Monday, December 31, 2007
The Houston Chronicle summarizes its view of this matter in the news thus:
When insurance company officials arbitrarily denied a California patient life-preserving care recommended by her doctor, the case provoked outrage and inspired the hope that medical coverage for all citizens can eventually become law.
Rather than a tragic waste, the death of 17-year-old Nataline Sarkisyan should become a rallying cry for supporters of the universal health care plan passed by the Golden State's House of Representatives last week. The bill faces tough sledding in the state Senate.
Sarkisyan had battled leukemia for three years and had received a bone marrow transplant from her brother the day before Thanksgiving. In response to complications, her liver ceased to function and her team of doctors at the University of California at Los Angeles Medical Center recommended she receive a liver transplant in order to prolong her life. A candidate organ became available but could not be implanted because insurer CIGNA ruled that the procedure was experimental and was not covered under Nataline's mother's policy.
What I find ironic about this is the notion that CIGNA's wrongdoing, assuming it did do wrong, somehow supports the case for government-controlled health care. This is like saying that if Federal Express negligently or even maliciously failed to deliver a package on time, it would just go to show that all packages should be sent by the U.S. Postal Service.
It may well be that CIGNA acted wrongly. But if they did act wrongly, the nature of their wrong was to breach a duty they had under an insurance contract with Natalie's mother. There seems to be an issue of fact at the heart of this dispute. Recognized experts at the UCLA medical center said the proposed liver transplant for Natalie was not experimental, while CIGNA says its experts said it was. If the treatment really was not experimental and, nuances aside, CIGNA failed to fulfill its contractual duties, I am quite happy to see them hammered for it.
But the notion that if governments were making treatment decisions instead of private insurance companies, they would somehow not face decisions such as whether to approve payment for a transplant, or that when facing such a decision, they would make them better, is the sheerest nonsense. If anything, there is every reason to suspect that under anything like a single payer system, or any system in which government strongly influenced the rationing of health care, treatments such as transplants for seriously ill patients would quickly go by boards, to make more resources available for more basic and routine medical care. Natalie's problem was not that she lacked health insurance. It was that either her insurance did not cover her problem, or that it did, and her insurer breached its contract.
The reputation of government health care systems such as those in Canada and the UK is that you really don't want to be the sick person who needs expensive, let alone experimental care, in those countries. True, you might be better off there than in the US with no insurance in some area without large hospitals willing to underwrite your care. But last I heard, the prognosis for what is in the US usually an utterly routine case, an otherwise healthy 70-year old male with early stage prostate cancer, was in Canada, certain death as the disease took its course unopposed, or opposed too late to help.
If CIGNA did breach its contract in this case, it is very much to be blamed. It would not only discredit itself, but the whole system of private medical insurance, at a very bad time to do so. But the idea that the public sector would have done a better job for Natalie is more than unproven; it's utterly implausible. If the federal government can't even take care of veterans at Walter Reed, I don't see why they are going to better with civilians in LA.