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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""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, you want the state/taxpayers to restrict Mrs. Yount's procreation choices."
I don't know how you got that.
***Since she applied for insurance in the first place my guess is she wasn't planning upon paying for treatment herself.****
So you admit to having insurance yourself, right? So does this mean you are also "not planning on paying for treatment" and "sponging of others?" Or are you exempt because you are
Sorry, can't afford it. DH and I are paying well over $15,000 to the insurance companies now in premiums for health care we're not using.
It's long past time to take insurance companies out of the loop. They haven't held down prices, they haven't provided universal coverage, the only thing they've done well is serve their own bottom line by refusing to cover people like Maggie. I would be glad to give them a KITA.
As for your other suggestion, it doesn't surprise me but I don't share your OPINION. Instead, I repeat my good wishes for the Younts' health and prosperity. May they confound the naysayers.
Jabberwocka
"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."
And after that, they did what?
" Looks to me like Anthem BC is padding their own pockets by rejecting people and forcing them to go into a government subsidized pool of higher rate insurance."
Anthem is a private company. Their business if they're padding their pockets. But it seems unlikely if the California high-risk pool is anything like my state's. They run it here, and it's a money-loser for them.
"As I see it they were "stepping up to the plate" by seeking out insurance they expected to pay out of pocket for in the first place. So your point is invalid."
I don't see it that way. I see people who sought out insurance at a rate of payment they wanted to pay. When it wasn't forthcoming, they have decided to be really careful. And complain America isn't Canada.
"So you admit to having insurance yourself, right? "
I always though that it was extremely foolish to be without it.
" So does this mean you are also "not planning on paying for treatment" and "sponging of others?"
If I had several million dollars sitting in the bank I might not have insurance as I could pay cash for my own medical care. I do not. I purhcase private insurance that will pay that several million.
" Isn't that the whole point of insurance, to cover medical costs?"
Yes, taht's why I buy it.
" Does this mean that EVERYONE who buys insurance isn't planning on paying for treatment and is sponging?"
People who buy insurance purchase it to provide means to pay their medical bills. Maggie at present isn't buying it. If her brilliant plan to be real careful doesn't work and she incurs medical cost who is going to pay them? If the Younts pay their own bills no problem. But if they have so much money they can afford that then why be concerned with insurance. Someone pointed out once that it isn't likely Bill Gates even carries health insurance. Since I doubt the Younts have this much cash if they run up big medical bills they will not be able to pay them, thus the bills will be passed on to the taxpayer. That is sponging.
Well I can' afford it either. Nor can the citizenry of California.
"As for your other suggestion, it doesn't surprise me but I don't share your OPINION. Instead, I repeat my good wishes for the Younts' health and prosperity. May they confound the naysayers."
As long as they do it their own dime have at it.
Hm.
After cogitating about this issue a bit further, I have come to the conclusion that emergency room staff and EMT personnel should be actively discouraged from performing extraordinary measures in dealing with victims of accidents or unexpected illness.
After all, those people MIGHT not be insured. And if they're not then those victims/patients who are not insured will be a drain on the rest of us.
In other words, unless they can "do it on their own dime" (and that fact has to be ascertained before any costly medical care has been given) they should not receive any care which would cost money.
WHERE a person comes from previously, say Canada, isn't logically a salient factor at all.
At the end of the day, that's the most cost effective way to approach health care. Whether lives and bodies are ruined......
Jabberwocka
They appear to be trying to take care of themselves.
The writer chose to write about Maggie. If he had chosen to do so he could have written about one of these Americans that are allegedly so prevalent. He did not.
If you have another story like Maggie's feel free to post it. However my take on it most likely would be much the same.
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