reponsible for little girls death?

Quote :

" GLENDALE, California (AP) -- A 17-year-old died just hours after her health insurance company reversed its decision not to pay for a liver transplant that doctors said the girl needed. Nataline Sarkisyan died Thursday night at about 6 p.m. at University of California, Los Angeles, Medical Center. She had been in a vegetative state for weeks, said her mother, Hilda. "She passed away, and the insurance (company) is responsible for this," she said. "They took my daughter away from me," said Nataline's father, Krikor, who appeared at a news conference Friday with his 21-year-old son, Bedros. Mark Geragos, attorney for the girl's family, said he plans to ask the district attorney to press murder or manslaughter charges against Cigna HealthCare in the case. The insurer "maliciously killed her" because it did not want to bear the expense of her transplant and aftercare, Geragos said. Nataline had been battling leukemia and received a bone marrow transplant from her brother. She developed a complication, however, that caused her liver to fail. Doctors at UCLA determined she needed a transplant and sent a letter to CIGNA Healthcare on December 11. The Philadelphia-based health insurance company denied payment for the transplant. On Thursday, about 150 teenagers and nurses protested outside CIGNA's office in Glendale. As the protesters rallied, the company reversed its decision and said it would approve the transplant. Despite the reversal, CIGNA said in an e-mail statement before she died that there was a lack of medical evidence showing the procedure would work in Nataline's case. "Our hearts go out to Nataline and her family, as they endure this terrible ordeal," the company said. " ... CIGNA HealthCare has decided to make an exception in this rare and unusual case and we will provide coverage should she proceed with the requested liver transplant." In their letter, the UCLA doctors said patients in situations similar to Nataline's who undergo transplants have a six-month survival rate of about 65 percent. District attorney spokeswoman Sandi Gibbons declined to comment on Geragos' planned request for murder or manslaughter charges, saying it would be inappropriate to do so until Geragos submits evidence supporting the request. Officials with CIGNA could not immediately be reached for comment Thursday night"

http://www.cnn.com/2007/HEALTH/conditions/12/21/teen.liver.transplant.ap/index.html

12/21/2007 7:45:38 PM

okay...

i hate the heartless and evil insurance companies as much as the next guy, but here's the key:

Quote :

"She had been in a vegetative state for weeks"

but whats the fucking point of putting a new liver into a braindead person, who's just going to lay in a coma the rest of their life?

transplants are SO fucking hard to get for millions of people who need them, that liver should have been marked for someone who could actually use it.

I know CIGNA doesnt have control over who gets which liver ...

but refusing to pay for hundreds of thousands of dollars -- probably more like tens of millions over a lifetime -- to extend the life of someone who is in a vegatative, braindead state... I'm sorry, but that's just the way life goes.

I have a child and I feel her pain, but damn. i hate to say it, but you just have to let go at some point. it sucks, but being braindead is a reality you cant just wish or hope or pray away.





[Edited on December 21, 2007 at 7:57 PM. Reason : ]

12/21/2007 7:54:10 PM

^ Such economizing is only legal in countries with socialized medicine. This is America, and what is good for the AMA is good for America.

12/21/2007 8:10:42 PM

There's always hope, right?



But yeah, a very costly medical procedure (in terms of cash and in terms of a fairly rare, available liver) for someone who has been in a "vegetative state for weeks"......tough decision, but probably the right one, given the information in the article.

12/21/2007 8:11:34 PM

I can see a vegetative state for years... but weeks? And these people had insurance. Thats what insurance is for. Who the hell is the insurance company to decide who lives and who dies, especially when these people paid for the coverage?

12/21/2007 8:20:52 PM

And this is what our torts system exists for - breach of contract, gross negligence, wrongful death, etc. And any resulting criminal charges they can convince a DA to pursue.

Try that on a state or Federal government and you'll get a sovereign immunity clause thrown at you.

Mechanisms exist to punish private actors like this (assuming they work correctly). Try doing that with the government.

[Edited on December 21, 2007 at 8:31 PM. Reason : .]

12/21/2007 8:30:57 PM

^^ Usually when two parties interact on such an arangement there will be a contract they both signed outlining the responsibilities of the two parties in various circumstances.

More accurately, you could just go read the law passed by the state legislature. There is very little room for insurance companies to maneuver in efforts to cut costs, as I understand it.

