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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How do you google something you don't know exists in the first place? Plus as Jabberwocka points out, not everyone has internet access. I live in one of those regions not every home even gets internet, not even dial up. My friend found out about it, from the clerk at the hospital, before internet technology was very common. At least 12 or more years ago. I don't think we could even GET internet service or cable TV here 12 years ago. I think it was 2000 that we were finally able to get cable, when a wealthier subdivision went in down the road.
Wow. Without any visible means that I can discern, you have decided that Maggie has a computer, lives in a home on the beach (though most of San Diego qualifies as "near the ocean" and beachfront wedding ceremonies do NOT mean that participants own beachfront property--look at your link which even says "other ocean-side marriage ceremonies that take place there on a regular basis"), is a deadbeat, is a complainer, and has a husband who has "skipped out" (whatever that means). Passing strange.
Moreover, I was referring to the cost of my DD's deductible. She certainly doesn't own a house on the beach or warrant a comment of "boo frigging hoo" for being concerned about the expense of medical care and her insurance deductible. This jumping to conclusions seems likely to result in a fall of Luciferic proportions.
The contrast between our health care choices (poor as they are) and those of Canada which appears to be considerably more generous to its citizens, is probably a contributing factor to the journalists' decisions to report on Maggie. Said that before--a couple of times if memory serves.
There are millions in this nation LIKE Maggie, in that they are refused access to insurance because they have pre-existing conditions. Focus on the insignificant (Maggie's immigrant status) and ignore the elephant under the rug (those health care-poor "irresponsible" millions--how dare they get sick or become victims of accidents!).
Still sad.
Jabberwocka
Don't you know that everyone in California lives by the beach? (Seriously, a lot of people who don't live in California belive this.) Also, all our beaches are warm and sunny.
**ignore the elephant under the rug **
Is that what that big, freekin,
This is a woman who has married an American citizen. I think she is far from irresponsible. If you want irresponsible, let's discuss the ever-increasing burden on the U.S. healthcare system caused by immigration that is illegal.
No, it's an elephant. More easy for non-Californians to relate to than either beaches or forests.
Speaking of forests, the redwoods in northern California are so tall and so dense that they can actually block GPS reception--might have also had something to do with the fog. Had it happen last fall when we drove down the coast from Crescent City (sunny and warm beaches, my fanny!) to San Francisco.
Jabberwocka
"This is a woman who has married an American citizen."
Yep, and her husband was supposed to provide for her healthcare needs as her sponsor. He isn't doing what he promised to do.
" If you want irresponsible, let's discuss the ever-increasing burden on the U.S. healthcare system caused by immigration that is illegal. Why should those who aren't even supposed to be in the country at all be given healthcare at taxpayer expense, yet Maggie, who has immigrated here legally, be denied healthcare even though she's willing to pay for it herself?"
I couldn't agree with you more regarding those here illegally. If I had my way they'd be packed up and shipped back from wherever they came from pronto. Regarding Maggie, yes she is here legally and her sponsor made certain promises that permitted her to be here legally. I think they should be kept.
"Managed healthcare has been one of the worst things to ever happen to America. As for pre-existing conditions, it has nothing to do with where someone comes from. My son, whose American roots go back to before the Revolutionary War, cannot get affordable healthcare because of a "pre-existing condition." It's simply a matter of corporate greed owning the very health and well-being of the people."
There are several issues here, one is pre-existing conditions. The other is immigration and the responsibilities of both immigrants and their sponsors. I do not see why I (or you) should be paying for the healthcare needs of an immigrant who chose to come here with a sponsor who raised up his hand and said Yes I'll accept responsibility for her. The amount Maggie is willing to pay for her coverage is inadequate. Either pay what is required or head back to Canada. I wouldn't mind if she took her husband with her, though perhaps it isn't right to stick them with another irresponsible individual.
"Wow. Without any visible means that I can discern, you have decided that Maggie has a computer,"
Well this wedding announcement provided a clue ....
http://registry.weddingchannel.com/coupledir/200810/S/R304635836/MAGGIE_SCOTT_AND_DORAN_YOUNT.htm
"The contrast between our health care choices (poor as they are) and those of Canada which appears to be considerably more generous to its citizens, is probably a contributing factor to the journalists' decisions to report on Maggie. Said that before--a couple of times if memory serves."
If Maggie wanted to live in Canada with its "considerately more generous health care" than the US she was free to do so. Her husband could have lived there with her. He also chose not to do so. They arew responsible for the choices they have made.
~Yep, and her husband was supposed to provide for her healthcare needs as her sponsor. He isn't doing what he promised to do.~
He isn't?
Maggie's spouse lives and has a job in the U.S.
You've done as much as possible to paint the Younts in a negative light. Hasn't been terribly successful because their cardinal "sin" appears to have been that they didn't anticipate the antiquated state of the U.S. health care coverage and payment system.
I daresay that if all of us were pilloried for what we didn't know ahead of time, there would be nobody punishment-free--you included. The Younts did assume responsibility for their choices, try though you have to ignore that fact.
What must have been intended as a poster child for "bad behavior" in the OP didn't behave badly at all. Maggie immigrated legally, filed for insurance, and could not possibly have predicted (based on her humane treatment in Canada) how she would be discriminated against here. And yes, it's discrimination. Legalized discrimination but still discrimination.
In the meantime, there are millions of people who didn't immigrate who are STILL in straits as bad, or worse, than those of Maggie Yount. If you ignore them (as seems to be the current trend), it will look suspiciously like spin. But that's nothing new either.
Jabberwocka
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