“We have completed our underwriting review and are sorry to advise that we must decline your request for insurance coverage…We regret that we are unable to consider based on medical history as noted in your medical records”

I received this letter in the mail from Independence Blue Cross nearly 9 weeks after applying for coverage. As I roll over in bed, nearly two feet of snow lie on the ground and lying on my side trying to fall back asleep, my hand brushes over my chest and I feel it flutter and stop. Thud, thud, th-thud, stop…thud. My heart erratically beats on as my mind scrambles with anxiety. “Jesus, why is this happening to me” I lament, as I wonder if this will be the day that it does not restart.

About three weeks ago I went to my doctor with a terrible sore throat, body aches and chills. Despite not having health care, I stammered in to my regular doctor office and after only a few minutes I wandered into the examining room, took off my shirt and waited patiently as the doctor took my blood pressure as part of a general examination. “Hmm” he remarked curiously, “have you felt any discomfort in your chest” he asked. “None” I replied. “Well, I’m pretty sure the sore throat and lethargy is Strep Throat, I’ll write you a prescription for Amoxicillin, that should be pretty cheap, but one thing that is concerning me is your heart seems to be skipping some beats, maybe we ought to check this out.”

My general practioner, a saint that insists on charging me as little as possible during my anxious visits, performed an ECG and it read like a topographic map of the Himalayas. Skewed jagged peaks following long valleys that slashed downward into deep canyons, across the top of the page read: “Possible left atrial abnormality” and “frequent premature ventricle contractions”, I typed the heading as I read it off the wall- paper length data sheet, dictating it to a frantic Google search after leaving the doctors office; “Usually benign”, “Ventricular tachycardia”, “can develop ventricular fibrillation, which is a fatal heart rhythm” I read as I scrambled to learn as much information as possible about my newly diagnosed condition.

“What am I going to do now?” I thought as I sheepishly dialed the cardiologists’ office at Jefferson Hospital. “What insurance do you have?” she asked as if I was boring her “none” I replied. “Well we usually don’t accept patients without health insurance, the doctor’s visit alone will cost $200.”

In 2008 I had a dream. I had competed for 7.5 years as a rower on boathouse row and had become absolutely infatuated with the sport. When it came time to finally retire from competition I knew I wouldn’t be happy unless I earned a job as a professional rowing coach. I understood that it meant that I would have to work my way up from the bottom and spend countless hours performing the menial tasks of an assistant rowing coach, getting paid next to nothing. That’s exactly what I did, from coaching successful crews to cleaning and organizing office spaces, I worked my butt off, willing to do near anything to build my resume and improve my skills as a coach. In October, I earned a position working at Yale University and although it was for minimal pay and no health insurance, it was an incredible opportunity to work for one of the top rowing colleges in America under an elite coach.

After a year at Yale, funding dried up for my position and I was forced to move again in search of work. I again sought work with the most experienced coaches at the most prestigious institutions and found volunteer work under a three-time Olympic Medalist and World Class Coach in Philadelphia. There I worked my way from a volunteer assistant, working only 3 or 4 days a week, to a salaried, nearly full-time employee. In my spare time I took over another high school program in New Jersey and learned to repair boats in my free time. For 12 months prior to my promotion as a full time employee, I worked like a dog to subsist on my paltry salary which offered no health care, but I loved every minute of it. This was my American dream and I knew if I worked long and hard enough under the best people, that I lived in a country that would allow me to have an opportunity to try to become the best in the sport and make a respectable living from it.

In the summer of 2009, after 3 years of hard work, I coached a crew that qualified for an international regatta and represented the United States at the U23 World Championships, and felt like I was on my way. By December of that year I had grown my salary to a respectable level, and I was ecstatic to begin paying down my credit cards and purchase independent health care. Now, one month before my raise was to take effect I was diagnosed with a “pre existing condition”, a modern day scarlet letter, and felt an ominous cloud hang over my head. In a country I believe to be based on the best ideals which offered me the incredible freedom to chase my dreams, I felt cheated. I did not want a handout from anyone, I did not ask for anyone to purchase health care for me, I just wanted to purchase it for myself and now, after I had spent years working hard to improve my own condition, the system was not allowing me to do so.