[Edited on December 21, 2007 at 8:33 PM. Reason : ^]

12/21/2007 8:32:35 PM

Well, the fact that they reversed the decision showed that approving it was well within their discretionary means.

12/21/2007 8:47:32 PM

That, or their prior decision was an administrative or other kind of error. I mean, before we assume malice here, there are still the possibilities of human fallacy and simple stupidity to be considered.

12/21/2007 8:50:20 PM

Quote :

"Who the hell is the insurance company to decide who lives and who dies,"

Well..we're all too eager to let the gov't decide who lives and dies under socialized medicine.

Just imagine how wonderful it will be when a gov't bureaucrat informs you that you've led a good long life and ...we're very sorry..but you cannot have any more surgeries. Too costly. Plus we noticed you voted for the other side last election.

12/21/2007 8:56:05 PM

^ What the fuck?

Who is all too eager? Save your "oh dear god the liberals are going to drag us into socialistic hell" talk for when Scuba Steve officially brings it into the thread.

12/21/2007 9:19:17 PM

Survival of the Fittest.

12/21/2007 9:42:15 PM

Scuba Steve, you do realize that HMO's are PROFIT CAPPED by the states? The whole "omg they just care about increasing profits" line is bullshit.

12/22/2007 4:00:48 AM

Quote :

"Who the hell is the insurance company to decide who lives and who dies"

This is kinda my thing as well. CIGNA is an insurance company. People pay them premiums on a monthly basis and in return, they get coverage for things that they need. Usually, its the doctors who decide what they need. In this case, seems like CIGNA just decided they didnt see a good reason this transplant. I dont think thats thier call. If these folks paid thier premiums, they should be covered for a potentially life saving surgery. Not doing so cost the family the life of this girl. I think its completely CIGNA's fault and they should be held responsible.

12/22/2007 7:57:34 AM

Quote :

"If these folks paid thier premiums, they should be covered for a potentially life saving surgery."

... under the terms of their insurance policy. That's the thing that we're forgetting here, that there are limits to your insurance. Part of that limit is a cut off point where your chances of survival are ever diminishing. A 65% chance of surviving the next 6 months after the treatment is not very good odds.

Quote :

"Not doing so cost the family the life of this girl. I think its completely CIGNA's fault and they should be held responsible."

Why is it not the family's fault for not buying a better insurance plan? Why isn't it their fault for not paying out of pocket when the insurance company declined to cover it? Why isn't it the hospital's fault for not doing the work for free? Why isn't it the fault of all the protesters who instead of protesting outside the insurance company's office, could have instead donated money to the girl's family? I know we like to talk about evil insurance companies, but just like it's not their decision who gets livers, they didn't deny her a liver either, they just declined to pay for it.

12/22/2007 9:21:29 AM

^^ I disagree. While I have not read their contract, I would hope that my health insurer is at least trying to keep my premiums down. If a transplant for a girl that is probably brain-dead anyway is going to drive up all our premiums by $1 a year then I would hope they do not do it. Some sacrifices for the general good of policy holders are desirable, and I do realize that I am risking my life in the name of saving my own money through this principle. But fire-fighters do this every-day, why shouldn't the insurance company be able to offer us protection with limits since it is cheaper and let us decide?

[Edited on December 22, 2007 at 9:30 AM. Reason : ^]

12/22/2007 9:30:34 AM

^^

OK OK....both good points. The terms of the contract are very important. No telling what they were in this case. It just seems like if they were paying for health care coverage, they should get it, contractually speaking.

^

I hear what you are saying, and I agree with you ...but its just like...well...like you said... I want my premiums down too, but God forbid the day comes when like, my wife or my daughter needs something like, I would hope they would help me....


I dont know...its a rough situation...I guess I would want to know what the terms of the contract were...

12/22/2007 9:49:24 AM

The important thing here is that medical decisions should be left to medical professionals, not suits.

With multiple doctors agreeing that a liver transplant was a good idea, that should have been enough to authorize treatment.

Ultimately the coming lawsuit is going to cost Cigna a hell of a lot more than the treatment would have.

12/22/2007 10:47:57 AM

The only decision the suits made was that the particular procedure in question, for this particular case was not covered by the specific insurance policy in question. The actual decision to go ahead with the transplant was still in the hands of the parent and the doctors.

