Down and Out in San Diego
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| 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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"If Doran Yount had ever applied for coverage, been in steady good health, and never had anything which was defined as "pre-existing" he wouldn't know that insurance companies can use previous illnesses, congenital defects, or injuries as grounds for refusal to cover."
Personally I don't buy this .... but for the sake of argument let's say it is true. What was our immigration department thinking when they allowed such an uninformed, ignorant individual to become a sponsor for an immigrant? Where was the information briefing to educate Joran? Of course as ICE can't even get rid of the millions of people here illegally perhaps expecting something like education of sponsors is asking too much of them
So whether because of their own ignorance or the incompetence of ICE Maggie and Joran "didn't know" about American health care. They know now. What are they doing about it? Joran is not doing anything about it, Maggie is expounding upon how wonderful Canada was. Maybe she should convince Joran of Canada's wondefulness, and they can both reside there together.
"It would be jumping to conclusions (again) to assume that she has not applied to that high-risk pool. Were all facts of her life, her future plans, and her past actions covered in the two interviews she's given?"
The point of this article was to portray the horror of the American insurance system. The liberal press loves to do this. An added saga of Maggie and her experiences with the horrible high-risk pool would be more fodder for this reporter to use.
Apparently, unlike you, I read the information posted by others about the restricted number of people the pool will be accepting - how they are already dumping people from it.
"And, FYI, it doesn't matter whether or not the individual the author in the OP wrote about is an American or not - they will still face the same problems. IMHO, they chose a Canadian because, while their system isn't perfect, at least everyone can GET medical coverage."
But it wasn't enough to keep Maggie there.
"You can keep repeating 'Apply to the high risk pool.' all you want but it won't change the facts. The slots in the high risk pool aren't there...and if they are able to get in, more than likely they still won't be able to afford the annual premiums. "
And your proposal is for other people to pay the "unaffordable" premiums? The state of California has been living like that for some time, and is presently almost bankrupt.
"Another large part of the problem are the Pharms. Yes, there are some doctors who make a lot of money, but I know quite a few that work in medical clinics, etc., that don't. Costs in hospitals are high for a variety of reasons - some being because they have to take care of so many who can't afford insurance...."
Yes, how will all these people who can't afford insurance suddenly be able to afford the increased taxes necessary to pay for the sigle-payer health care so many are eager to see us adopt? They are so destitute they can't meet their own healthcare needs now.
So while Maggie lives the good life in California at her new home near the ocean, I am supposed to work for single-payer insurance so her good life in Southern California isn't disturbed by paying for her own healthcare. I don't think so .....
She WAS trying to get insurance that SHE paid for...and she was denied! I would think
That's a hoot .... I don't believe there are many young couples living on fledgling budgets who reside in homes by the beach in one of the most expensive areas in the country.
Do they rent or own?
If Maggie requires medical care before she gets any insurance coverage, she and her spouse will have to pay out-of-pocket expenses. If she needs care which can be scheduled, she might find a clinic with low/no cost care. But if emergency care is required, the financial outlook for Maggie and her husband could be grim.
If expenses are significant enough and a payment plan over time cannot be agreed upon, they could be bankrupted, lose their house, lose any other assets they have acquired. Or they could do what some people do and throw fundraisers to attempt to defray costs--sometimes enough money is raised but there are no guarantees.
This are the status quo choices:
Forgo medical care of any kind.
Find a clinic for low-income patients.
Pay medical care providers for treatment, tests, pharmaceuticals as you go (often-exorbitant for those without insurance)
Pay insurance companies premiums which have increased almost exponentially over the past five years--IF you can qualify for coverage at all.
Totally spend down all assets and throw yourself on the mercy of Medicaid.
Primitive, ain't it? Scrooge, in his pre-visitation mindset, would have been proud.
Jabberwocka
"She WAS trying to get insurance that SHE paid for...and she was denied! I would think that you'd be on the case of the greedy insurance companies for denying coverage for such flimsy reasons - oh wait, because you're a conservative capitalist, you believe they have every right to suck us dry...that's right...."
