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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"They appear to be trying to take care of themselves. However, if she is constantly being denied on a flimsy 'pre-existing conditions' excuse (and believe me, the insurance companies will use that whenever & wherever possible), what's she supposed to do?"
Apply for the high risk pool.
Yes, those without insurance could be compelled to wear some distinguishing feature--maybe a yellow star or a black cross. That way those who "deserve" care could be distinguished from those who clearly did not have the foresight they should and without whom society would be much better off.
I was being facetious. The notion that only those with insurance should be given access to medical care is the natural outcome of a system which puts ability to pay above need. Even if "most Americans" have insurance, the number of those who have lost coverage along with jobs (you do know about the recession and unemployment at 9.5%, right?), translates into millions without coverage. See: http://www.nchc.org/facts/coverage.shtml Exactly how many millions don't have insurance is a subject for defensive posturing and spinning (primarily from insurers and talking-head "I got mine" conservatives).
The current approach makes about as much sense as debtors prison made in Dickensian England. Those who are NOT able to access quality care, particularly for traumatic, chronic, or degenerative conditions, have little likelihood of contributing to society, particularly if they've been refused access to care because they've been refused insurance based on a pre-existing condition (an abundantly clear Catch 22).
The same cold-hearted and blatantly immoral mindset would dictate that such individuals should be refused treatment--and encouraged to die ASAP so as to avoid becoming a drain on taxpayers. Is that what you want?
The high risk-pool, to which you referred as "coverage", has a waiting list and even when those who have applied are allowed to join, there are still drawbacks (which I pointed out in an earlier post). And the state of California apparently subsidizes THAT too, at least to the limit of $75,000.
Face it. The system we have is fatally flawed and getting worse. Time to euthanize the system itself and find something more tuned to the needs of all people. Life (which presumably doesn't mean chronic illness/disease/poor health), liberty, and the pursuit of happiness. Remember?
Edited to correct a mis-spelling.
Edited 6/7/2009 10:07 pm ET by jabberwocka
Jabberwocka
"The current approach makes about as much sense as debtors prison made in Dickensian England. Those who are NOT able to access quality care, particularly for traumatic, chronic, or degenerative conditions, have little likelihood of contributing to society, particularly if they've been refused access to care because they've been refused insurance based on a pre-existing condition (an abundantly clear Catch 22)."
Maggie has not been refused access to care, nor refused all insurance. She has been refused the insurance she thinks she's entitled to.
"The same cold-hearted and blatantly immoral mindset would dictate that such individuals should be refused treatment--and encouraged to die ASAP so as to avoid becoming a drain on taxpayers. Is that what you want?"
Happens in countries with single-payer, socialized medicine all the time.
"The high risk-pool, to which you referred as "coverage", has a waiting list and even when those who have applied are allowed to join, there are still drawbacks (which I pointed out in an earlier post). And the state of California apparently subsidizes THAT too, at least to the limit of $75,000."
So now you have what you want, a state program. Yet you are still complaining. Why would I want to give government control over my health care when they can't even manage a high-risk pool?
Wrong. "Entitled" to insurance? Where did you get that?! Your own link (which apparently you did not read very carefully before posting) says otherwise:
"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."
There is nothing in that paragraph which indicates a sense of entitlement though I quite understand that it's easier for system supporters to blame its victims rather than acknowledge the system's huge flaws.
My daughter lived in Sweden. They have a "single-payer, socialized system". She says it works quite well. By all means, prove your assertion that hastening the demise of an ill or seriously injured person through refusal of services, "happens all the time".
I didn't complain about the subsidy of the high-risk pool, only pointed out that it was, in fact, subsidized. The reason the high risk pool* is not working well is because it's underfunded and because medical care is still horribly expensive (thanks, as I've pointed out before, to the fact that the insurance industry has managed to make a profit not by cutting out waste or by putting a limit on fees for services, but by refusing to cover patients whose care is deemed too costly).
*I posted a link which gave more information about that pool. Did you read it? Here it is AGAIN: http://www.mrmib.ca.gov/MRMIB/Unavailable_at_Any_Price_MRMIP_Report-AARP.pdf
Jabberwocka
"Wrong. "Entitled" to insurance? Where did you get that?! Your own link (which apparently you did not read very carefully before posting) says otherwise:
"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."
Yes, she applied for that policy, plus one other one. After being rejected, she has elected not to apply for the high-risk pool, only to complain about how bad the American health care system is and how wonderful Canada is (while sitting in America.)
"My daughter lived in Sweden. They have a "single-payer, socialized system". She says it works quite well. By all means, prove your assertion that hastening the demise of an ill or seriously injured person through refusal of services, "happens all the time".
Is she still residing there?
http://www.physorg.com/news96567339.html
http://www.telegraph.co.uk/health/healthnews/5299490/Cancer-doctors-do-not-tell-patients-about-drugs-which-could-prolong-lives.html
http://www.biggovhealth.org/resource/case-study-united-kingdom/
http://www.biggovhealth.org/resource/case-study-canada/
http://www.findingdulcinea.com/news/health/July-August-08/British-Cancer-Patients-Denied-Costly-Drugs.html
http://74.125.47.132/search?q=cache:OFtZl-R0vHYJ:www.jpands.org/vol13no1/larson.pdf+swedish+health+care+denial+of+treatment&cd=9&hl=en&ct=clnk&gl=us&client=opera
There is nothing in the OP to indicate that Yount refused to apply for the high-risk pool. Even if she applies to the high risk pool, she won't get insurance until accepted for participation. And the OP says nothing one way or the other about whether Yount applied for that program.
No, my daughter and her husband do not currently live in Sweden. They came back last August and are dealing with the flawed system the U.S. is saddled with. DD had an ingrown toenail which became infected at the beginning of the year and she didn't want to see a doctor because their plan deductible was so high that surgery and antibiotic treatment would basically wind up being paid out of pocket. It was a cost which they hadn't anticipated and didn't want to incur because they had just bought their first house in December. I pointed out to DD that losing a toe, or even her foot, would be far worse and ultimately costly, than taking care of the toenail. DD wants to know why doctors can't guarantee their work, since she recently had a recurrence of inflammation even after having surgery in January. I'd like to know that too, since health care customers pay so much for both insurance and out-of-pocket expenses.
Jabberwocka
I've seen assumptions and jumping to conclusions before in the "blame the victim" set. Armed with time, money, technology/information and hindsight, they make judgments about those who haven't demonstrated the same level of perspicacity and obvious superiority.
Walking a mile in someone else's shoes has never occurred to them because they don't particularly WANT to consider life from any other perspective. Hubris again. Manichean again. Cruel again.
Jabberwocka
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