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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"A person who owns a boat and a pool (does he use the one in the other?!) would presumably consider his offspring more important than either. 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 conclusion 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 nor do first glances tell all."
My neighbor isn't secretive about his lifestyle choices. He has been advised by the local school system that one of his kids should be evaluated for possible ADD/ADHD. He hasn't done this because it would cost a lot of money that would come out of his own pocket due to the extremely high deductible he has on his health insurance. His boat is important to him. His son was bragging about how much fun the pool would be when it was being installed. These are not lifestyle choices I would make ....however this is America, which provides the freedom to make choices that others may not approve of. Yet he has expressed envy of the level of care my ADHD son gets and if we just had nationalized health care everyone would get the same level and wouldn't that be grand.
He's healthy enough to fish for himself, to provide the better care for his family. He elects not to. He would like my tax dollars to do this for him.
"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)."
My previous home repair man could have afforded health insurance, but it would have meant a less ambitious vacation. He wasn't a could not, he was a I don't wanna. Same with the one horse owner who elected to own two.
It's possible that his son may not be covered on his Ins. Ins companies really don't want to cover children who are ADD/ADHD. There is someone on the ADD/ADHD board who posted that since her DH changed jobs, the INS will not cover her childs ADD/ADHD
I very much doubt that you know as much about the particulars of either the repairman or the horse owner as you seem to think you do.
There was a pattern of erroneous assumptions and mischaracterizations with the Younts, also with information I shared about my own family (which I am far more likely to be privy to than a poster on a board).
Jabberwocka
The school system has recommended he be evaluated for ADD. As this has never been done he does not have an official diagnosis. We suggested he consider HUSKY for him, which in this state would have to insure him regardless of pre-existing condition ( which technically isn't a pre-existing condition). But it would cost him more money.
My kids are on Concerta. It is supposed to go generic, however there is presently a fight in court over this. Have never tried Adderal.
How sad. Many years ago, I asked a child psychiatrist if there was any reason to get a diagnosis of ADHD/ADD other than to treat with pharmacopoeia. He was quite agitated by the question and counterattacked by implying that any parent who considered an alternative was derelict in parental obligations. And now insurance companies are using the same rationale to drive up premiums, probably because they too presume that powerful drugs are the only recourse (which BTW, is far from true).
I too would be reluctant to add ADHD/ADD to the list of "pre-existing" conditions which are monitored by the insurance industry as though we're subversives intent on taking down their precious business. BTW, your wording in the earlier post was deceptive. It gave the impression that your neighbor chose between insurance and a pool/boat. Now you say that he has an extremely high deductible. And it would not surprise me at all to learn that the pool is seen as a physical outlet for the son's tendency towards high activity levels.
As regards "envy", "bragging", etc. I see no particular reason to take those as absolutely accurate descriptives. Too many times in the past there have been "inaccuracies" used in describing the thoughts and emotions of others.
Jabberwocka
I am almost struck speechless. While accountability for both politicians and programs certainly makes sense, the idea that others could be interrogated or that "they'd better be prepared for a lot of questions about their lifestyle choices" is worrisome in quite a few ways.
IF health care reform is passed and IF a more affordable way is found to provide quality care for all, then the "questioning" becomes moot. There won't be a need for others to hoard "theirs" and demand some sort of restitution or accounting for those who dare to choose differently.
Witchhunters will have to crawl back into their dank dark suspicious pits and gnaw on the bones of past hatreds.
Jabberwocka
"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."
Says a better policy, not no policy. He chose a crappy policy with a high deductible. Hopefully the swimming pool will prevent him from having to repeat a grade as was the case a few years back.
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