Down and Out in San Diego
Find a Conversation
| 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."

Pages
But it wasn't enough to keep Maggie there.
I have to respond to this...Because she fell in love.
"I have to respond to this...Because she fell in love. I have a very good friend who's DH moved here from Vancouver, BC when they married. He had no intention of ever moving to the U.S. until he met her. My mom moved to Seattle from northern Minnesota (via Fairbanks) when she married my father. People meet their 'loves' - then they usually move to where the one who will earn the most resides."
Where people move to and who they fall in love with isn't my concern. When they bad-mouth my country (the one they chose to move to) it's a different story. When they expect their new country to alter their ways of doing things (especially at my expense) it becomes my business.
You could take up your issue with the INS/ICE/USCIS/whatever.
Or maybe join one of the "America for Americans" groups whose whacked-out logic conveniently ignores that their ancestors IMMIGRATED here.
I simply don't see how how you can make assumptions about what Maggie and Doran* Yount know, think, say or do, on the basis of so little information--two interviews given and just about every other internet link some reference to or variation on one of those interviews.
Making assumptions about what you think to be possible, but which "facts" were not explicitly stated in either of those interviews, for the sake of drawing desired conclusions, is almost certainly a recipe for disaster. See: weapons of mass destruction.
Maybe alphabet soup immigration agency could set up "enhanced interrogation techniques" for sponsors--get them to confess to non-compliance with whatever. Would cut waaaaay down on any new immigrants.
Wouldn't do diddly squat for the MILLIONS who don't now have access to affordable care.
*That's his name according to your gift registry link.
Jabberwocka
Will you be sending a gift?
They're registered at the Pottery Barn.
"Wouldn't do diddly squat for the MILLIONS who don't now have access to affordable care."
It may prevent any more from dropping in "without understanding" how America does things like halthcare.
It is socially questionable to send a gift to someone who's unknown. But the Younts do have my heartfelt best wishes for good health and prosperity--in that order.
I suspect the health care payment and delivery of services model in the U.S. is about to change though probably not as drastically as I'd like.
If or how changes will affect immigrants (who aren't necessarily the MILLIONS now suffering from lack of affordable care) remains to be seen.
Jabberwocka
Coverage of the high risk pool would certainly give an added fillip if the reporter himself knew of its existence!*
Seems to be the case that the program is not exactly high profile or details of its provisions widely disseminated.
*Two can play at the "let's speculate wildly and interpolate at will" game.
Jabberwocka
The Younts don't live on or even near the beach. Would rather not give specific details of how I found out because it seems to me that some are altogether too irrationally hostile for the wellbeing of Maggie and Doran.
Myriad assumptions and characterizations are being made about the Younts, on little or no evidence. Rather unhealthy (pun intended), IMHO; and certainly not based on critical thinking or rigorous research.
Jabberwocka
Where people move to and who they fall in love with isn't my concern. When they bad-mouth my country (the one they chose to move to) it's a different story.
OMG!
Pages