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
Mon, 06-15-2009 - 8:34am

So feel free to pick out some deserving, uninsured family and purchase an insurance policy for them.

Let me know the state; perhaps I can assist you. That will answer my question for one uninsured family ... cl-nwtreehugger will be paying the bill. Now how about you try to answer for all the rest of the uninsured ... how will those who can't afford insurance premiums pay for the tax increases necessary to fund their government health care?

My state is very much into regulating the health insurance industry. I am made aware of that every time my premiums go up.

Avatar for ddnlj
iVillage Member
Registered: 03-26-2003
Mon, 06-15-2009 - 8:38am

Few people, unless they work in the industry, understand the costs they actually pay for healthcare in the long run

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iVillage Member
Registered: 03-18-2000
Mon, 06-15-2009 - 9:17am

"Everytime you visit a doctor or hospital, the cost of those who did not pay their bill is passed on to you."

 


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Avatar for claddagh49
iVillage Member
Registered: 07-20-2004
Mon, 06-15-2009 - 9:29am

I honestly wonder about this . How about Bush had said "I need to go to War with Iraq. To pay for it, I'm going to raise taxes on the wealthy, also other areas to pay for this war" But nope, he gave the wealthy tax breaks and started a war.


Health ins. for all is more important that WARS.

iVillage Member
Registered: 02-19-2008
Mon, 06-15-2009 - 9:31am

" Everytime you visit a doctor or hospital, the cost of those who did not pay their bill is passed on to you. This is one of the reasons healthcare is so high for those you DO pay for it."

How will this change? The non-payers allegedly "can't afford" to pay premiums. How will they be able to afford those premiums after health care reform?

"Here's an example. My stepson was hit by a car last year. He was barely 19 years old, no longer covered by his parent's insurance, and working p/t at a restaurant. Auto insurance did not cover the medical expenses because the accident was my stepson's fault - he rode out in front of the car. He spent 12 hours in a trauma room, needed extensive x-rays and CT scans, and had to have a plastic surgeon called in to stitch up his face. The hospital bill ALONE came to $22,000.00. That's not counting doctors, x-ray, lab, etc. There was no way a teenager with a part-time job and no insurance could pay that, so he was given a letter of hardship by the hospital and the bills were written off."

So he couldn't afford insurance at his part-time job. How will he pay the tax increase necessary to fund the government-provided healthcare he can't afford now?

"We desperately need a safety net for those who fall through the cracks. Not everyone has a job that provides affordable health insurance."

I understand this problem completely. That's why I purchase my own.

" Not everyone has a job that provides affordable health insurance. Not everyone can afford private health insurance. "

How will these people pay the tax increases necessary to fund the single-payer system?

"Those of us who are able to afford it are already paying the costs for those who can't. In the long run, it would be cheaper for ALL of us if a system was in place that made sure everyone was covered, rather than the hit or miss system we have now that leaves so many without healthcare and costing the rest of us much more over the long haul."

How will the coverage for everyone be paid for? People like your stepson can't afford it. If he can't afford it, who will pay it?

iVillage Member
Registered: 03-23-2003
Mon, 06-15-2009 - 11:41am

That's not how it works & you should


iVillage Member
Registered: 03-23-2003
Mon, 06-15-2009 - 11:49am

Well said!



Avatar for ddnlj
iVillage Member
Registered: 03-26-2003
Mon, 06-15-2009 - 12:01pm

You're missing the point because you're trying to lay blame. You can buy your own insurance, so what? So can I. You and I make a whole lot more than most 19 year old kids that have been kicked off their parents' policies but certainly aren't out in the world making big wages at big jobs.


You WILL, in the long run, save money if these people who are in health insurance limbo are able to use a single payer program. Hospitals will get reimbursed and won't be charging YOUR insurance company outrageous fees to cover non-paying patients, fees that are eventually passed on to you and I in premiums and co-pays.


I'm really sorry if you're worried about your taxes being raised. I wonder if you complained about the amount of tax it costs to foot this ridiculous fiasco of a war we've been paying for for the last 7 years.

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iVillage Member
Registered: 08-30-2002
Mon, 06-15-2009 - 1:08pm



iVillage Member
Registered: 03-03-2009
Mon, 06-15-2009 - 1:50pm
Hear, hear!

Jabberwocka

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