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: 03-23-2003
Wed, 06-10-2009 - 11:45am

OP you seem really removed from the world up there in your ivory tower. I have family in San Diego. Some of them young couples who are struggling to make it there. They rent funky little houses, not so much so they can languish and kvetch on the beach, but so they can live near their mother, who bought her house there over 30 years ago.


HUH?


iVillage Member
Registered: 02-19-2008
Wed, 06-10-2009 - 12:11pm

"When they expect their new country to alter their ways of doing things (especially at my expense) it becomes my business.

Hmmmm....last time I checked, she wasn't leading the brigade for change, that was being done by AMERICAN citizens who can see the inequities & are willing to help others (even if that means going without a 'me-me-me toy' or two)."

I have suggested here that people purchased the insurance coverage that is available for Maggie. The response was they can't afford it.

iVillage Member
Registered: 03-18-2000
Wed, 06-10-2009 - 12:26pm

This proverbial horse has been beaten to death.


Have you tried writing fiction?

Photobucket

 


Photobucket&nbs

iVillage Member
Registered: 03-23-2003
Wed, 06-10-2009 - 12:38pm

I have suggested here that people purchased the insurance coverage that is available for Maggie. The response was they can't afford it.


What insurance would that be?


Avatar for claddagh49
iVillage Member
Registered: 07-20-2004
Wed, 06-10-2009 - 12:51pm
Yes, stop beating the dead horse. the Zebra doesn't change it's stripes!
iVillage Member
Registered: 02-19-2008
Wed, 06-10-2009 - 2:52pm

"And yes, many people can't afford up to $10,000/yr for medical insurance. They have things like rent, food & utility bills to pay. Also, I'm not referring to those who are stupid enough to opt for 'toys' over insurance...I'm talking about the millions of Americans who have NEITHER."

And how will they afford the $10,000 per year tax increase?

iVillage Member
Registered: 08-30-2002
Wed, 06-10-2009 - 2:56pm
Sorry about that, I didn't change the thingy. Wasn't responding to you.


iVillage Member
Registered: 02-19-2008
Wed, 06-10-2009 - 2:58pm

".and even at the lowest premiums, it still took a monthly chunk out of my wallet."

Takes a chunk out of mine as well. If there are millions who can't afford to pay for their own premiums whose wallet will the premium come out of?

iVillage Member
Registered: 03-23-2003
Sun, 06-14-2009 - 1:40pm

LOL!


iVillage Member
Registered: 03-23-2003
Sun, 06-14-2009 - 2:07pm

Takes a chunk out of mine as well. If there are millions who can't afford to pay for their own premiums whose wallet will the premium come out of?


Obviously not YOUR wallet.


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