My alternative is apparently The One sucking us dry ....
http://finance.yahoo.com/news/Obama-Its-OK-to-borrow-to-pay-apf-15483626.html?.v=13
Obama: It's OK to borrow to pay for health care
Obama-proposed budget rules allow deficits to swell to pay for health care plan
WASHINGTON (AP) -- President Barack Obama on Tuesday proposed budget rules that would allow Congress to borrow tens of billions of dollars and put the nation deeper in debt to jump-start the administration's emerging health care overhaul.
The "pay-as-you-go" budget formula plan is significantly weaker than a proposal Obama issued with little fanfare last month.
It would carve out about $2.5 trillion worth of exemptions for Obama's priorities over the next decade. His health care reform plan also would get a green light to run big deficits in its early years. But over a decade, Congress would have to come up with money to cover those early year deficits.
Obama's latest proposal for addressing deficits urges Congress to pass a law requiring lawmakers to pay for new spending programs and tax cuts without further adding to exploding deficits projected to total about $10 trillion over the next decade.
If new spending or tax reductions are not offset, there would be automatic cuts in so-called mandatory programs -- although Social Security payments and the Medicaid health care program for poor and disabled would be exempt and cuts to Medicare would be sharply limited.
"The 'pay-as-you-go' rule is very simple," Obama said. "Congress can only spend a dollar if it saves a dollar elsewhere."
Last month Obama suggested a tougher plan that would prohibit Congress from swelling the deficit in one year by putting off until later years the tax increases or spending cuts to pay for it.
The requirement for legislation to be financed over the coming decade generally mirrors existing congressional rules and reflects the likelihood that Obama's health care plan will add many billions of dollars to the deficit in the early years. Savings and revenues in later years would have to make up for the initial deficits.
Congress lived under a so-called "pay-go" regime in the 1990s and the early years of this decade. But it didn't stop lawmakers from passing President George W. Bush's landmark 2001 and 2003 tax cuts and big increases in farm subsidies without making the required spending cuts elsewhere. A $127 billion surplus in 2001 subsequently turned into deficits over the next four years of $159 billion, $377 billion, $413 billion and $319 billion.
The rules still exist and lawmakers routinely find ways around them. For example, a bill to effectively double GI Bill education benefits was enacted last year. Congress also regularly waives the rules to pass an annual "patch" to the alternative minimum tax, sparing some 20 million families from a $2,000 tax increase on average.
Still, Democrats profess a faith in pay-as-you-go rules.
"It is no coincidence that this rule was in place when we moved from record deficits to record surpluses in the 1990s -- and that when this rule was abandoned, we returned to record deficits that doubled the national debt," Obama said.
In fact, the surpluses of the late 1990s were largely due to a huge influx of tax revenues from a booming economy.
Rep. Dennis Moore, D-Kan., said the House is likely to pass Obama's latest proposal next month. The plan faces far tougher sledding in the Senate, where Budget Committee Chairman Kent Conrad, D-N.D., has expressed serious reservations.
Conrad said Obama's proposal does nothing about the fiscal perils the country already faces, including deficits that the Congressional Budget Office predicts will average nearly $1 trillion a year over the next decade.
"I remain concerned about the potential effect of this proposal on American farmers, seniors and veterans," said Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee.
Republicans said new budget rules ring hollow in the wake of the Obama-championed $787 billion stimulus package and other deficit spending. They said legal limits on appropriations should be put into place as they were in the 1990s, though such "caps" were easily evaded when surpluses appeared.
Congress is just ramping up the annual appropriations process, which in the House would award increases averaging 12 percent to non-defense programs. Obama's proposal does not include the comparable "caps" from the 1990s.
"Time after time this year, Democrats have ignored calls for fiscal responsibility," said House GOP leader John Boehner of Ohio. "We don't need more rhetoric and gimmicks. We need action to tackle the tremendous fiscal challenges facing this nation."
Obama's proposal would require future tax cuts to be financed by tax increases elsewhere. But again, he carves out several exceptions, including for an extension of Bush's tax cuts due to expire in 2011 and relief from the alternative minimum tax.
The federal deficit is on pace to explode past $1.8 trillion this year, more than four times last year's all-time high. The record borrowing is credited with pushing up interest rates, which could imperil chances for a recovery later in the year.
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