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
"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."
Did this being kicked off parent's policy at 19 come as a total shock? My policies cover mine till age 26. When does childhood officially end? When are we self-responsible? Is this the same 19 year old that is employed part-time? What about full-time employment?
"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."
No they will charge the government. If these non-paying people (those who can't afford health insurance) continue to be non-paying the government must get the money from somewhere to pay for them. Where will that money come from?
"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. If we have money for war, if we have money to rebuild another country that we so ignorantly tore apart, then we have money to take care of our own people."
I wonder why people always try to change the subject. I wonder why so many expect the government to take care of them.
"Healthcare is something that is so far out of reach of so many Americans it's coming to being a privilege for the wealthy. There needs to be other options and other plans; something there for those in the middle who are neither rich nor poor - the working class who happens to be at the lower end of the pay scale."
Many people who are not wealthy manage to get their healthcare needs met.
"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."
Again, can you post evidence to support the mudslinging?
Jabberwocka
Repeatedly, you have referred to "my taxpayer money". Clearly, your money is more important to you than just about anything else. Soooo, it logically follows that you are outraged over a war which was based on assumptions, circular logic and outright LIES concerning the threat presented to the United States. The Iraq war has cost over 4,000 U.S. lives in addition to billions of dollars (tip of the iceberg--there's a lot more hidden costs in global prestige, maimed lives and lost lucre). Not only has the war been costly, it has resulted in no significantly improved conditions in Iraq. Saddam is dead and gone. So are over a hundred thousand Iraqis.
No change in subject if you're fixated on taxpayer costs.
"Many people who are not wealthy manage to get their healthcare needs met", you say. And I say that many people are struggling--much as you prefer to blame them for their woes rather than acknowledge the huge flaws in the current sick sick sick system.
Sad.
Jabberwocka
Deamonte is the victim. He didn't ask to be born to an incompetent parent who chose to rely upon an incompetent government worker.
""Many people who are not wealthy manage to get their healthcare needs met", you say. And I say that many people are struggling--much as you prefer to blame them for their woes rather than acknowledge the huge flaws in the current sick sick sick system."
And you prefer not to hold too many people responsible for their actions (or inactions). That is also sad.
" Anything to show she just sat on her behind the whole time? "
The entire article.
Jesus said, "Judge not lest ye be judged".
I already know the flaws of the health care system from observation. It's a cobbled-together patchwork quilt if you're not wealthy enough to afford either a good insurance plan or out-of-pocket medical expenses.
And when the cold wind of ill health/job loss/disastrous accident blows, keeping warm under that tiny quilt with fragile seams can be an exercise in futility.
I could blame those without coverage until the cows come home and STILL the flaws of the system won't go away. But for those who've got theirs, and consider it due to their innate superiority, the system is just fine, peachy keen wonderful and they rant furiously at anything hinting of a change which might benefit others.
Still sad.
About that war........nada. Hmmmmm. Apparently it didn't cost you enough.
Jabberwocka
Pages