Also, there was nothing which prevents the parents from paying out of pocket and then suing the insurance company for reimbursement if they honestly believed it should have been covered by their policy.

In the end, the decision not to go ahead with the procedure, and the decision to take the girl off life support was entirely in the hands of the parents and the doctors.

It's a crappy situation I agree, and I hope that I would never be in such a position to decide whether I would put myself into extreme debt or let a family member die, but in the end, that was the decision to be made, and the family made a monetary decision just like the insurance company did.

12/22/2007 11:17:40 AM

I thought the lawyer's name sounded familiar: http://en.wikipedia.org/wiki/Mark_Geragos

This article has more information than the OP:

Quote :

"Tough calls in transplant case A Northridge teen dies shortly after her insurer reverses its refusal to pay for a treatment it called experimental. By Molly Hennessy-Fiske, Los Angeles Times Staff Writer December 22, 2007 The case of a Northridge teenager taken off life support just as her insurance company reversed itself and agreed to pay for a liver transplant is highlighting tensions among physicians, patients and insurers over the definition of experimental procedures. Nataline Sarkisyan's family blames their insurance company, Cigna HealthCare, for the teenager's death Thursday. A leukemia patient, 17-year-old Nataline had been in intensive care at UCLA Medical Center for about three weeks after suffering complications following a successful bone marrow transplant Nov. 21, relatives said. She was covered under the policy of her mother, a real estate agent. Doctors treating Nataline told the family and Cigna in a letter that patients in similar situations have a 65% chance of living six months if they receive a liver transplant. Doctors had qualified Nataline for a transplant Dec. 6 and a liver became available four days later, the family said. But the transplant was not performed because Cigna had refused to approve and pay for the procedure, they said. Cigna turned down the transplant, calling the procedure experimental because it was not supported by enough medical literature as safe or effective in such cases. The family's benefit plan does not cover experimental treatments. But this week, after receiving an appeal from the family and UCLA doctors, the company reconsidered. Arlys Stadum, a Cigna spokeswoman, said the insurer submits all transplant requests to physicians with transplant expertise for review. Every request that is refused has been seen by at least one expert physician, she said. In explaining the reversal, she said, "It was really just looking at how complex the decision was." Stadum said she couldn't provide more details because the Sarkisyans had not given the company permission to discuss Nataline's case. Doctors at UCLA also refused to discuss the case without family permission , but other transplant physicians said doctors and the insurer faced a difficult call. The family mobilized supporters with the help of local Armenian groups and Eve Gittelson, an online health policy writer known as "nyceve" whose dispatches appear on the influential Daily Kos blog. On Friday, Nataline's father and brother held a news conference, lashing out at Cigna and giving their version of the events leading up to the teenager's death. Nataline's father, Krikor Sarkisyan, said he was protesting with relatives and supporters outside Cigna's Glendale office Thursday afternoon when his sister phoned and summoned him to the hospital. Doctors said Nataline's condition had worsened, that she was not likely to recover and gave the family the option of removing her from life support. About 4:40 p.m., just as Sarkisyan said the family had decided to remove Nataline from life support, Cigna sent a letter to the family's attorney approving the transplant. The letter, faxed to attorney Mark Geragos, is stamped 4:44 p.m. Geragos said his staff tried unsuccessfully to reach the Sarkisyans at the hospital. The family said they didn't see the letter until after they removed Nataline from life support at 5:20 p.m. "They took my daughter away from me," Krikor Sarkisyan, 51, an automotive technician, said at the news conference outside Geragos' downtown L.A. office. In the letter, Deborah Garnsey, a registered nurse who reviews cases for Cigna, said she had reviewed the family's appeal on Thursday and decided that day "to make an exception in this rare and unusual case." She noted that the family's appeal was reviewed by an oncologist and liver specialist. "We are making this decision on a one-time basis, based on the unusual circumstances of this matter, although the treatment, if provided, would be outside the scope of the plan's coverage and despite lack of medical evidence regarding the effectiveness of such treatment," Garnsey wrote. Dr. John Roberts, chief of the transplant service at UC San Francisco, said Cigna faced a difficult decision in the case, based on the facts presented by the UCLA team. Roberts said his center generally will not accept a patient without a 50% chance of living five years. According to UCLA's letter to Cigna, patients like Nataline had a 65% chance of living six months. "The problem that they got into is, here's a situation where she didn't have very long to live," he said. "Probably in this situation, they're probably better off to say, 'The transplant center really feels like this is the right thing to do, let them go ahead.' " The standard of care for this particular situation is "going to be pretty hard to know," Roberts added. "I think it's a very difficult decision for both the transplant center and the insurance company." Of the 1,107 patients under age 18 who received liver transplants nationally from Jan. 1, 2004 to June 30, 2006, nearly 92% survived at least one year. But most were not as ill as Nataline. Dr. Goran Klintmalm, chief of the Baylor Regional Transplant Institute in Dallas, said the operation that UCLA wanted to perform was a "very high-risk transplant" and "generally speaking, it is on the margins." But Klintmalm said he would consider performing the same operation on a 17-year-old and believes the UCLA doctors are among the best in the world. "The UCLA team is not a cowboy team," he said. "It's a team where they have some of the soundest minds in the industry who deliver judgment on appropriateness virtually every day." Karen Ignagni, chief executive of America's Health Insurance Plans, an industry trade group, said that the case shows how few employers, and even individuals, want to pay for experimental care coverage when they buy insurance, but that when people find themselves in dire health, everyone wants it. "We've been looking very seriously at this issue because [experimental coverage] is over and above what employers purchase," she said. "But individuals, when they are facing these extreme circumstances, want to have a place to go. They want solutions. We need to address this issue from a societal perspective." Ignagni said her organization, which represents Cigna and other major health plans, is considering proposing that some sort of reinsurance program be created to cover certain experimental procedures. The California Nurses Assn. publicized Nataline's case, calling it an illustration of the need to abandon private insurance coverage in favor of a single-payer plan. "If Cigna could approve the transplant yesterday in response to hundreds of phone calls and people pounding on their door in Glendale, why couldn't they have done it eight days earlier?" said Charles Idelson, spokesman for the Oakland-based group. Although it isn't clear that Cigna could have saved Nataline by approving the transplant earlier, Idelson said, the insurer should have trusted her doctors. "The transplant was recommended by the medical professionals at the bedside," Idelson said. "They should have been listened to." Nataline's mother said she believed that Cigna was just trying to save money. "They just like to collect," Hilda Sarkisyan said. "They don't want to deliver.""

