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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Yes, I read this and Obama and the rest of them on Capitol Hill have to stop this sort of greed driven thing the Ins companies do PRONTO! I wanted to tell my local represenative this last night on the phone. I get a call to participate at least once a month, to participate in discussions about the economy,etc but it always comes while we are eating dinner! ARRGH!
I wonder just how many thousand of the uninsured out there who could afford ins, but were denied because of pre-exhisting conditions. Instead of taking over the banks which unfortunately needed to be done, the Government needs to control the Health ins companies! they need to STOP their crapola!
There is no dispute that too much fluoride damages bones.
Apparently you are in the minority.
In my opinion, private insurance companies do very little to enhance health care. We don't need them, we need affordable, accessible, and high-quality medical/health care. Whether that translates into a single provider system or whether it means that the AMA's stranglehold is broken and an increased supply of health care providers become part of the marketplace (I'd prefer the latter), insurance is unnecessary as part of the solution.
Nor am I the only person who is concerned about costs, coverage, and reform. A University of Michigan* study came out just yesterday:
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In the survey, nearly one in four people said they feared of losing coverage in the next year. About the same number reported that they or a family member delayed seeing a doctor in the past year because of what it might cost.
The poll, released Wednesday, was conducted by the University of Michigan to measure consumer confidence in the health care system. The study was financed by the Robert Wood Johnson Foundation, a health care philanthropic organization.
In its measure of consumer confidence about insurance coverage and access to care, the poll found a drop of 1.3 points from April to May. The confidence index, which the pollster and foundation officials initiated in May, was fixed at 100 points and dropped to 98.7. The index will be tracked and released monthly.
The poll comes as lawmakers in Washington consider a sweeping overhaul of the nation's health care system — a top legislative priority for President Barack Obama. More than three in four people, 86 percent, said they viewed health care reform as an integral part of tackling the nation's economic crisis, the survey said.
Overall, 46 percent of those polled worried they would not be able to afford health care in the future. In February, the government estimated that health care costs this year would average $8,160 for every man, woman and child in the U.S. — an increase of $356 per person from 2008.
Concerns about losing insurance coverage in the next year were reported by 24 percent of those surveyed. The biggest group fearing such a loss were between 50 and 64 years old, and more women than men fretted about losing their health insurance.
"As the economy continues to falter, health care insecurity is becoming an even greater issue," said Risa Lavizzo-Mourey, president and chief executive of the foundation, which provides extensive financing for health care research.
It's estimated that nearly 50 million Americans are uninsured. The Senate this week took the first major step toward an overhaul as the Senate Health, Education, Labor and Pensions Committee began drafting legislation to revamp the health care system.
The Senate measure would cost about $1 trillion over 10 years but leave 37 million people uninsured, according to an analysis from the nonpartisan Congressional Budget Office.
One of the brighter notes in the foundation poll: Eighty-six percent of people reported receiving quality health care — described as either good, very good or excellent. A higher number, 88 percent, had health insurance.
The telephone survey of more than 500 people had a margin of error of plus or minus 4.3 percentage points.>>
http://tinyurl.com/lp394c
*U of M has an excellent reputation for rigorous polling standards and methodology.
Jabberwocka
***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.****
Most likely, he wouldn't even if it was paid for through national health care. This sounds more like a parent that doesen't want to put the time or energy towards dealing with the issue and "cost" is the convenient excuse. I have similiar friends who didn't do testing on their child either. They HAD insurance with low deductibles that would pay for it. Their priorities were different. They felt their family benefitted more by taking a cool vacation every year, going to the mall on weekends,
***I wonder just how many thousand of the uninsured out there who could afford ins, but were denied because of pre-exhisting conditions.****
I know that my partner would LOVE,LOVE, LOVE, LOVE to be able to get affordable insurance. He would LOVE to be able to start putting money towards retirement every year, which is the right and responsible thing to do, instead of worrying that his assets will kick
"Yes, but in many cases it can be a life long medical condition, ADD/ADHD as bi-polar is. When you children get older and get jobs and fill out medical/ins forms, they will HAVE to list ADD/ADHD on that form! Whether or not they are still being treated for it."
It is a lifelong medical condition. What would you have them do? Lie? That's why I purchased the adult policies with this listed .
"We can no longer stand ididly by and let Insurance companies run things, run our lives, because they certainly are now!"
Since the alternative is da gubamint, I think I'll stick with my current plan.
The "fishing" is metaphorical, not literal. I used a variation of the old analogy about teaching a man to fish, versus giving him a fish. I referred to being healthy enough to fish (make a living and take care of family/self).
This is how the other poster was describing the man in question:
"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. "
Some parents feel that using potent (and expensive) drugs to treat the hyperactivity of ADHD is not the way to go and try to find other outlets for the energy of the child. Wouldn't surprise me at all to learn that such was the case.
In any event, it's all supposition since NONE of us know the intimate details of the man, the child, the family.
Jabberwocka
Well, at least the sensationalism level is dropping.
You are free to make choices for yourself. Use bottled water if you like or drill a well (which will certainly eliminate fluoride supplementation in your water).
I don't at all like attempts to jerk strings by using half truths, manipulated "facts" and breathless calls to "get fluoride out of the water" as though the majority of the population is adversely affected by its presence.
IF the issue is truly of import, ALL the facts will be sufficient to make your case. Otherwise, you risk the same outcome as the boy who cried wolf or the president who ranted about WMD and "mushroom clouds".
Jabberwocka
What is da gubamint?
Her way of saying "the government."
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