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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Avatar for claddagh49
iVillage Member
Registered: 07-20-2004
Wed, 06-17-2009 - 12:03pm

I agree with you 100% We really need to do something. Our congresscritters and Senate and President also need to grow a spine and tell these greedy Ins companies NO MORE! that they have to stop this out of control greed.

iVillage Member
Registered: 08-30-2002
Wed, 06-17-2009 - 12:17pm

***Pharma companies say they need to charge a lot for their drugs to keep up with R&D.***


As someone with a science background I do understand that R&D is expensive.


But a couple of years ago, when we ran into an insurance/med hang-up (this is when we looked into the PAP-patient access program), the Dr. was able to give us an entire months worth of free samples, that were sitting in his office.


When I shared this with my sis, she said "Well, someones getting ripped off somewhere."


I asked "What do you mean?"


She said "When you went to pick up his medication, it was going to be over $700, right? But the Dr. had over $700 worth of meds. sitting in his office that the pharma sales people had given him for nothing, right....? Somewhere, someone, is getting ripped off. Someone is paying over $700 in one window, while they are



iVillage Member
Registered: 03-18-2000
Wed, 06-17-2009 - 12:18pm

"Maybe this was why I was discharged less than 24 hours after my back surgery."


Makes sense. This happened to a friend/co-worker about 15+ years ago. Same as you she'd had back surgery & the doc. let it slip-out that's why she was being discharged.

 


Photobucket&nbs

iVillage Member
Registered: 03-03-2009
Wed, 06-17-2009 - 2:32pm

This is OLD (and semi-hysterical) stuff.

<>
https://eee.uci.edu/programs/humcore/students/huberpaper.htm

I guess there's no expiration date on whacko conspiracy theories.

Jabberwocka

iVillage Member
Registered: 02-19-2008
Wed, 06-17-2009 - 3:23pm

"Your private insurance company has turned down hundreds of thousands of people for one reason or another."

Please post the evidence of this statement.

Avatar for ddnlj
iVillage Member
Registered: 03-26-2003
Wed, 06-17-2009 - 3:28pm

Photo Sharing and Video Hosting at Photobucket
iVillage Member
Registered: 02-19-2008
Wed, 06-17-2009 - 4:04pm

" Which is why I support a healthcare system in this country that will be available to anyone who may need it."

Not I. I do not want to insure illegal immigrants. I don't want to insure immigrants who have sponsors that are supposed to do this (a la my neighbor.) I don't want to insure my neighbor who won't purchase a better policy for his kids because the expense may effect his ability to afford his boat and pool. I don't want to insure my former home repairman; he didn't want to buy health insurance due to expense but could afford a trip to Canada to ski down a glacier. I don't want to insure a poster on another board who, upon finding out it would cost a lot of money to buy an individual health insurance policy, said the heck with it and bought a second horse.

"While I may not need it right now, I'm not so arrogant as to believe that life is all rainbows and butterflies and that I might not need help at some point later on."

This statement is arrogant.

iVillage Member
Registered: 02-04-2004
Wed, 06-17-2009 - 4:23pm

Actually it's what you say that is outdated.

iVillage Member
Registered: 03-03-2009
Wed, 06-17-2009 - 5:49pm

I posted a link (not outdated) on the history of attitudes towards fluoride. Whacked out hysteria about purposes and side effects has been around for a long time.

So it came as no great surprise to see yet another campaign to try to whip up public fear.

Here's what the NRC/National Academies' site actually says:
Fluoride is one of the drinking water contaminants regulated by the U.S. Environmental Protection Agency (EPA). This report, Fluoride in Drinking Water: A Scientific Review of EPA’s Standards, evaluates the scientific basis of two of the agency's guidelines for fluoride and their adequacy for protecting public health. One of the guidelines is a health-based standard called the maximum contaminant level goal, which is designed to prevent the public from being exposed to harmful levels of fluoride. The other guideline, known as the secondary maximum contaminant level, is used to reduced the severity and occurrence of a cosmetic consequence (mottling of tooth enamel) of exposure to fluoride.