http://www.latimes.com/business/la-fi-transplant22dec22,1,3777077.story?page=2&track=crosspromo&coll=la-headlines-business

[Edited on December 22, 2007 at 11:34 AM. Reason : ]

12/22/2007 11:27:20 AM

This is the sort of shit that inclines me to believe that we should transfer over to a socialized health care system like they have over in Europe. Because privatized insurance companies make a profit off of you not receiving coverage, they have an incentive to find any reason to deny you. That's not necessarily a fault of the free market, we're in the mess that we're in because insurance companies have built a suffocating monopoly. That's also not to say that socialized health care would somehow be perfect, but under that system there'd be no reason to deny anybody a life-saving operation (in theory, anyway, not sure how it'd pan out in practice).

Quote :

"[You should get coverage] under the terms of their insurance policy. That's the thing that we're forgetting here, that there are limits to your insurance."

Fine, you have a point. But isn't it a little bullshit that your ever-increasing premiums go towards paying some corporate mook's ludicrous salary, only for him to turn back around and say "sorry, because you filled out form x-22 instead of form x-21, we will not pay for this operation that will spare you considerable pain and discomfort, and possibly even save your life?"

I can even give you a real world example. My dad's an ob/gyn doctor, and occasionally he'll have to perform last-minute hysterectomies or other similar surgeries because maybe one of his patients have an infection in their reproductive organs that, left untreated, can kill them later on. As a doctor he's obligated to save their lives. But Mr. BCBS has this nifty little rule that says that patients have to fill out a sterilization consent form (among a myriad of other consent forms) within 30 days before the procedure. A patient might not have 30 days, sometimes they need to be operated on now! So does my dad see any money from BCBS? No, it's left up to the patient. And typically the ones who can fill out the forms in time were the middle/upper class patients who were thinking about getting spaded anyway, the ones who need the emergency operations are the poor and unemployed. In a county that's almost nothing but unemployed people, my dad doesn't see a dime either way.

