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Coming Soon, Being “Human” will be a “Pre-Existing Condition”

Charlotte is asleep and the puppy is curled up in her crate. I’m watching TV (Bill Moyers Journal of course, a report on farm subsidies) with Gary and since I tend to have to be doing more than one thing at a time, I find myself browsing the news. I went to the OC Register and I read about insurance companies dropping people from their policies due to the fact of an “undisclosed” pre-existing condition. But not just at any time, they are dropping these people after they’ve had expensive and necessary treatment and they are now left with thousands of dollars of unpaid health care bills.

When Karen Knee filled out an online application for health insurance four years ago, she scanned her address book and her memory.

She wrote down the names and numbers of her doctors and listed her recent health history – anti-depressants after a death in the family, a normal Pap smear and a bladder infection.

She never thought to mention that her back sometimes felt sore after playing soccer or that she’d once taken pain pills after a muscle spasm.

“I’d never been a sick person,” said Knee, 47 of Newport Beach. “It’s not like I had diabetes and was trying to hide it. These little isolated things, we all have them. It doesn’t mean it’s a chronic thing.”

More than a year later, Knee had accumulated $30,000 in medical bills – the most expensive for removing benign cysts on her scalp. She then received a letter from Blue Cross informing her that the insurer had reviewed her medical records and found that she had not disclosed a preexisting back condition. As a result, Blue Cross dropped her coverage retroactively and refunded her monthly premiums.

Blue Cross added that had she “given accurate answers” she “would not have been accepted” into a health plan.

It was as if she’d never had insurance. Every bill was now her responsibility.

The Orange County Register

Health care is one of the most pressing issue facing our State with the environment and education. The hardest part for me to grasp about it is how people who call themselves “pro-life” don’t support universal health care. I know, why even go there? Because it’s at the heart of the issue for me, that “for profit” businesses should not be deciding who gets to live or die or who gets treatment and who does not. It should be solely up to the patient and the doctor. When someone faces a life threatening illness and they have a possibility for treatment, no matter how experimental, they should be given the choice. If they are not, then we are just supporting corporate euthanasia.

Yes, you read that right. Ability to pay should not determine who lives or dies. Employment should not be tied to health care and everyone should receive treatment no matter how rich or how poor, it should be a personal decision not the decision of someone who is merely trying to keep their costs down, otherwise know as “death by spreadsheet”.

Denise Wheeler, 49, of Laguna Beach had her Nationwide insurance canceled in 2006 for failing to disclose a heavy menstrual period. Wheeler says her medical records were checked after she underwent a six-hour operation for a perforated ulcer that she said was unrelated. After the cancellation, the insurer refused to pay nearly $50,000 in medical bills. Her case settled recently for undisclosed terms.

“If we have to start disclosing every time our weight fluctuates, what is really the parameter of filling out an application?” Wheeler said. “What is considered a part of your health history?”

Imagine having a life saving operation that is going to cost you thousands of dollars and you have done nothing wrong and yet you are left with the cost. You’ve paid your premiums, “played by the rules” and you are kicked to the curb for not disclosing something that many would not even think to consider a “pre-existing” condition. I mean, I hate to get graphic here, but I doubt any woman hasn’t had something unusual to do with their period, hormones wreak havoc on our bodies, being human means being fragile and being vulnerable, life is not without it’s bumps and bruises and if we are to go by this current system, as it stands, I’m sure very few people would qualify for health insurance. You see, the bottom line comes before human beings and it just doesn’t work. In short, we have a private safety net that’s so full of holes, any one of us could lose our health insurance for frivolous reasons.

California has the ability to end this now and to create a system that actually upholds the standards of what medical insurance should provide if it is deemed successful.

The California Progress Report, Why Medical Students Believe in SB 840 by Senator Kuehl and How It Can Save California $8 Billion per Year and Guarantee Quality Comprehensive Health Care for All.

First the hubris: as healthcare professional students, we are the future of healthcare, which affords us both a special privilege and responsibility to fill a seat—and a large one–at the table of healthcare system reform. The system created today is the one we manage tomorrow; thus, our voice is crucial to the success of any reform.

Further, we know what we are talking about. We have actually studied (that’s what students do!) our current non-system hodgepodge. We have educated ourselves about the reality—we call it evidence-based medicine–of the world we are about to enter. (Granted it does not require a professional degree to comprehend: Walter Cronkite, the great avuncular voice of American broadcasting, said it succinctly, “The American healthcare system is neither healthy, caring, nor a system.”).

Thus, we know (versus those whose arguments are based in rhetoric and ideology) that we are doing things the wrong way in this country. And, better, we know the fix—because Uncle Sam has provided it, in the form of the five Institute of Medicine (IOM) Guiding Principles of Healthcare Reform (Report #6):
1. Universal – Everybody in, Nobody out.
2. Continuous – “womb-to-tomb” or “cradle-to-grave;” i.e. lifelong and guaranteed
3. Affordable –predictably so, both to individuals and families
4. Sustainable to society, specifically in two ways:
a. Everyone contributes, because everyone benefits.
b. Simple – eliminate complex billing, underwriting and regulatory requirements, which not only increase administrative costs, but also negatively impact health outcomes.
5. High quality care – patient-centered and evidence-based, where the goal is improved health of the population.

SB 840 is the only California proposal that meets all five IOM criteria, making it the “gold-standard” of healthcare reform proposals. Better yet, it’s also “gold” in another sense: the landmark Lewin Group (itself a subsidiary of a private health insurance company, so not likely any gratuitous assumptions) analysis predicts $8 billion savings in the first year, reaching a cumulative $340 billion in the first 10 years. SB 840, then, will be the next California “gold rush”!

But of course, our Governor is already planning to veto the bill if it passes. I urge you to study the bill and it’s benefits and to also push your representatives to support it and to tell the Governor you want him to withhold his veto on this very important piece of legislation.

A 4-min video, mostly of Sen Kuehl’s speech at our Rally on Lobby Day.

For information about SB 840, visit Senator Kuehl’s page.

To get involved, please contact your local HealthCare for All chapter.

Parker Duncan, an MS4/MPH(c) at UC Irvine. He was the co-coordinator of Lobby Day 2008 for the California Alliance Legislative Action for Universal HealthCare and is a student board member of the California Physicians Alliance. Photos courtesy of Khanh Trinh, UCSF, MS3.


  1. Homewrecker Homewrecker April 14, 2008

    Not to be unsympathetic, but I’d like to know if Ms. Knee plans to put her vote where her mouth is or whether she go for John McCain in November like her NB neighbors undoubtedly will.

  2. Heather Pritchard Heather Pritchard Post author | April 14, 2008

    Homewrecker – It’s a valid question. McCain’s views on health care would not in anyway help individuals like Ms. Knee. Elizabeth Edwards pointed out that McCain’s health care plan would not have covered his cancer treatment nor hers.

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