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: 03-20-2003
Mon, 06-15-2009 - 4:57pm

The sad thing is financially, it would be cheaper to provide her with health care BEFORE she gets so sick she needs an x-ray for pneumonia.






Community Leader
Registered: 04-05-2002
Mon, 06-15-2009 - 5:01pm
Oops, sorry, posted under the wrong name again.










iVillage Member
Registered: 02-19-2008
Mon, 06-15-2009 - 5:19pm

One of my favorite liberal sob stories.

This poor child required something even the One can not provide ... a functioning, competent parent.

"Some poor children have no dental coverage at all."

My children don't have dental coverage at all.

Not one has died.

iVillage Member
Registered: 02-19-2008
Mon, 06-15-2009 - 5:43pm












Sunday, March 04, 2007


The Bloody Shirt

Have you heard the name Deamonte Driver? Well you should, for he is about to become the bloody shirt waved in 2008 by the advocates of more goverment-provided and controlled healthcare.

Here is his story:

For Want of a Dentist
Pr. George's Boy Dies After Bacteria From Tooth Spread to Brain
By Mary Otto
Washington Post Staff Writer
Wednesday, February 28, 2007; B01

Twelve-year-old Deamonte Driver died of a toothache Sunday.

A routine, $80 tooth extraction might have saved him.

If his mother had been insured.

If his family had not lost its Medicaid.

If Medicaid dentists weren't so hard to find.

If his mother hadn't been focused on getting a dentist for his brother, who had six rotted teeth.

By the time Deamonte's own aching tooth got any attention, the bacteria from the abscess had spread to his brain, doctors said. After two operations and more than six weeks of hospital care, the Prince George's County boy died.

Deamonte's death and the ultimate cost of his care, which could total more than $250,000, underscore an often-overlooked concern in the debate over universal health coverage: dental care.

It's a very sad story about the horrors of poverty, American-style. But you have to do some hard reading between the lines to perceive those horrors as they really are. In conformity to the most ancient canons of liberal advocacy journalism, reporter Mary Otto has ignored the real story - a shocking account of parental incompetence and neglect - to advance an agenda.

You have to scroll more than halfway down into the story to arrive at these details:

The Driver children have never received routine dental attention, said their mother, Alyce Driver.

But doesn't Medicaid cover dental care?

The children's Medicaid coverage had temporarily lapsed at the time Deamonte was hospitalized.

Wait a minute: how does Medicaid "lapse"? Maryland's Medicaid program covers children under 19 whose parents earn up to 200% of the federal poverty level : $33,000 for a family of 3. If Driver earned more than $33,000 from her "bakery, construction, and home healthcare jobs," you would think she might be able to afford a visit to the dentist for an ailing child. Or did her coverage "lapse" for some other reason? What was it?

To find that answer, you have to wait till the very end of the story. Driver ends up in a homeless shelter.

She suspects that the paperwork to confirm their eligibility was mailed to the shelter in Adelphi, where they no longer live.

In which case, would it not have been truer to add one more "if" clause to the opening above: "If only his mother had not been so utterly neglectful as not to take one single solitary personal step to ensure that her Medicaid coverage continued when she changed addresses?"

But wait, it's not Ms Driver's fault!

And even with Medicaid's promise of dental care, the problem, she said, was finding it.

It took me three clicks at 1800Dentist.com to find a dentist office in north Washington, convenient to Prince George's county, that had an appointment available for a Medicaid patient this very morning.

This next passage speaks for itself I think:

When Deamonte got sick, his mother had not realized that his tooth had been bothering him. Instead, she was focusing on his younger brother, 10-year-old DaShawn, who "complains about his teeth all the time," she said.

DaShawn saw a dentist a couple of years ago, but the dentist discontinued the treatments, she said, after the boy squirmed too much in the chair.

Now this:

By September, several of DaShawn's teeth had become abscessed. Driver began making calls about the boy's coverage but grew frustrated.

Did this frustration impel her to more frantic efforts to help her sons? Not at all. She turned the whole problem over to

Laurie Norris, a lawyer for the Baltimore-based Public Justice Center who tried to help the Driver family

- and who also emerges as the principal source for Mary Otto's wave-the-bloody-shirt story.

Norris secured the Drivers some help, but seems not to have brought much urgency to Deamonte's care.

