Monday, December 31, 2007

CIGNA denial of coverage case sows confusion
Tom Smith

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.

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Posted by: dearieme | Jan 1, 2008 3:40:04 AM

The #1 cause of injury, disability, and DEATH in America is, Health Care. More people die now from contact with the American Medical Health Care system than from any other cause of death. More than from Cancer, Heart disease, or Stroke. More than any other country in the world. Many times more than any other people in the world. Contact with the American medical health care system is the #1 risk factor now for injury, disability, and premature DEATH in America. This fact is a catastrophic indictment of the entire US Health Care System.

Driven by greed. And a rush to profit. Thousands of Americans are killed, and injured daily in America. By compromised health care. Cutting corners. Over, and under treatments. And poisonings with all manor of toxic, poisonous pharmaceuticals. Especially the children. America only makes up 2-4% of the world population. But Americans buy, and consume 50% of all pharmaceuticals world wide.

This is an emergency. America is in a crisis. And more Americans have died from this health care crisis than have died in all the wars in US history.

But the tide has turned. And the message is getting out. And taking hold about the fact that we have a very serious, and major health care crisis going on in America. Hurting everyone. Especially our precious little children. Rich, and poor alike. And most all Americans seem to understand now that "HR 676 Not For Profit Single Payer Universal National Health Care For All (Medicare For All)" is the way to go. Like all the other developed countries have done. Americans want government managed, tax payer supported health care Now. Medicare for all. Like other developed countries have. And like older Americans have now. Accept no substitute.

I am sick and tired of hearing how the candidates, and politicians health care plans are going to protect, and preserve the private for profit health insurance companies that have been killing, and ripping off the American people. And now the politicians want to mandate (require) that every American has to support the private for profit insurance company's that have been killing, and ripping you off. Or you will be fined, and PENALIZED. Thats right. PENALIZED. Ridiculous! The politicians really think you are all detached idiots. CASH COWS! To lead to the slaughter. Don't put up with that.

Just look at what is already happening with Massachusetts insurance mandates. It's a catastrophe. Financially, and medically for all the people of Massachusetts. And the private insurance companies just raised their rates by as much as 16%. And everyone has to pay now. It's a slaughter.

It's NOW TIME to bring out the BIG GUNS!! The BIG GUNS!! are you. The American people. And anyone else that wants to help. From now until HR 676 is passed into law. I want every person to reach out and touch their fellow Americans every day if you can. I want you to take a phone book. And call at least one of your fellow Americans every day. And ask them to pickup the sword of HR 676 Single Payer Not For Profit Universal Health Care For All (Medicare For All).

Call more than one each day if you can. And ask them to do the same as you are doing if they can. And also to put maximum pressure on their politicians to get HR 676 done. And to make sure their politicians support HR 676. Accept no substitute. HR 676 is a no-brainer. It's the best way to go on health care. It's the only moral, and ethical way to go. That is why every other developed country has done it. Most did it years ago. See sickocure.org, and http://www.house.gov/conyers/news_hr676.htm

I know that many of you have been doing a fabulous job of spreading the word by talking it up with family, friends, and co-workers. And putting pressure on the politicians to get HR 676 done ASAP. The phone calls to your fellow Americans will increase the pressure. And increase momentum for HR 676 at an astonishing, and exponential rate. And I know many of you have been wanting to do something more to help. The phone calls to your fellow Americans is something you can do every day to help.

Trust me. It will be something to see. But you have to keep the focus, and pressure on getting HR 676 passed pronto. They will try to distract you. With all manor of other crises, and catastrophes. And other plans. Don't be distracted. HR 676 Single Payer Not For Profit Universal Health Care is the #1 concern of the American people. Thousands of Americans are dieing daily now. And you or your loved ones could be next.

There is no good reason HR 676 cannot be passed into law well before the coming elections. And SCHIP should have been passed by now. Even if it was for 3x the 35 billion congress ask for. Do not tolerate delays. If it is not passed before the coming elections. All America will know which politicians are on the side of the American people. And which are not when they vote. Well before the elections. This is supposed to be a democracy. And well over the majority of Americans want tax payer supported single payer government managed health care for free for all Americans as a right. Many of the politicians will be soliciting your financial, and political support for the coming elections. Make sure you send a note telling them that you expect them to support HR 676 if they expect you to support them.

Everyone can do this. Most of you are well informed about HR 676. This truly is one of those no-brainers. Be considerate of your fellow Americans when you call. But be comfortable about calling. These are your fellow Americans. Some will be receptive. And some will not be. Some maybe rude, and mean. Just thank them, and move on to the next. Most will be with you. And if you get a call from one of your fellow Americans about HR 676. Let them know you are already on board. And thank them for calling. Build them up. And keep them strong. They are fighting for all of us.

Keep fighting. Pickup that phone, and call your fellow Americans. It's the right thing to do. It's time to start swinging your political sledge hammers. Until your government gets the message you want HR 676 NOW! And nothing else. No more insurance mandate bait, and switch. Or hokey tax deduction lunacy, and lies. Start using all your power Now. There are at least 250-300 million of you that want HR 676. The insurance, and medical industry want to keep our disgraceful system as it is. And force you through mandates to pay them to rip you off, RAPE! You, and KILL you, and your loved ones.

Everyone knows the true story now. If we continue to let them get away with this through our politicians, and our corrupted political system. The American people will be known as the worlds biggest bunch of lazy chumps, and dummy's. Don't let that happen. Start swinging your political sledge hammers with all your might until HR 676 is law. So we can have the best Universal Health Care system in the world. Bless you all... KEEP FIGHTING!!!!! Be creative. Your doing great!

Posted by: jacksmith | Jan 1, 2008 5:08:14 AM

"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."