It's not fair to the patients who are forced to pay for everything out of pocket, and it's not fair to the doctors who don't get their just compensation. All the insurance companies have to do is stop being assholes and do what they're payed to do, but instead they're too preoccupied with their bottom line. They have complete reign over the market, so they can jack up prices to their hearts content while providing little-to-no service. It's disgusting and I wish to Vishnu that somebody would do something about it.

12/22/2007 11:51:30 AM

Quote :

"Nataline's mother said she believed that Cigna was just trying to save money. "They just like to collect," Hilda Sarkisyan said. "They don't want to deliver.""

Except when they deliver on payments for Leukemia treatment and bone marrow transplants, and ICU care when complications arise. Again, it's a shitty situation, and I feel for the family, but there are always options.

^ But at what point is it no longer a life saving procedure and just a last ditch attempt? When her chances of survival fall below 50%? 40%? 2%?

[Edited on December 22, 2007 at 11:56 AM. Reason : asdf]

12/22/2007 11:53:05 AM

50%? You wouldnt give somebody an operation when the odds are 50%!

Jesus man, those are pretty good odds. I mean, its a human freaking life we're talking about. If we don't have life, we don't have anything.

12/22/2007 12:01:23 PM

Quote :

"This is the sort of shit that inclines me to believe that we should transfer over to a socialized health care system like they have over in Europe. Because privatized insurance companies make a profit off of you not receiving coverage, they have an incentive to find any reason to deny you. That's not necessarily a fault of the free market, we're in the mess that we're in because insurance companies have built a suffocating monopoly. That's also not to say that socialized health care would somehow be perfect, but under that system there'd be no reason to deny anybody a life-saving operation (in theory, anyway, not sure how it'd pan out in practice). "

We are in this mess because the federal and state governments have so heavily regulated HMO's, that no competition can enter the market.

We have an oligopoly (not a monopoly) in the health insurance industry. And it's ENTIRELY due to government regulation to "help ensure quality of care".

This is yet another example where good intentions have led to all kinds of fucked reality when the goverment gets involved on behalf of its people.

Remove the regulations, it opens the market to new competition which will massively lower costs and raise standards of care.

12/22/2007 12:52:41 PM

Quote :

"which will massively lower costs and raise standards of care"

I doubt it

12/22/2007 3:05:35 PM

Quote :

"The average state has 36 mandates on an individual health insurance policy. And with each mandate, the cost to the consumer goes up. These mandates often stand in the way of making health insurance more affordable in the first place. Just as options on a new automobile add to the total cost of the car, so too do insurance mandates. If affordability and accessibility are the problems behind the number of uninsured, then why haven’t state governments removed the mandates for those who want to buy a basic policy? It’s not just the government’s desire to micromanage — it’s interest-group politics. Acupuncturists, for example, certainly provide an important pain-relief service to many individuals. But is it really necessary for everyone to have acupuncture coverage whether they want it or not? It would make far more sense to give individuals the freedom to purchase policies that suit their specific needs."

Or it would make more sense to give the insurance company freedom to spend money on a liver for a dying girl than be required to cover acupuncture for everyone. But I suppose common sense is the least common of all senses, especially if you're referring to the government.

12/22/2007 3:24:21 PM

Quote :

"50%? You wouldnt give somebody an operation when the odds are 50%! "

Would you bet your money on a 50/50? I wouldn't. Sure, it's a 50% chance they live, it's also a 50% chance they die. Especially if it was 50% that they would live another 6 months. Because that means your odds are going down from there.

Quote :

" I mean, its a human freaking life we're talking about. If we don't have life, we don't have anything."

So why didn't the parents pay out? Why didn't the hospital? Why is it soely the fault of the company who's contract with the family explicitly spells out that they will not pay for such odds that this treatment wasn't paid for? Again, the ONLY thing the insurance company decided was that they weren't paying for it. Everything else was up to the family.

Quote :

"I doubt it"

Why do you doubt it? Has there ever been a point in history where open competition has raised the costs and reduced the quality of the products?

12/22/2007 7:04:26 PM

Quote :

"And these people had insurance. Thats what insurance is for. Who the hell is the insurance company to decide who lives and who dies, especially when these people paid for the coverage?"

Bingo. What the hell good is "insurance" if it's not going to fucking pay for what it is "insuring."

Quote :

"Because privatized insurance companies make a profit off of you not receiving coverage, they have an incentive to find any reason to deny you."

Tell me, what do you think is going to happen when citizens are bitching about how much they are paying in taxes for a socialized medical system?

