Even for those willing to pay, health insurance can be unobtainable

Regarding "No tears for those who choose not to buy health insurance" (Letters, Oct. 9): I agree wholeheartedly with the position of letter writer Rikki J. Scoggin, MD, of Holdenville, Okla., that individuals need to be personally accountable and responsible for their health care. However, the situation is not always a matter of personal choice.

I shared Dr. Scoggin's perspective until I found myself uninsurable after leaving a post at a medical practice too small to be covered under COBRA.

I was a very healthy, athletic, nonsmoking 32-year-old nurse practitioner, and my only health problem was a postviral condition that had left me with significant vocal chord inflammation, irritation and dysfunction.

I was in the process of being evaluated for this, after it had not improved in six months, and I was reliant on corticosteroids to be able to speak. I could not purchase an individual health plan in Nevada. I was deemed uninsurable because there was not a valid diagnosis for my condition, so I could not be risk-stratified.

This is not to say I couldn't afford a plan. I was denied by every insurer. I could not purchase a plan for any amount of money.

Ultimately, my husband (a pediatrician) elected to give up his fairly decent health care plan and purchase a catastrophic policy through the AMA. I could be covered as a dependent on this plan, but I couldn't purchase it individually. Even with a $20,000 deductible (for a 24-month period), any costs that were considered by the insurer to be in any way possibly related to my vocal chord condition were carved out.

I know another 30-something female in generally good health who could not obtain insurance. She and her husband had left their large employers to open their own business. She had had recurrent tonsillitis, finally resulting in a tonsillectomy. Other than wellness exams, this was the only health care problem for which she had sought medical attention in the past three years. She could not buy an individual or small-business policy for any amount of money because she was deemed uninsurable due to "overutilization." In her case, her condition had been cured. This situation led to her and her husband's decision to bury their dream and close their small business before ever being able to recoup their start-up costs, and return to previous jobs.

I know countless people, some of them my patients, who lost their employer-sponsored coverage when they lost their jobs because they couldn't work for an extended period due to illness or injury. There they were at the time that they needed their health insurance the most, only to lose coverage because they couldn't work as a result of illness or injury Afterwards, they couldn't purchase insurance again, because they had had a lapse in coverage and were overutilizers.

While we all subscribe to cable television and get our hair done, I don't think that any of these cases demonstrate poor consumer choices. If I had suffered my recent bowel perforation during the time that I was uninsured, it would have wiped us out financially, despite the fact that I was being responsible, my husband and I have good incomes and financial reserves, and we are not frivolous spenders.

Kimberley M. Morris, Reno, Nev.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2006/11/27/edlt1127.htm.