In mid-December after my diagnosis, I applied for Health Care with the hope that I could get Health Coverage even if it excluded my heart condition. I spent the next 8 weeks, anxiously awaiting a decision from Independence Blue Cross. In January, a month after I originally applied for care I received a letter requesting my medical records which I immediately sent and by the first week in February, I had still heard no word so I repeatedly sent email inquiries. On February 5th I finally received this reply from ehealthinsurance:

“Independence advised that they received your medical records on 01/15/2010, however, the underwriter is still reviewing the information. We were advised at the beginning of January that the underwriters were behind at least three weeks in their underwriting process. When I requested a timeline for when an actual decision would be made, the representative advised me that they would not provide timelines regarding decisions. I am sorry we are not able to provide you with a specific date for when Independence will complete their decision, at this time. But please beware they are reviewing the information at we are continuously following up with them until a decision has been reached.”

Finally, I decided that I could not wait any longer to see a specialist, so despite warnings from friends who had seen a cardiologist and the sizable bill, I set the earliest appointment I could in late February, nearly two months after my initial diagnosis.

“I think going to the cardiologist is giving me heart problems” I remembered thinking as I strolled into the sterile looking office. The receptionist greeted me with a smile and handed me a clipboard filled with unusually cheery questions regarding my symptoms. I mentally calculated my quiz score in my head as I answered each question individually. “Doesn’t smoke, drinks moderately, relatively healthy eater, recently completed the Philadelphia Marathon” I jotted proudly as my mood improved. History of heart problems, damn, grandfather died of a heart attack and parents have high blood pressure. Are you regularly nervous, anxious, or depressed? “I’d say that’s a reasonably accurate description of how this office is making me currently feel” I giggled to myself as I wrote.

I’m generally a jittery hypochondriac in a doctor’s office anyway, but I’m quite certain that showing up to a cardiologist without healthcare increased my chances for a heart attack. A female doctor with a masculine name strolls into the office to greet me without a smile. She’s pretty and I can’t sense if this fact is comforting or making me more nervous. The fact that I don’t have insurance has already spread throughout the office as if it were texted to everyone in the room by the homely looking receptionist, eliciting pitying glances from everyone that comes into the drably colored office. This makes me furious. I was promised the pursuit of happiness as an inalienable right, I shouldn’t have to choose between being healthy or being happy and I didn’t want any pity.

There is something inherently wrong with a system where producers have an incentive to deny consumers from purchasing their product. Obviously, our capitalist system has been successfully applied in nearly every avenue of democratic life, in many ways it is the foundation of our freedom; spurring competition, stimulating production, and allowing for the opportunity to better yourself as you gain skill. However, when profitability impedes our ability to remain healthy, some level of our “American Dream” has broken down.

The U.S. Department of Health and Human Services estimated that “12.6 million non-elderly adults…were in fact discriminated against because of a pre-existing condition in the last three years”. Further, “It is still legal in nine states for insurers to reject applicants who are survivors of domestic violence, citing the history of domestic violence as a pre-existing condition.” In fact, in some states, health care providers can rescind health coverage retroactively for patients that have expensive conditions like cancer if they have a medical history that was not claimed prior to obtaining insurance, even if they didn’t know this condition existed at the time.

I am so proud to live in a country were I have been able to create my own opportunities, I have done so by the merit of my own hard work, with little help from anyone and I am so proud of myself for sticking with my dreams and making a respectable living out of my passion, but I am sickened by the fact that I may have to give that up because I simply can’t find anyone that will sell me Health Coverage. In the end, thankfully, it looks like my heart is ok, but to be honest I still haven’t been able to save up all of the money I need to get a stress test or wear a 24-hour monitor. Though I make good money, these tests combined can cost thousands of dollars, and so I can currently only afford a partial diagnosis and am still left in a panic every time I feel a flutter or get heart burn. Ultimately, I feel lucky that I haven’t been diagnosed with something worse like Cancer. I have the benefit of thinking, “I’ll probably be ok”, but I have a taste of what it’s like to have to make the choice between my health and my financial future and that seems to me to be an inherently un-American one.