She’s hip to health insurance reform

“It’s probably not a good idea to go into surgery without having paid the anesthesiologist yet,” Melanie Winter joked in the admissions office at Cedars-Sinai Medical Center on Monday. But her options were limited.

Winter had kidded that she might have to marry one of the volunteers at her nonprofit agency so she could use his health insurance to get a new hip.

A friend had suggested she move to Canada for a while and take advantage of its national healthcare system.

Instead, having gone nearly 20 years without insurance and unable to buy it because of her preexisting condition, Winter hobbled up to the doors of Cedars-Sinai with the help of a walker, prepared to pay $40,000 for hip replacement surgery.

“Your doctor’s name?” asked a clerk.

“Penenberg,” said Winter, 49, a lanky former dancer and actress, as she winced away the pain.

David Brunk, a Mount Washington resident and volunteer at Winter’s agency, the River Project, had driven her to the hospital and helped with her bags. He said he and others were grateful for the lead role Winter had played in turning the Taylor Yard railroad property in Cypress Park into Rio de Los Angeles State Park.

“She has a great spirit and has been doing this work for not much pay, and she doesn’t even live near the park,” Brunk said of the Studio City resident, who has worked on open-space and river preservation projects for years.

That’s why, when Winter needed surgery, people came through, Brunk said. Grateful Cypress Park residents and other supporters held a fundraising party with live mariachi music. Friends set up the Melanie Winter Medical Fund at www.hip4mel.net.

It’s crazy that it came to this, but with roughly $25,000 raised, Winter had enough to make a down payment and schedule the surgery.

In the admissions office, a clerk said she needed to pony up a $250 fee before she would be taken to pre-op. Winter insisted she had made arrangements to pay it later, and after a bit of back-and-forth, the clerk relented.

Winter says she earns too much to qualify for Medicaid but not enough to be able to afford a good health insurance plan, even if she could find a company willing to cover her.

“It’s insane,” Winter said, telling me she was last covered as a member of the Screen Actors Guild. Since then, she has tried to live a healthy lifestyle and avoided medical care except when absolutely necessary. In rare cases, she paid cash for doctor visits or went to an L.A. County hospital.

As her hip problem grew worse, Winter ruled out county hospitals for surgery. Even if they would agree to treat her, it would take months to get in, and she was leery of trusting a public hospital for a procedure that would determine how well she gets around the rest of her life.

“Among my friends and colleagues, there are so many similar stories,” Winter said. Just trying to navigate the healthcare system is enough to make you ill, she said, adding that she doesn’t trust any reform plan that doesn’t remove the profiteering of the insurance and pharmaceutical industries.

“Hillary [Clinton] has backed way off,” Brunk said, referring to the New York senator and presidential candidate who has gone from brave reformer to a favorite recipient of donations from the health insurance lobby.

In California, Gov. Arnold Schwarzenegger and key legislators are darlings of the same special interests, which explains why there’s often talk of reform, much of it halfhearted, but little follow-through.

Jerry Flanagan of the Foundation for Taxpayer and Consumer Rights noted that two of the biggest state senate recipients of insurance company donations, Democrats Gloria Negrete McLeod of Chino and Leland Yee of San Francisco, did not cast votes last month on a bill that would have regulated insurance premiums. The bill died in the Senate Health Committee.

Flanagan is drafting an initiative that would give voters a chance to do what legislators don’t have the stomach for, despite growing, multibillion-dollar profits by the insurance industry and consumer outrage.

The initiative calls for a 20% rollback of health insurance rates and regulation of future increases. It would bar insurance companies from refusing to sell policies based on a person’s health, something that’s already law in nine other states. And it would phase in universal care by offering all residents access to a public insurance pool, forcing private companies to lower their rates to stay competitive.

“If you don’t have coverage from your employer, in California, insurance companies can refuse to sell you insurance for any price,” Flanagan said. “If you’ve had allergies or asthma, you could be denied.”

You can read the initiative and offer your own comments by going to www.consumerwatch

dog.org and clicking on “Patient Revolt.” Flanagan, who is still tinkering with it, said he expected to submit the initiative to the state in the next couple of weeks, and it could be circulated for signatures by late summer or early fall. If it qualifies, it would be on the ballot in 2008, either in June or November.

Winter, by the way, said an initiative might be the only way to restore sanity. And if California can show the way, maybe the rest of the nation will follow.

With a little more time to heal and retire her debt, Winter might be able to lead the parade. She reports that Monday’s surgery went well, and on Tuesday afternoon she took her first steps with the new hip.

steve.lopez@latimes.com