When I tried to download the actual report, my browser came back with a message that "the server at fermat.nap.edu is taking too long to respond." So I took another tack and went to the NSF Fact Sheet from February 2008 and thence to CDC links:
http://www.nsf.org/business/water_distribution
/pdf/NSF_Fact_Sheet.pdf
http://www.cdc.gov/fluoridation/
http://www.cdc.gov/fluoridation/safety/nrc_report.htm

I found nothing in any of those links to back the statement that "Americans can be harmed by fluoride - even at the low levels added to water supplies - specifically, thyroid and kidney patients, babies and high water drinkers" UNLESS added fluoride in conjunction with naturally occurring levels of fluoride push the total fluoride level above the NSF/ANSI Standard 60 levels.

I would have preferred to read the actual NRC report but for whatever reason, its download site isn't functional. In lieu, here is part of the CDC (Centers for Disease Control) statement:
<>
and
<This report is important for people living in areas with high concentrations of natural fluoride greater than 2 mg/L or 2 ppm. This represents approximately one half of one percent of the U.S. population. The EPA estimates that approximately 220,000 Americans receive water from public water systems with fluoride levels that are equal to or exceed 4 mg/L. The Committee concluded that people who consume water with this high fluoride content over a lifetime, when compared to people consuming water with 1 mg/L, are likely to be at increased risk for bone fractures. Another 1.4 million people in the United States drink water from community water supplies that have a natural fluoride level ranging from 2.0 mg/L to 3.9 mg/L. The Committee found that water at 2 mg/L or greater may put children 8 years old and younger at increased risk for severe enamel fluorosis, a condition that causes staining and pitting of the enamel surface of teeth. In communities with fluoride levels greater than 2 mg/L, CDC recommends that parents and caregivers of children 8 years and younger should provide children with drinking water from an alternative water source. At levels less than 2 mg/L (equivalent to 2 ppm), the committee found that the prevalence of severe enamel fluorosis was very low (near zero).
The findings of the NRC report are consistent with CDC’s assessment that water is safe and healthy at the levels used for water fluoridation (0.7–1.2 mg/L). CDC reviews the latest scientific literature on an ongoing basis and maintains an active national community water fluoridation quality assurance program. CDC promotes research on the topic of fluoride and its effect on the public’s health. CDC’s recommendation remains the same—that community water fluoridation is safe and effective for preventing tooth decay. Water fluoridation should be continued in communities currently fluoridating and extended to those without fluoridation.>>
http://www.cdc.gov/fluoridation/safety/nrc_report.htm

Old bugaboo, new form, same scare tactics of innuendo, half truth, and seemingly deliberate disinformation/misinformation. Sorry, but the fluoride sky isn't falling.

Jabberwocka

iVillage Member
Registered: 03-03-2009
Wed, 06-17-2009 - 6:29pm

Since empathy and fellow-feeling don't seem to be major considerations in tackling the issue of affordable health care, let's look at the issue in terms of "your" dollars and cents.

When an otherwise productive individual cannot work because of a health condition which he or she could not afford to prevent or resolve, he or she cannot contribute to the nation economically (both in taxes and in goods/services). That person also becomes a tax liability in terms of social programs. I suppose "pure" capitalists would suggest that relatives or friends could be expected to provide. In some cases they can, but in others they cannot. And when they cannot, "your taxdollars" are expended unless you think it better for that individual to starve/freeze or do away with self. Think of it as a variation of the man fishing metaphor. If he's healthy enough to fish for himself, he can feed himself.

A person who owns a boat and a pool (does he use the one in the other?!) would presumably still consider his offspring more important than either boat or pool. Do you know his situation in its entirety? In my opinion, it's presumptuous and premature to make judgments without fully knowing the facts. Given past jumps to erroneous conclusions in this thread, I daresay that only part of the story is known or being told in all of the examples given. Life isn't Manichean ("good" or "bad") nor do first glances tell all.

And I don't agree with your OPINION of DDNLJ's sentence.

Edited to correct a misspelling and clarify sentences.




Edited 6/17/2009 8:21 pm ET by jabberwocka

Jabberwocka

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