But seriously, this is why we need to fix the problem w/ health care so that people don't need insurance any more. Hillary's plan to mandate that people have insurance is fucking ridiculous, and it should prove how much the insurance lobby is paying her.

12/22/2007 9:45:02 PM

An aaronburro post I kind of agree with!

What's the world a-comin' to?

12/22/2007 10:01:53 PM

^^ completely agree

12/26/2007 3:08:13 PM

Quote :

"Just imagine how wonderful it will be when a gov't bureaucrat informs you that you've led a good long life and ...we're very sorry..but you cannot have any more surgeries. Too costly."

It will be pretty much exactly as wonderful as when an insurance company representative does the exact same god damned thing.

This whole situation is the result of a private company's bureaucracy fumbling just like a good old fashioned government one. The one isn't looking a whole lot more efficient than the other.

Quote :

"Why is it soely the fault of the company who's contract with the family explicitly spells out that they will not pay for such odds that this treatment wasn't paid for?"

It couldn't have been too explicit, since they managed to change their minds on the issue.

12/26/2007 4:30:21 PM

^ so what, a company can't decide to act in your favor despite their contract with you? The family asked for an exception to the policy, the company granted it. It isn't CIGNAs fault that the family made the decision to take their daughter off life support before they heard back. It isn't their fault that the family made the (economic) decision to not go ahead with the surgery and deal with the insurance later or that the doctors made the (economic) decision to not do the surgery on their own dime. In fact, dare I say the only people in this whole procces who made the right decisions were cigna? Their first decision was made based on their legal contract and obligation to the family, and then when asked to reconsider their decision was made on the extenuating circumstances.

12/26/2007 5:52:03 PM

Quote :

"It isn't their fault that the family made the (economic) decision to not go ahead with the surgery and deal with the insurance later or that the doctors made the (economic) decision to not do the surgery on their own dime."

The whole reason that people get insurance is because they realize that, should the need arise, they will be (economic)ally incapable of paying out-of-pocket. That's why insurance companies exist. Also, the doctors aren't the ones who are paid premiums to finance operations.

CIGNA, on the other hand, had the assets necessary to pay, and in fact were paid to do so.

I'm curious to see more details on what qualifies as an "experimental procedure." Liver transplants aren't brand new or anything.

---

Even assuming that CIGNA fulfilled the terms of its contract to the T, the situation would still stand as a clear demonstration of the flaws of the private health care system. Ultimately, insurance companies are capable of paying large sums of money for legal counsel to devise contracts that leave them these outs. They are also in the advantageous position of not really needing any individual subscriber, whereas that individual does need insurance. They've got the gun to our heads as sure as the government would.

12/27/2007 1:27:08 AM

Healthcare actually should be provided by the state and you'd be actively engaging in doublethink if you believe otherwise.

Honestly, a for-profit company in charge of my medical treatment? I wonder which way they'll tend to vote when it comes down to 'cheap' or 'healthy.'

I also find it a bit ironic that some of the nation's poorest people argue against government provided health care.

12/27/2007 1:31:51 AM

Healthcare is one of those very few issues where wasteful, excessive spending is preferable to lowballing.

[Edited on December 27, 2007 at 1:34 AM. Reason : alive and poor > dead and marginally less poor]

12/27/2007 1:34:16 AM

^ You're looking to incur the wrath of LoneSnark there.

12/27/2007 1:42:54 AM

I frequently find myself drifting off to sleep with many worries on my mind. That I might have incurred the wrath of libertarians is not among them.

12/27/2007 1:51:36 AM

Being threatened by a Libertarian is akin to being told you're going to hell by Gene Simmons.

12/27/2007 1:53:31 AM

Quote :

"The whole reason that people get insurance is because they realize that, should the need arise, they will be (economic)ally incapable of paying out-of-pocket. That's why insurance companies exist. "

Right, but in the end, you still need to work out with your insurance company which services they will cover and which they will not. Your insurance does have limits, how high those limits are is ultimately a matter if how high you want your premiums to be. You have a choice of the type of coverage which you will have, ultimately the choices you make will affect the outcome of the decisions you ask your insurance company to make. Furthermore, nothing at all stopped this family from taking on debt to the hospital, having the surgery performed and fighting the insurance company for reimbursement later.

