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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"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."
Nothing in the article said she did apply. Her current plan is to be very careful from now on.
"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."
So let's see .... they elected to utilize a plan with a high deductible. They then chose to avoid paying the deductible by not seeking medical care. They didn't wish to incur this expense because they chose to buy a house.
Your DD was able to purchase inexpensive, high-deductible insurance to help facilitate the purchase of a home. In a one size fits all health care model, she may not have been able to purchase a home. Do you think that would be better?
" 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."
You, IMHO, are absolutely correct.
"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."
Professionals generally do not guarantee outcomes. A doctor is expected to work within reasonable and accepted practice rules.
"Apparently we would have this information via our psychic powers or crystal ball or a general knowing, those who cannot acquire insurance, glean osmotically."
I didn't need a crystal ball or psychic powers to get this knowledge ... I used this new-fangled thingy called Google.
Huh? I cannot see how you can arrive at the conclusion that my "DD was able to purchase inexpensive*, high-deductible insurance** to help facilitate the purchase of a home. In a one size fits all health care model, she may not have been able to purchase a home."
They were able to purchase their first house because they saved religiously while overseas; and subsequently looked at and chose a smaller (and less expensive) house than what they were told they could afford on their income. They searched long, haggled hard, and found a house which needs work they didn't anticipate even with careful inspection by DD, SIL and a licensed home inspector. My DD has a frugal streak and wants her hard-earned money to count, so I completely understand all her feelings even if they sometimes make me sweat bullets about possible misplaced priorities.
Guess what else. In Sweden, many people own two places; a summer cottage and a town home or apartment.
I don't know how many professionals you have occasion to hire and/or work with. My DH is a professional engineer (P.E.) and he has to stand behind the designs and plans he and his company generate. Doctors gripe about malpractice insurance and claim that "frivolous" lawsuits are causing them to be unable to practice. IMHO, if they were more humble about their abilities (in general terms) and expressed a willingness to guarantee their work (which, BTW, some hospitals have begun to do), they MIGHT conceivably be able to justify the prices they charge. For too many years, medical doctors have been high-handed, not just high-priced.
*The insurance plan they have is NOT "inexpensive", it just was a bit less expensive than those with lower deductibles. All comparative, eh?
**A thousand dollars is a big chunk of change to a young couple like the Younts and my DD/SIL.
Jabberwocka
The "new-fangled thingy called Google" won't work without a computer and internet access. Many older people are unfamiliar with the technology and don't realize how useful the investment of money and time can be--provided they can afford either. Some can't, you know.
People who are sick/disabled and don't have a computer of their own may not be able to get to a library (if their library has enough money to afford computers and internet access).
Don't think that all people have the same resources on which you draw with such ease.
Jabberwocka
"My DD has a frugal streak and wants her hard-earned money to count, so I completely understand all her feelings even if they sometimes make me sweat bullets about possible misplaced priorities."
I have a frugal streak myself. That's why I don't see why I should be ending any more tax dollars to support people like the Younts. Mr Yount had an obligation to ensure his immigrant spouse had health coverage. He didn't do it.
"**A thousand dollars is a big chunk of change to a young couple like the Younts and my DD/SIL."
Boo-frigging-hoo....
"Now, happy newlywed Maggie Yount is finally starting the life she had been planning at her new home near the ocean — albeit with a few restrictions. She knows she still has a way to go before she is considered fully recovered, but she happily reports that she will resume her writing career when she finishes the classes that were delayed by the accident and are needed to graduate from Concordia. As much as she can, she is getting on with living the good life in southern California."
www.westmountexaminer.com/article-i244157-Happily-ever-after.html -
So while Maggie lives the good life in California at her new home near the ocean, I am supposed to work for single-payer insurance so her good life in Southern California isn't disturbed by paying for her own healthcare. I don't think so .....
"I don't know how many professionals you have occasion to hire and/or work with. My DH is a professional engineer (P.E.) and he has to stand behind the designs and plans he and his company generate."
Are you actually saying that your DH guarantees buildings that he doesn't physically construct will never fail?
Interesting and ****surprise, surprise**** inconsistent. You don't want "your" tax dollars to be spent in a way which you consider to be not frugal, but the cost of a high deductible to young couples is "Boo-frigging-hoo....". They can't be equally concerned about the cost of medical care and the impact of that cost on their fledgling budgets?
Apparently you grudge Maggie Yount her recovery, her presence in this country, and her lack of insurance (though it was clear that she had tried to obtain coverage). How sad. What did she ever take from you?
Maggie was probably chosen as the subject of the pieces you posted because they point up the ugly differences between Canada's approach and the ineffectual and costly system here in the U.S. But Maggie is far from alone in falling through the cracks. Numbers vary--42 million, 36 million....fill-in-the-blank millions. Yes, that many who don't have insurance coverage, or affordable health care for various reasons.
It does appear, once again, to be the case that the U.S. health care system must needs be served and its flaws projected onto those people who prove the flaws. How sad.
Jabberwocka
His firm designs HVAC systems, fire suppression systems, electrical systems, and plumbing systems--all with an emphasis on efficiency. If any of those systems don't work because of design flaws, yes he has liability and must pay to have the problem rectified. PE's have to put their seal on drawings which they have generated or overseen for precisely that reason.
The idea that professionals shouldn't have to stand behind or guarantee their work is utterly laughable. Why else have any boards which certify that there is a certain level of competence? In fact, the inference of "professional" is that such a person has the training and experience to stand behind work done.
Jabberwocka
"Interesting and ****surprise, surprise**** inconsistent. You don't want "your" tax dollars to be spent in a way which you consider to be not frugal, but the cost of a high deductible to young couples is "Boo-frigging-hoo....". They can't be equally concerned about the cost of medical care and the impact of that cost on their fledgling budgets?"
That's a hoot .... I don't believe there are many young couples living on fledgling budgets who reside in homes by the beach in one of the most expensive areas in the country.
"Apparently you grudge Maggie Yount her recovery"
Nope.
" her presence in this country"
I admit to not particularly caring for immigrants with sponsors who are deadbeats and who complain that the country they chose to move to isn't like the one they left.
"and her lack of insurance (though it was clear that she had tried to obtain coverage)."
It was actually her DH's responsibility. But since he skipped out she elected to apply for the insurance she felt she deserved. When it wasn't forthcoming she has now chosen to be real careful, as well as kvetch that this isn't Canada.
"Maggie was probably chosen as the subject of the pieces you posted because they point up the ugly differences between Canada's approach and the ineffectual and costly system here in the U.S. But Maggie is far from alone in falling through the cracks. Numbers vary--42 million, 36 million....fill-in-the-blank millions. Yes, that many who don't have insurance coverage, or affordable health care for various reasons."
I'm sure the writer could have picked one of these alleged millions. He didn't.
"It does appear, once again, to be the case that the U.S. health care system must needs be served and its flaws projected onto those people who prove the flaws. How sad."
About all Maggie's case proves is we have another immigrant complaining about the country they chose to move to, another irresponsible sponsor of an immigrant and that irresponsible people will continue to try to get other people to support them. As these 2 presently reside in a state that's in fiscal crisis they seem to showcase the very reason it got into its current state. That is sad.
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