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Thread: Canada's healthcare saved her; ours won't cover her

  1. #1
    Elite Member celeb_2006's Avatar
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    Thumbs down Canada's healthcare saved her; ours won't cover her


    Maggie Yount, a Canadian citizen, got months of treatment and rehab in Canada after a drunk driver crashed into her car in 2007. The accident broke 13 of her bones, injured her brain and left her in a coma for four days.


    Canada's healthcare saved her; Ours won't cover her - Los Angeles Times

    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."

  2. #2
    Elite Member Grimmlok's Avatar
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    Incredible.

    Americans must be just absolutely paranoid that they'll get into an accident.. probably what fuels the incredibly litigious atmosphere too
    I am from the American CIA and I have a radio in my head. I am going to kill you.

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    Damn straight! One of our biggest fears is not having insurance. Every single time something happens, we worry about whether or not it'll be covered and if we'll lose coverage.

    My best friend just had to have a hysterctomy as a preventative for ovarian cancer. You would think that the insurance company would rather pay for a 4 hour surgery instead of the mounting costs of treatment when cancer popped up. Instead, the insurance company debated on coverage, kept sending letters to her work and her requesting other coverage information (which she doesn't have) and basically stalling to see if they could get out of paying for it. Eventually they did pay for it but it was a fight. My husband swears that insurance companies are nothing more but a legalized gamble on your luck and I think sometimes he's right.
    Snooky Wookums, prepare for the invasion!

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    Elite Member cmmdee's Avatar
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    Quote Originally Posted by mklady View Post
    One of our biggest fears is not having insurance.
    Absolutely.
    That is really sad about your friend, MK.

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    She was covered and they took it all on Tuesday, yay! She's 30 and already had a bout of melanoma that was because of the BRCA2 that she carries. She'll never be able to get life insurance and most likely won't be able to add any for her daughters if they wait until after genetic testing for them.

    I made my hubby insure me finally for the same reason. I'm high risk for colon cancer, I want to get the testing done but if I came back positive, I wouldn't be able to get coverage.

    It's criminal, a person can take care of themselves and just be at risk for something and be refused but someone who lives a crappy life can get coverage. It's all in the statistics and odds.
    Snooky Wookums, prepare for the invasion!

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    Elite Member cmmdee's Avatar
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    Quote Originally Posted by mklady View Post
    It's criminal, a person can take care of themselves and just be at risk for something and be refused but someone who lives a crappy life can get coverage. It's all in the statistics and odds.
    It is criminal and it sucks

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    Elite Member sputnik's Avatar
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    jesus christ, why do people put up with this system? it's fucking criminal. there should be a law that makes it mandatory for people to have insurance, and mandatory for insurance companies to insure everyone, including people with pre-existing conditions. it's not that hard, there are countries that do just that. and to avoid companies then charging prohibitive fees to people wiht conditions, there is a legal cap on how much they can make you pay per month.
    I'm open to everything. When you start to criticise the times you live in, your time is over. - Karl Lagerfeld

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    Elite Member cmmdee's Avatar
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    ^ But that's socialism!

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    Elite Member sputnik's Avatar
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    ^^
    not at all. that's how it works in switzerland and they're not socialist at all and their heathcare is much more privatised than it is in the rest of europe.
    also, people on unemployment or who are poor are insured by the state and have their healthcare taken care of.

    it's not socialism. it's the state doing its job.
    I'm open to everything. When you start to criticise the times you live in, your time is over. - Karl Lagerfeld

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    Elite Member McJag's Avatar
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    I like my own US insurance. I get in immediately & get great care. I worked hard for that coverage and it was well worth it.
    I didn't start out to collect diamonds, but somehow they just kept piling up.-Mae West

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    Elite Member greysfang's Avatar
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    McJag, the point is, you could lose that coverage through no fault of your own.
    FUCK YOU AND GIVE ME MY GODDAMN VENTI TWO PUMP LIGHT WHIP MOCHA YOU COCKSUCKING WHORE BEFORE I PUNCH YOU IN THE MOUTH. I just get unpleasant in my car. - Deej

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    Elite Member cmmdee's Avatar
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    Quote Originally Posted by sputnik View Post
    ^^
    it's not socialism. it's the state doing its job.
    I agree. Was just making a funny

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    Elite Member lurkur's Avatar
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    Quote Originally Posted by greysfang View Post
    McJag, the point is, you could lose that coverage through no fault of your own.
    Right. Plus, though I have no doubt about McJag, plenty of people work very hard and get jack squat.

    Health insurance is there precisely to protect the unhealthy. If everyone was always healthy, we wouldn't need insurance, let alone doctors. If someone falls in a hole, we should help them get out, not smack them over the head with a shovel when they're down because it's more cost efficient.

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    Elite Member cupcake's Avatar
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    I love my coverage too. Blue cross and blue shield, I dont want to ever have to change it. I feel for the ones not getting good coverage or no coverage at all
    My grace is sufficient for you, for my my strength is made perfect in weakness...I love you dad!
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    Elite Member Grimmlok's Avatar
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    blue shield sucks for the self employed.. premiums have gone up 300%, but the maximum has stayed at what it was since 1997

    insane
    I am from the American CIA and I have a radio in my head. I am going to kill you.

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