Now that I said my peace above. Let me answer this. Because you make a very good point indeed. What the politicians hate most about single payer universal health care for all is that they will have to answer directly to all of the American people about the quality, and cost of our health care.

And for the first time in American history. They will be answerable to the demands of the majority of Americans . I assure you. We will have the best Universal Health Care in the world. Or their heads will role. And they know it. :-)

Posted by: jacksmith | Jan 1, 2008 5:30:37 AM

Dead girl, mis-delivered package, same-same. Right?

Posted by: Person of Choler | Jan 1, 2008 11:43:25 AM

Given that many transplant centers agree to perform transplants for less than full reimbursement, and this unfortunate young woman was a longterm patient(and they were paid for the bone marrow transplant presumably), perhaps the surgeons should have performed the transplant if a liver was available, and debated the responsibility of Cigna later. I am impressed that virtually all coverage of this terrible event, has avoided mentionong what UCLA could have done. I agree that if this was a breach of contract, Cigna must be held accountable.

Posted by: DrAndrewJ | Jan 1, 2008 12:57:27 PM

I think I would also be willing to bet, and bet heavily, that: (a) this sort of thing would happen at least as often with the government (federal or state) in charge of making health care decisions and (b) the government will not be subject to suit (or will have greatly limited liability) for its erroneous decisions.

So, the girl in this case would likely still be dead, and there wouldn't be anyone to sue. That would be progress?

Posted by: krm | Jan 2, 2008 7:28:37 AM

"So, the girl in this case would likely still be dead, and there wouldn't be anyone to sue. That would be progress?"

Now that I said my peace above. Let me answer this. What the politicians fear most about single payer universal health care for all is that they will have to answer directly to all of the American people about the quality, and cost of our health care.

And for the first time in American history. They will be answerable to the demands of the majority of Americans. I assure you. We will have the best Universal Health Care in the world. Or their head will role. There will be no need to sue.

And all other developed country's have a fund to compensate victims for medical injury's. Whether at fault or not. As part of their Universal Health Care. And we should have that too.

Posted by: jacksmith | Jan 2, 2008 9:25:41 AM

jacksmith

1. Name one other government program in US history that has been even a fraction as good as you seem to think we're going to get.

2. Name one other government run healthcare program elsewhere that has been even a fraction as good as you seem to think we're going to get.

3. Name one reason that the US politicians are going to be any more afraid of being voted out of office than they are now (which is "not at all" given the political map) should their pipedream of government run healthcare come to the bad implementation that every other government program has had. They are elected from safe districts, the unhappy people don't have any significant choice as to voting anyone out.

Posted by: krm | Jan 3, 2008 9:53:51 AM

krm,

1.)Medicare

Administrative cost aprox 2-3%, Private insurance aprox 30%. Most seniors are very happy with Medicare. The only problem area with Medicare is the part covered by private insurance.

2.)France, Spain, Briton, Germany, Canada. No one in those country ever has to worry about getting the health care they need. Or if they can afford to see a doctor. And they never have to worry about losing their homes, or going bankrupt from medical bills. Ever... And if you are visiting their country and you get hurt, or sick they will take care of you. AMAZING!

3.) Their will be no safe district when your people are unhappy about their health care. And you are the one standing in the way of fixing the problem. You will be history.

Posted by: jacksmith | Jan 3, 2008 1:28:27 PM

jack

1. Medcicare only works because it has the wide private system to leach onto (and more and more doctors are deciding not to take medicare patients). Once the whole system converted over, the downward spiral would get going fairly quickly.

2. I know people in Canada & the UK, they hate their systems. These friends worry greatly about getting the care they need - it is rationed such that many people don't survive the months (or years) it takes to get treatment (and the UK is now routinely denying any care to some classes of people).

3. Once the private system is killed, we won't be in a position to go back to it. The current congress critter vs his/her opponent will be irrelevant.

Posted by: krm | Jan 7, 2008 7:08:37 AM

firstly i should say i'm a brit living in the UK, i'm a fan of many aspects of america, american life and americans themselves.

1. the world health organisation ranks france's - socialised - healthcare system as the best in the world. they rank italy's healthcare - also socialised - as second best. therefore i don't believe that socialised medicine necessarily = downward spiral.

2. these days the british national health service (NHS) is far from perfect - my personal opinion is that it's: underfunded, possibly under the thumb of the pharmaceutical companies, can be impersonal and inconvenient to access.

on the plus side we can all get access to treatment of some kind (even tho we sometimes have to wait) and we don't have to worry about medical bills.

i currently have three friends who are - please g-d - being successfully treated for cancer by the NHS and, other than the tax they pay out of their salaries, it won't cost them a penny.

there are patients who believe they are not given the best treatment due to NHS rationing, they are probably correct. i don't have the numbers of people in this situation. knowing the percentage of americans who can't afford healthcare, i would estimate that the percentage of brits unhappy with their NHS care is lower than the percentage of people in privatised healthcare countries who can't afford insurance or who are denied care under their insurance.

in a civilised and comparatively rich nation, surely it should be a given that people get the healthcare they need, not the healthcare they can afford?

3. healthcare and pharmaceutical companies have literally billions of dollars, my personal opinion is that they will find a profitable way continuing their businesses.

Posted by: freelancemermaid | Jan 18, 2008 1:39:25 AM

The problem with market-run healthcare is that we are selling people their own lives back to them, the demand for one's own health and life tends to be pretty inelastic so prices tend to be very very high, we can see that quite clearly with the U.S. having the highest costs of any healthcare systems while the more socialized French and German systems have both better outcomes and much lower costs.

Posted by: james | Feb 6, 2009 5:48:42 PM