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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Yep, they must however be residents of the state of California. Maggie has been occupying space there for a year.
Feel free to give them a call.
She does not qualify for the healthcare plan of her choosing. Her brilliant idea is to be "very, very careful about everything". So when she eventually requires medical care she will be sponging off the taxpayers, unless they get wise and tell Mr Yount to start acting like a responsible sponsor and pay for her healthcare. Who knows, with California's current budget problems they just might.
Eh? Look at the words you quoted from my earlier post--the very first adjective was "affordable". Here's a definition, courtesy of Merriam Webster:
< af·ford
Pronunciation:
\ə-ˈfȯrd\
Function:
transitive verb
Etymology:
Middle English aforthen, from Old English geforthian to carry out, from ge-, perfective prefix + forthian to carry out, from forth — more at co-, forth
Date:
14th century
1 a: to manage to bear without serious detriment b: to be able to bear the cost of 2: to make available, give forth, or provide naturally or inevitably
— af·ford·abil·i·ty \-ˌfȯr-də-ˈbi-lə-tē\ noun
— af·ford·able \-ˈfȯr-də-bəl\ adjective
— af·ford·ably \ə-ˈfȯr-də-blē\ adverb >>
At one time, the AMA didn't carry the clout to restrict supply of practitioners and thus ensure huge salaries to medical doctors. They got greedy, costs went higher, the concept of medical insurance was devised, and now we wind up paying for both. Shame on us.
Also strange that you're now pointing out how expensive medical care can be--after railing about a woman's inability to get insurance (which she couldn't really control aside from the feeble notion that she should never have immigrated to the United States in the first place; she SHOULD have known about the primitive state of our health care system).
Some words of advice: Be careful about being too smug and self-satisfied. Those who think that things will always go their way because they're innately superior, suffer from an affliction of the psyche called "hubris" (See: Bush, Cheney, Rumsfeld, Wolfowitz, etc.)
The Greeks believed that their gods would smite such arrogance--and almost invariably something did arise which punctured the hot-air balloon of complacency. IMHO, the gods had nothing to do with such punctures. Life has a way of dealing out adversity to all of us in ways for which we are not always ready or prepared.
Humility is a more desirable trait. "There, but for the grace of God, go I" ought to be a regular reflection for all of us; rather than "I got mine, and nobody's gonna take it away except from my cold dead hands".
Jabberwocka
I don't think the 800 number will work here, but I emailed out of curiosity (not doubting you :)
~So when she eventually requires medical care she will be sponging off the taxpayers~
Who says that they won't incur the cost themselves?
I do not believe Maggie's and her husband's irresponsible behavior needs to be supported by taxpayers. Please stop repeating the falsehood about an ability to get insurance (though she is in need of coverage) .... I have posted several options here and nowhere does this article indicate she has pursued any of them. Personally I find it very arrogant to immigrate to another country without looking into matters such as healthcare, then whine that the country that you chose to move to doesn't feel obligated to alter their ways to accomodate your decision to move to it.
Falsehood? Did you READ your own link? I quote from it:
"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."
Yes, you've come up with several options which you think MIGHT be available to Maggie. There's a huge gap between possible and certain--but not surprisingly, you've already decided and rendered judgment. Pay no attention to specifics and facts when they might not result in the desired outcome.
And yes, you've made it abundantly clear how you feel about the woman and others like her. I wonder if you will ever be subjected to the same sort of harsh judgment. What goes around, comes around.
As far as "whining", the phrase about taxpayers supporting a person/program of which you do not personally approve, sounds mighty like......well....., whining.
Jabberwocka
You're attempting (unsuccessfully) to separate "coverage" from "insurance". There's no difference. There is a high-risk pool--but it's still insurance "coverage". Here's more info on it:
"Those lucky enough to be offered MRMIP enrollment will find high, often unaffordable, premiums, and limited coverage. One-third of MRMIP subscribers pay more than $8,300 annually for their insurance, with 10 percent paying more than $10,080 a year. Unlike insurance through an employer, this cost is fully paid with after-tax dollars by the individual."
BTW, it sounds like that high-risk pool is subsidized:
".....the state only helps with medical costs up to $75,000 per year"
http://www.mrmib.ca.gov/MRMIB/Unavailable_at_Any_Price_MRMIP_Report-AARP.pdf
(for both above quotes)
Given posts about the "preborn" and the righteous sense of justice at Dr. Tiller's murder ("killer killed"), it's absolutely confounding to read:
"Who sponsored this non-able bodied person into this country? Why should the taxpayers of California be responsible for the lifestyle choices of Mr Yount".
Seemingly, at the same time, you want the state/taxpayers to restrict/eliminate Mrs. Yount's procreation choices (hey, what if Maggie gets pregnant--are you OK with prenatal and birth care or does she just have to shift for herself on that one too?).
One can only marvel at the disconnect and lack of consistency. The non-sentient deserve protections but the fully sentient had damn well better be able to manage regardless of life's slings and arrows? Amazing, absolutely amazing.
I wish Maggie well. May her tenacity and will-to-live outlast the sanctimonious, the self-absorbed, and the hypocritical.
It would be wise to pray fervently that neither you nor any of your loved ones ever get sick/badly-injured; and in need of resources beyond your immediate ability to provide. There might be just as much compassion as you're showing Maggie.
Edited to insert a quotation mark and add a paragraph.
Edited 6/5/2009 9:38 pm ET by jabberwocka
Jabberwocka
"I wish Maggie well. May her tenacity and will-to-live outlast the sanctimonious, the self-absorbed, and the hypocritical"
Then please feel free to purchase her health insurance/coverage for her. Or give her sponsor the KITA he deserves.
***Depeands on your view, I guess. I see Maggie and her DH as two people who need to step up to the plate and assume some responsibility for themselves***
I see that they were doing that when she applied for insurance in the first place, only to be rejected by Antem Blue Cross, one of the companies on the state high risk pool. Looks to me like Anthem BC is padding their own pockets by rejecting people and forcing them
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