Down and Out in San Diego
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| 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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***I could blame those without coverage until the cows come home and STILL the flaws of the system won't go away.***
Very true.
Bingo. '....there are those that think if someone else "gets theirs" then that must mean they have to "lose theirs." Maybe because that's how they "got theirs" in the first place?'
I am so sorry for your SIL and the horrible way she suffered. My mother died of breast cancer which metastasized through her body.
Many people don't realize that COBRA means a laid-off worker can retain a health insurance policy only by paying the monthly premiums in full. Darn expensive. Particularly when you have no job!
Jabberwocka
"Many people don't realize that COBRA means a laid-off worker can retain a health insurance policy only by paying the monthly premiums in full. Darn expensive. Particularly when you have no job!"
Known that for years. I had to do it myself.
"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."
Which might benefit others .... you can't even come up with a plan to pay for this plan. My private insurance company, for all its faults, has managed to do this.
Many, many more CANNOT get healthcare for one reason or another.
Then why are looking towards the US Government?
As I've stated ad nauseum before, I forsee a combo of both.
Though this is somewhat OT, this is an obit. for a local Dr. that started the first low income clinic in our area. I have highlighted his words that speak to this matter we are discussing. He is a true healer. His death a great loss to our community. I credit him with saving my daughters hearing, when she was a lowly "Healthy Families" child.
http://www.theunion.com/article/20090616/NEWS/906159977/1066&ParentProfile=1053
Merely mention Dr. Glaister “Dee” Dawkins and the glowing tributes flow for the beloved physician who died unexpectedly June 8 after a short bout with cancer at age 76.
“He didn't judge people for what they had, color, religion or anything else,” said Aileen Robinson, a 25-year patient of Dawkins. “He just took care of them, because that was his nature.”
At a memorial service set for 6:30 p.m. June 30, more accolades for the physician, fisherman and humanitarian will undoubtedly fill the First Baptist Church in Grass Valley, of which he was a member.
“Dee would approve of a 6:30 p.m. memorial,” said Steve Star, a physician's assistant who worked with him at the former Miners Clinic for 20 years. “He wouldn't have approved of it at 9 a.m. because we would have to shut the clinic down.
“He was always there for poor people in Nevada County,” Star said. “He was concerned about people getting good health care regardless of their income or health insurance status.”
“The dude was a saint,” said Dr. Scott Kellermann, who helped Dawkins start the Miners Clinic in the mid-1980s and worked with him for 28 years. “He had all the good qualities, including humility.
“He was a good fishing buddy, and he never let up. That was his legacy,” Kellermann said. “There are a few persons in life who make you a better person, and Dee was one of them.”
Dawkins was born in May Pen, Jamaica, in 1933.
“Nobody wanted to be a doctor more then he did since he was a young boy,” said Callie Dawkins, his wife of almost 37 years.
“He always felt everyone deserved the same kind of care. He always said, with a little twist of fate, any of us could get in trouble,” Mrs. Dawkins said. “When others weren't seeing Medicare and MediCal patients, he was.”
To get through Howard University Medical School in Washington, D.C., Dawkins drove a cab and built his business into a fleet.
Later, he earned a master's degree in business administration from St. Mary's School of Business.
He met his wife after setting up shop in Riverside County.
“He was the only one delivering babies in Riverside County, in this huge community, and he was always on call and decided that was enough,” Mrs. Dawkins said. “We were looking to the Midwest, and somebody in my family said, ‘You should look at Grass Valley.'”
They moved to the Nevada County foothills in October 1975.
When he saw how many indigent patients were using the emergency room for all kinds of care, he started Sierra Care Physicians and later, Miners Clinic.
“He took care of some of the richest people in town and he took care of some of the poorest,” Mrs. Dawkins said.
“He went to see his convalescent patients when he could barely walk,” back in March, Mrs. Dawkins said. “I think he packed a couple of lifetimes into his life.”
“When we found out in May he had cancer, I was in shock,” said Robinson. “The last day I saw him, he was in so much pain, but he walked in with a big smile.”
The deceased doctor was active in Rotary International, was a board member for Big Brothers Big Sisters, and served on the board of Catholic Healthcare West, which owns Sierra Nevada Memorial Hospital.
Dawkins served on the Grass Valley hospital's staff and was medical director of its transitional unit and the Meadow View Manor Convalescent Hospital.
Huh? "A plan to pay for this plan"? Are you referring to a way in which there would be financial viability for an alternative to this current sick system? I have a whole slew of ideas, if that's the case.
BTW, your private insurance plan will pick and choose who it does cover, and what sort of rate its customers will pay. That company is in business to make money. So the pool of customers which it allows are there NOT TO GET QUALITY HEALTH CARE, as the primary goal, but to ensure a profit for the insurance company. And that's the major fault of all for-profit insurance plans.
Pool risks after eliminating the highest ones (like Maggie Yount) and then make sure that you have a significant number of low-risk customers paying premiums which will certainly cover their own care as well as that of the higher risk subscribers. Charge more of the higher risk subscribers so they cover their own costs AND have some left over. Sure-fire recipe for making a "healthy" (pun intended) profit. And not too far removed from a Ponzi scheme.
As insurance companies become increasingly choosy about who they'll allow (since both health care providers and the insurance companies are looking to make money), the number of applicants who don't qualify by virtue of excellent health and/or ability to pay increasingly expensive premiums, that is, the number of people who have little or no safety net, becomes even greater.
The current system may serve a select few well (those currently at the top of the pyramid), but do an indifferent job of serving the vast majority. The system does a TERRIBLE job of serving those with unanticipated health care needs or financially imperiled living conditions--and in a recession there are LOTS of people in that latter category.
