She then tried to obtain health coverage under the U.S. system. Her American husband works as a software engineer on a contract basis and doesn't have employer-provided coverage.

Before applying to Anthem, Yount applied for an individual policy offered by Aetna Inc. She received a letter a couple of months ago informing her that her application had been rejected.

The letter noted that Yount's medical record includes "a history of traumatic brain injury with multiple fractures treated with hospitalization." It concluded that "this condition exceeds the allowable limits provided by our underwriting guidelines."

That's a fancy way of saying there's a pretty good chance Yount will require medical care of one sort or another in the future. This would be bad for Aetna's business.

"If anybody from Aetna had actually spoken to me, they'd see I'm not mentally challenged because of the brain injury," Yount said. "I still have some issues related to it, such as short-term memory loss, but I no longer have the need for acute medical care."

As for all those broken bones: "They've healed," Yount said. "That's over. What, are they going to deny people coverage because they once had a broken arm?"

Anjanette Coplin, an Aetna spokeswoman, was unable to discuss Yount's case. But she said the company considers a variety of factors before rejecting an applicant for coverage. These can include a person's overall condition, medical history and prospects for ongoing treatment.

"We feel that our underwriting guidelines give the greatest number of consumers the opportunity to purchase affordable, quality health insurance products," Coplin said.

Yount's response: Companies like Aetna and Anthem are denying coverage based solely on history rather than a reasonable expectation of what could happen down the road.

"I want insurance for what could happen in the future -- just in case," she said. "That's what insurance is for. But I can't get it."

I don't blame Aetna or Anthem. If you offer health insurance as a for-profit business, it goes without saying that you'll do everything you can to avoid making payouts. That means you'll shun anyone with even a whiff of medical trouble.

But this is no way to run an insurance system, let alone to protect people from financial ruin due to catastrophic events such as being sent to the hospital by a drunk driver.

The Obama administration has already rejected the idea of a single-payer system similar to Canada's -- a mistake, in my opinion. Instead, it wants a smaller public program that would compete with private insurers and keep costs down.

Private insurers, not surprisingly, are lobbying aggressively to kill off that idea. They'd rather have a national mandate that would require all Americans to buy their product.

In return, they say, they'd stop sending rejection letters to people like Yount with preexisting conditions. But policyholders would still be subject to the companies' various terms and conditions.

Maybe one compromise would be to let private insurers handle the small stuff and to have a public program that could tackle the catastrophic stuff.

I asked Yount what would have happened if she'd gotten into her accident in Southern California instead of Nova Scotia.

"I can't say whether my care would have been better or worse," she replied. "But I know this: I'd be bankrupt now."

"I'm not a religious person," Yount added. "But I thank God my accident happened where it did."

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iVillage Member
Registered: 08-30-2002
Wed, 06-03-2009 - 9:38pm
It is, if you are someone with a pre-existing condition that would like health insurance. My SO was diagnosed at 24. His meds, Dr. appts and lab tests run approx. 12K a year to manage his illness, so he can work, support his child , pay income and property taxes. He can't get a catastrophic health policy (or life insurance to insure his dds future if he should die.). That means a broken leg, sickness, car accident could easily bankrupt him.


iVillage Member
Registered: 02-19-2008
Wed, 06-03-2009 - 9:43pm
Maggie is here due to her marriage to an American citizen. Why isn't he stepping up to the plate here?
iVillage Member
Registered: 03-03-2009
Wed, 06-03-2009 - 9:58pm

Huh? How would marriage to an American citizen do ANYTHING to address the "pre-existing" condition issue?*

*Pssst. I'll give you a hint. That marriage would matter diddly-squat! The only way that he could be of benefit is if he's independently wealthy and could completely cover Maggie's health care "out of pocket". Am absolutely amazed that anybody defending status quo doesn't appear to know that salient fact.

Jabberwocka

iVillage Member
Registered: 02-19-2008
Wed, 06-03-2009 - 10:08pm

Psst, I'll let you in on another secret. Sponsors are supposed to be responsible for those whom they choose to sponsor. So she just up and moved here and she and her husband have just learned she can't get the insurance she wants. A bit irresponsible, don't you think?

iVillage Member
Registered: 03-03-2009
Wed, 06-03-2009 - 10:21pm

Let me get this straight. You think her husband should have asked, pre-proposal "Maggie, do you have any pre-existing conditions which would keep you from getting health care?"

And of course Maggie was totally in the dark herself since she had been in a country where such nonsense simply plays no part.

The insurance industry is not interested in providing quality health care, it's interested in making money. As such, clients/customers are NOT well-served by the current model--Maggie included.

The odd thing is that your link makes clear that very point yet somehow the thread is supposed to make Maggie or her husband look remiss? Weird, very weird.

Jabberwocka

iVillage Member
Registered: 02-19-2008
Wed, 06-03-2009 - 10:36pm

"Let me get this straight. You think her husband should have asked, pre-proposal "Maggie, do you have any pre-existing conditions which would keep you from getting health care?"

More like Maggie, I would like you to move to the United States as my spouse. Let us look into what this will mean for your health care as I would be your sponsor and responsible for it.

"And of course Maggie was totally in the dark herself since she had been in a country where such nonsense simply plays no part."

Of course, Maggie has no responsibility whatsoever to look into the medical care situation in a country she elects to reside in.

"The insurance industry is not interested in providing quality health care, it's interested in making money. As such, clients/customers are NOT well-served by the current model--Maggie included.

The odd thing is that your link makes clear that very point yet somehow the thread is supposed to make Maggie or her husband look remiss? Weird, very weird."

Maggie and her husband have made themselves look remiss.

iVillage Member
Registered: 02-05-2009
Wed, 06-03-2009 - 10:46pm

The odd thing is that your link makes clear that very point yet somehow the thread is supposed to make Maggie or her husband look remiss? Weird, very weird.


I was wondering about that myself...


zz

iVillage Member
Registered: 03-03-2009
Wed, 06-03-2009 - 10:48pm

It's hard to ask questions about things of which you know nothing from experience. Maggie didn't know. If her husband had been in good health and never required significant medical care, he wouldn't know either.

As your own link pointed out "The United States is the only industrialized democracy that doesn't have a government-run insurance system."

The insurance model is a crappy one which insinuates a third for-profit party into the already (thanks to AMA pressures) pricey system.

Jabberwocka

iVillage Member
Registered: 02-19-2008
Wed, 06-03-2009 - 11:04pm

"It's hard to ask questions about things of which you know nothing from experience. Maggie didn't know. If her husband had been in good health and never required significant medical care, he wouldn't know either."

And of course we shouldn't demand anyone actually educate themselves about that which they "don't know". But now that they know, maybe a return to Canada should be in order for Maggie.

"As your own link pointed out "The United States is the only industrialized democracy that doesn't have a government-run insurance system."

Yep, and I'd like to keep it that way. At least until better arguments can be made besides Maggie and her husband.

iVillage Member
Registered: 08-30-2002
Wed, 06-03-2009 - 11:42pm

***The odd thing is that your link makes clear that very point yet somehow the thread is supposed to make Maggie or her husband look remiss? Weird, very weird."***


It also negates the fact that AMERICANS, born and raised here have the same experience as Maggie. OP would like to split hairs over ONE Canadian that married an American, when in REALITY,



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