Norris and her staff also ran into barriers: They said they made more than two dozen calls before reaching an official at the Driver family's Medicaid provider and a state supervising nurse who helped them find a dentist.
Why couldn't they find a dentist on their own?
On Oct. 5, DaShawn saw Arthur Fridley, who cleaned the boy's teeth, took an X-ray and referred him to an oral surgeon. But the surgeon could not see him until Nov. 21, and that would be only for a consultation.
Driver said she learned that DaShawn would need six teeth extracted and made an appointment for the earliest date available: Jan. 16.
But she had to cancel after learning Jan. 8 that the children had lost their Medicaid coverage a month earlier.
In other words, the lawyer who is supposedly urgently seeking care for an ill boy has likewise made no effort over the four months between September 2006 and January 2007 to determine whether the family had in fact sustained their Medicaid coverage - or to get it reinstated. Instead, Ms Driver cancelled her appointment and then ... did nothing.

It was on Jan. 11 that Deamonte came home from school complaining of a headache. At Southern Maryland Hospital Center, his mother said, he got medicine for a headache, sinusitis and a dental abscess. But the next day, he was much sicker.
Eventually, he was rushed to Children's Hospital, where he underwent emergency brain surgery. He began to have seizures and had a second operation. The problem tooth was extracted.

Now look: I'm not going to deny that there may well be much wrong with health coverage for America' poor. Obviously there is. And some of the steps mentioned at the end of the article, including expansion of dental service at state health clinics, may well be useful and cost-effective measures. Maryland could pay for a lot of routine care with the quarter-million dollars it spent at the end to save Deamonte Driver's life.

But no government program on earth can protect children's health from a custodial parent who refuses to bestir herself in any way to help them, no matter how obviously sick they are. And no responsible journalist should allow herself to be manipulated by welfare-industry advocates into minimizing or excusing this truth in her reporting.

Deamonte Driver was a victim of parental neglect, not the hard-heartedness of the Medicaid program. And the really tough question for the guardians of the poor is: How on earth do we insure against that?

**

Update: A reader suggests another question Mary Otto should have asked Alyce Driver. "How often did Deamonte brush his teeth?" Teaching your children to brush and floss will eliminate almost all cavities even in the absence of any visits to the dentist at all. And if the answer is that Driver neglected even this basic, basic level of hygiene, you have to wonder whether there was any conceivable government health program that could have saved her son's life - short, that is, of actually removing her children from her care. But that's a very different debate, isn't it?

03/04 09:02 AM









http://frum.nationalreview.com/post/?q=Mjg2NzZjY2NiMDhkNGU1ZTI0ODllN2VmMzJmNWMzZmQ=
Community Leader
Registered: 04-05-2002
Mon, 06-15-2009 - 5:59pm

"Not one has died."


Deamonte died.






iVillage Member
Registered: 02-19-2008
Mon, 06-15-2009 - 6:18pm

Or the state could have removed him from such an incompetent as Alyce. Or the attorney representing him could have protected him rather than showcasing his death after the fact for her own agenda.

Once I found a case on a horse rescue site. The horse had been removed from its owners custody due to neglect, mainly lack of appropriate dental care.

Community Leader
Registered: 04-05-2002
Mon, 06-15-2009 - 6:20pm

The whole conclusion is based on a possible conjecture, no proof, no evidence, dragging the distraught mother through the mud w/out reason.






Community Leader
Registered: 04-05-2002
Mon, 06-15-2009 - 6:21pm

Can you post evidence that the mother was incompetent?






iVillage Member
Registered: 02-19-2008
Mon, 06-15-2009 - 6:27pm

Attention to basic dental hygiene apparently isn't high on her list.

Sat on her behind without getting Deamonte dental care before it became fatal.

iVillage Member
Registered: 02-19-2008
Mon, 06-15-2009 - 6:32pm

"Yes, we are already paying one way or another. However, the current system is extremely inefficient (broken, really) & only benefits the insurance companies in the long run. I would prefer to see the money that I'm already paying going towards an efficient system that actually helps Americans who need it."

Then why are looking towards the US Government?

"And my state is quite involved in regulating insurance as well. That's why the pre-existing conditions garbage has limitations here. The insurance companies don't like it, but they want the business so they put up with it."

Same here. A good function for government.

"As for 'paying for tax increases', how do you know that they'll even be required to? Last time I checked, the new medical coverages plan hadn't been ironed anywhere close to such detailed info."

How do they plan to pay for it?

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