Easy to see why the select few would kick up a fuss. BTW, I'm in that group which can afford the premiums and enjoys generally good health. But I know many who struggle and ALL of us are only one accident, one chronic disease, one income loss away from experiencing the caprice and greed of for-profit-insurance.
Jabberwocka
Fluoride in your water? GET IT OUT
New York – June 17 -- Water suppliers nationwide, in the US, are required to supply consumers with annual Water Quality Reports or Consumer Confidence Reports at least once a year at around this time.
“Consumers should take this yearly opportunity to check their water fluoride levels,” says attorney Paul Beeber, President, New York State Coalition Opposed to Fluoridation, Inc. "If your water department adds fluoride chemicals, tell them and your legislators to stop. They are wasting your money and endangering your health," says Beeber.
“If your water is not fluoridated, don’t be complacent. The American Dental Association has mobilized their army of dentists nationwide to go to your legislators and convince them that you need to swallow more fluoride (a) without any knowledge of how much fluoride you are already ingesting,” says Beeber
Dental fluorosis (discolored teeth), the visible sign of fluoride overdose, now afflicts up 48% of school children, reports the CDC.
Fluoride's purported benefits are topical but its risks are systemic, says the CDC. "This means there is no good reason to swallow fluoride and no logical justification for water fluoridation," says Beeber.
A 2006 review of peer-reviewed studies in respected journals by the prestigious National Research Council (NRC) reveals fluoride is a health risk even at low levels added to water supplies. Especially harmed are high-water drinkers, babies, kidney and thyroid patients. The NRC panel found that fluoride’s links to cancer and lowered IQ are plausible.
Because of the NRC report, the CDC and the American Dental Association both advise that infant formula should NOT be mixed with fluoridated water.
The NRC report also caused the National Kidney Foundation to advise that “Individuals with CKD should be notified of the potential risk of fluoride exposure.” Too much fluoride damages bones and malfunctioning kidneys do not excrete fluoride properly allowing a toxic build-up in the bones.
Besides, fluoride ingestion is not stopping tooth decay in primary teeth.
According to a systematic review of fluoride supplement research published in the November 2008 Journal of the American Dental Association, "There is weak and inconsistent evidence that the use of fluoride supplements prevents dental caries in primary teeth." In fact, the authors could find only one study, from China, showing any fluoride benefit to primary teeth and that study was probably biased with a high withdrawal rate, the authors write.
Fluoride supplements never underwent FDA testing.(1)
"Fluoridation began with the untested belief that ingested fluoride prevented tooth decay in small children, only. Evidence-based-dentistry now shows that swallowing fluoride poses dental risks without benefits to the very children fluoridation was supposed to help," says Beeber
"It may...be that fluoridation of drinking water does not have a strong
protective effect against early childhood caries (cavities) reports
dentist Howard Pollick, University of California, and colleagues, in
the Winter 2003 Journal of Public Health Dentistry.
Beeber advises: Call your water department, ask if fluoride chemicals are added into your water supply. Then ask them and your local legislators, “Who has the authority to stop fluoridation?” Organize your neighbors to lobby the appropriate agency or department to have them cease fluoridation. You will be saving your community money and improving overall health with no increased dental risk. In fact, many studies show that when fluoridation ends, tooth decay rates actually go down or stay the same.
Fluoride does occur naturally in most water systems. But over 90% of fluoridating communities use silicofluorides, waste products of phosphate fertilizer production, which carry trace amounts of lead, arsenic, mercury and other toxins, according to NSF International, the governing body over water additives.(2)
Opposition to fluoridation is scientific, respectable and growing in numbers and political popularity.
On November 4, 2008, 53 US cities rejected fluoridation joining a growing list of communities saying "No" to fluoridation.
Dr. Joey Hensley, a respected practicing physician serving in the Tennessee legislature, urges all Tennessee Water Districts to stop fluoridation. At least 31 Tennessee water districts have already complied.
Over 2,500 professionals signed a statement urging the US Congress to stop water fluoridation until Congressional hearings are conducted, citing scientific evidence that fluoridation, long promoted to fight tooth decay, is ineffective and has serious health risks. See statement: http://www.fluorideaction.org/statement.august.2007.html
Also, 11 Environmental Protection Agency unions, representing over 7000 environmental and public health professionals, called for a moratorium on drinking water fluoridation programs across the country, and have asked EPA management to recognize fluoride as posing a serious risk of causing cancer in people. (3)
Fluoridation is now a political issue usually defended and promoted, without valid science, by organized dentistry and their members in federal and state health departments as well as those in private practice.
For more information on fluoride's adverse health effects, visit the Fluoride Action Network Health Page at http://www.FluorideAction.Net/health
Join the 21,000 Americans calling on Congress to stop fluoridation here: http://congress.FluorideAction.Net
References:
a) http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3589
1) August 2000 letter from NJ Assemblyman Kelly to Senator Robert Smith http://www.fluoridealert.org/fda.htm
2) www.nsf.org/business/water_distribution/pdf/NSF_Fact_Sheet.pdf
3) Press Release August 19, 2005, “EPA Unions Call for Nationwide Moratorium on Fluoridation, Congressional Hearing on Adverse Effects, Youth Cancer Cover Up,” Contact: Dr. William Hirzy, Vice-President NTEU Chapter 280
http://www2.fluoridealert.org/Alert/United-States/National/EPA-unions-call-for-moratorium-on-fluoride-in-drinking-water
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