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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It seems to me the folks screaming the loudest are #1 younger and healthy,#2 have at this time no preexhisting conditions, #3 have not been refused to have any procedures paid for by their ins.#4 aren't paying several hundred dollars a month to cover their family and themselves.
I just read on the ADHD board about a young family who has a son with ADHD. The husband switched jobs. The Ins company will NOT cover his ADHD meds. It is they say a pre-exhisting condition.
If Obama does anything, he needs to take Ins companies to task on this pre-exhisting condition fiasco! Tell them point blank, they can't do it any longer, and they can't keep raising their rates!
My insurance company is regulated by the state. It does not do business in any other state but mine. BO has no business sticking his nose into state business. This should be an interesting legal fight.
Nope, don't work for the state.
My insurance premiums are paid out of pocket.
Your private insurance company has turned down hundreds of thousands of people for one reason or another. Think not that they wouldn't drop you or refuse you or a family member coverage if they thought they were going to lose a dime.
My partner is one with a pre-existing condition. One of his meds just went up to over $800 a month. (This doesen't count other meds, Dr. visits, regular
What I'd like to see is nonprofit healthcare. IMO healthcare
**Preventative care instead of letting something develop into a full blown illness.**
I went to college and studied Animal Science. This is the basic premise of Veterinary Medicine. We take better care of our FOOD than our people.
"For all the claims of "family values" and all the claims of "pro-life" and all the claims of "work ethic"
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