This week she tells the story of a 17-year-old girl awaiting a liver transplant whose insurance company stonewalled approval of the operation; when the insurance company finally caved under public pressure and paid for the transplant, it was too late and the young girl died. This is cited as an example of how greedy insurance company executives kill people in their quest for profits. Unsaid in the article, but strongly implied, is that private industry has no business making these kinds of decisions.
But...government bureaucrats should? Take a look at countries where they do, like the UK; they have an entire government agency (ironically named "NICE") whose job it is to decide how much a patient's life is worth. If we had public health insurance in this country, we'd have our own NICE -- and, unlike with private insurance, we would have no recourse should such an agency deny treatment. (Note that, if a patient in the UK wants a drug that NICE hasn't approved, he can buy it -- but only if he pays the entire cost of his treatment, including everything that NHS normally would have covered. This, whether or not he has paid taxes to fund what the NHS would have paid for.) At least the family of Nataline Sarkisyan, the 17-year-old of the story, would not have been forced by her insurance company to pay for all of her previous treatment had they been able to raise money to pay for her transplant!
Chen is absolutely right that insurance companies, in their quest to make as much money as possible, often say no to medical care, and that the care they say no to might have been lifesaving in some cases. Does this bother you? It should. Do you want someone you don't know, who doesn't know you, your situation, your values, your full medical history, deciding whether or not you get a medical treatment? I sure as hell don't.
But the answer is not government intervention. All that means is that it's a government bureaucrat, who more often than not will be making decisions on a political basis (Breast cancer advocacy group waging a campaign for mammograms? Sure, we'll cover mammograms! Fiscal watchdog think we're doing too many unnecessary MRIs? Sure, we'll slash coverage for MRIs!), will be saying no, not that everyone will get a "yes."
The answer is a free market in medicine -- so that the only person saying yes or no is you, based on your values and what you can afford. In a free market, most of us wouldn't purchase the kind of low-deductible, routine-expense-covering policies we call "insurance." We'd very likely buy real insurance against catastrophic events, pay out of pocket for routine expenses, and save gobs of money -- some of which we could budget for emergencies. We could shop around to make sure that catastrophic coverage really did cover what we want it to. We'd have more money in our pockets to donate to charity, if we chose, so that a truly unfortunate person who believes an experimental treatment could save his life, but whose insurance company doesn't, could ask for help.
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The Sarkisyan case is recycled from the highly successful John Edwards Presidential campaign of ought-eight. The facts of this case are not nearly as cut-and-dry as Chen makes them seem. In fact, most parties other than the Sarkisyan's celebrity lawyer have kept quiet due to doctor patient confidentiality.
As Forbes and the WSJ pointed out, the claim that there was in fact an available liver is highly suspect. No insurance company, even the most dastardly, can prevent a doctor from making the transplant. This begs the question, "why didn't a non-profit hospital decide to just do the transplant and say 'suck it, CIGNA'?"
Nevertheless, Chen paints the picture of selfless doctors begging CIGNA to let them operate and a callous corporation that rejects every routine transplant as "experimental". I'm not sure how this word keeps getting used, but CIGNA was not claiming that liver transplants are experimental as Chen implies. They and the two independent specialists stated that it was too risky given Sarkisyan's weakened condition. As Chen herself puts it, Sarkisyan was "critically ill, as close to death as one could possibly be while technically still alive". And yet Chen believes implicitly that the independent boards were lying when they claimed a major surgery might be too risky.
Furthermore, we shouldn't be shocked that there was a dispute between the personal physician and the insurance company. People still have this notion that they should just do whatever a doctor tells them. Remember, the doctors have a profit motive too. They will be far more likely to recommend a procedure regardless of the risks.
It is also instructive to look at the dates in this case. Of course, this is never mentioned in the "CIGNA is evil" camp. Sarkisyan's doctors determined that she needed a transplant on Dec 10th, a few weeks after requiring a bone marrow transplant. CIGNA decided on its exception (after much political pressure) on Dec 20th, the same day she died. Clearly this all happened very fast, whereas a typical reader will probably recall stories of people waiting months or years on a donee list. However, this is clearly not the case.
The Sarkisyan case is recycled from the highly successful John Edwards Presidential campaign of ought-eight. The facts of this case are not nearly as cut-and-dry as Chen makes them seem. In fact, most parties other than the Sarkisyan's celebrity lawyer have kept quiet due to doctor patient confidentiality.
As Forbes and the WSJ pointed out, the claim that there was in fact an available liver is highly suspect. No insurance company, even the most dastardly, can prevent a doctor from making the transplant. This begs the question, "why didn't a non-profit hospital decide to just do the transplant and say 'suck it, CIGNA'?"
(cont'd)
Nevertheless, Chen paints the picture of selfless doctors begging CIGNA to let them operate and a callous corporation that rejects every routine transplant as "experimental". I'm not sure how this word keeps getting used, but CIGNA was not claiming that liver transplants are experimental as Chen implies. They and the two independent specialists stated that it was too risky given Sarkisyan's weakened condition. As Chen herself puts it, Sarkisyan was "critically ill, as close to death as one could possibly be while technically still alive". And yet Chen believes implicitly that the independent boards were lying when they claimed a major surgery might be too risky.
Furthermore, we shouldn't be shocked that there was a dispute between the personal physician and the insurance company. People still have this notion that they should just do whatever a doctor tells them. Remember, the doctors have a profit motive too. They will be far more likely to recommend a procedure regardless of the risks.
It is also instructive to look at the dates in this case. Of course, this is never mentioned in the "CIGNA is evil" camp. Sarkisyan's doctors determined that she needed a transplant on Dec 10th, a few weeks after requiring a bone marrow transplant. CIGNA decided on its exception (after much political pressure) on Dec 20th, the same day she died. Clearly this all happened very fast, whereas a typical reader will probably recall stories of people waiting months or years on a donee list. However, this is clearly not the case.
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