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: 02-19-2008
Thu, 06-04-2009 - 12:01am

I did not focus on one remiss Canadian and her remiss husband. A so-called journalist has, and this little tale of woe is the latest in a series of stories put forth as evidence that we need to chnage our system of health care.

BTW, Maggie can obtain health coverage.

http://statehealthfactsonline.org/comparetable.jsp?ind=605&cat=7

iVillage Member
Registered: 03-03-2009
Thu, 06-04-2009 - 10:20am

A wise person once said that that the more one learned, the more one knew just how much one didn't know. A considerably less-wise person phrased it in another (and obfuscating way)*. In a perfect world, we'd all be prescient and acquire the knowledge needed (in advance) to deal with the specific challenges we face. It's not a perfect world. And only fools claim they know it all.

I personally hope that we find a way to reform a badly broken system which adversely affects far more than just Maggie; rather than advocate for her return to Canada. Nobody who looked at our health care as it now stands would proclaim it exemplary in coverage, efficiency or cost.

I have noticed that many conservatives don't really give a damn about the nation as long as they've "got theirs".

*There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don't know. But there are also unknown unknowns. There are things we don't know we don't know.
--Donald Rumsfeld (February 12, 2002; Department of Defense news briefing)

Jabberwocka

iVillage Member
Registered: 03-03-2009
Thu, 06-04-2009 - 10:31am

Not only is the issue of pre-existing conditions ludicrous (who most needs affordable care but those with ongoing issues!?), but the rising costs of health insurance have compelled many small business owners to either reduce or eliminate coverage for their employees. And if those owners consider switching to another insurance provider, the Pre-E clause raises its ugly head. Broken, broken, broken.

We absolutely do not need health care insurance. We do need affordable, accessible, and high-quality health services; whether it be in prevention or in treatment.

Jabberwocka

iVillage Member
Registered: 02-19-2008
Thu, 06-04-2009 - 10:36am
I have noted many liberals aren't big on holding people accountable for their actions, as well as expecting the government to take care of them. Maggie seems to fit this description.
iVillage Member
Registered: 03-18-2000
Thu, 06-04-2009 - 12:59pm

"

 


Photobucket&nbs

iVillage Member
Registered: 03-18-2000
Thu, 06-04-2009 - 1:03pm

"It also negates the fact that AMERICANS, born and raised here have the same experience as Maggie..........."


Excellent points.

Photobucket

 


Photobucket&nbs

iVillage Member
Registered: 01-22-2009
Thu, 06-04-2009 - 1:20pm
Good item, thanks for posting it :)

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iVillage Member
Registered: 01-22-2009
Thu, 06-04-2009 - 1:27pm

~Maggie and her husband have made themselves look remiss.~


Oh, well.

iVillage Member
Registered: 03-03-2009
Thu, 06-04-2009 - 1:44pm

I do hold her accountable. Accountable for being an optimist. Accountable for being in love and wanting to be with her spouse. Accountable for being a survivor against huge odds.

But then again, I'm a liberal and think that individuals matter more than profits of insurance companies and big medicine. Before you go haranguing others for hoping that government will step in and do some major overhaul, you might seriously consider talking to small business owners (HARDLY "expecting the government to take care of them") about the toll insurance costs are taking on their bottom lines. Aside from the altruism issue, our current system is far from healthy for those small capitalistic companies.

Given the disarray of the previous administration, I can quite see the negative connotation of having "government" involved but it doesn't necessarily follow that governments have to be arrogant, inept, greedy, and immoral. Bush's reign of stupidity is over.

Jabberwocka

iVillage Member
Registered: 02-19-2008
Thu, 06-04-2009 - 4:24pm

President Bush did not tell Maggie to come here.

He did not tell her to marry someone unable or unwilling to fulfill his responsibility as her sponsor.

As her sponsor does not get health insurance from a company the subject of health costs to business isn't relevant.

Nothing wrong with being an optimist or in love. It is wrong when you expect others to foot the bill.

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