Quote :

"Also, the doctors aren't the ones who are paid premiums to finance operations. "

No, but they certainly have the money to do the occasional life saving operation for free. Why aren't they responsible for this girl's death since after the insurance company denied payment, they still greedily demanded payment before they would save her life?

Quote :

"IGNA, on the other hand, had the assets necessary to pay, and in fact were paid to do so. "

They were paid to fulfil the terms of the insurance contract that they had with the family. Nothing more, nothing less. And as far as having the assets to pay, as I said, so did the doctors.

Quote :

"I'm curious to see more details on what qualifies as an "experimental procedure." Liver transplants aren't brand new or anything."

But liver transplants to treat a failing leukemia patient are not standard reasons for liver transplants. From the above article (and yes, I know the only thing you can get two doctors to agree on is the third doctor is wrong):

Quote :

"Dr. John Roberts, chief of the transplant service at UC San Francisco, said Cigna faced a difficult decision in the case, based on the facts presented by the UCLA team. Roberts said his center generally will not accept a patient without a 50% chance of living five years. According to UCLA's letter to Cigna, patients like Nataline had a 65% chance of living six months. "

Quote :

"Even assuming that CIGNA fulfilled the terms of its contract to the T, the situation would still stand as a clear demonstration of the flaws of the private health care system. Ultimately, insurance companies are capable of paying large sums of money for legal counsel to devise contracts that leave them these outs. "

And what makes you think a public healthcare system will do any better? ANY system where you have a third party paying for YOUR health is going to be a system where at some point you are going to be denied coverage for treatment that you want.

Quote :

"They are also in the advantageous position of not really needing any individual subscriber, whereas that individual does need insurance. They've got the gun to our heads as sure as the government would."

The difference is, any subscriber doesn't need any one particular insurance company. Every single customer of CIGNA could today, switch to another provider if they wanted. They could say that CIGNA was wrong and they will no longer support them and find someone else to provide their coverage. What happens when it's the government denying transplants for little girls? Who do you switch to then? How do you stop supporting an evil system like that when the money is taken from you before you even get a chance to see it? And you are delusional if you think that situations like this won't arise under a government system.

Quote :

"Healthcare actually should be provided by the state and you'd be actively engaging in doublethink if you believe otherwise."

Health care should be provided by the individual, health INSURANCE should be provided by whomever the individual wants to contract with.

Quote :

"Honestly, a for-profit company in charge of my medical treatment? I wonder which way they'll tend to vote when it comes down to 'cheap' or 'healthy.' "

They aren't in charge of your medical treatment, you are. You can still ask for and recieve any treatment you want. It's just a matter of who pays.

Quote :

"I also find it a bit ironic that some of the nation's poorest people argue against government provided health care."

Perhaps because they're the ones that look at their paychecks each week and think that if only a little less was taken out of their check by the government, they could afford that visit to the doctor, or even afford that health insurance. I know I did. And you'd be a fool to think that taxes wouldn't go up. The government isn't going to cut funding from elsewhere to pay for it, they'll just up your taxes, again and again and again.

Quote :

"Healthcare is one of those very few issues where wasteful, excessive spending is preferable to lowballing. "

Wasteful excessive spending means more money paid in but less money paid out for everyone. By contrast, low balling just means that you pay out of pocket and sue for reimbursement.

12/27/2007 9:59:24 AM

Quote :

" Health care should be provided by the individual, health INSURANCE should be provided by whomever the individual wants to contract with. "

Quote :

" They aren't in charge of your medical treatment, you are. You can still ask for and recieve any treatment you want. It's just a matter of who pays. "

Stating replies in a matter-of-fact way does not make you insightful, original, or in this case even remotely approaching the realm of correct. Now unless the internet sarcasm plane flew over my head, I'm having trouble trying to figure out how you manage to perform basic logic functions on a day to day basis.

For starters, lets not confuse health care and health insurance as two separate distinct entities. Health care encompasses health insurance, private or public. Personal care, if such a phrase exists, encompasses you taking care of yourself. Hence the general term 'health' vs a more specific term 'personal.'

In fact, because this is TWW and everyone but myself and relatively few others are mentally lacking, I'll provide some of google's definitions for your enjoyment:

Quote :

" Definitions of health care on the Web: * Care, services or supplies related to the health of an individual. Health care includes, but is not limited to preventive, diagnostic, therapeutic ... http://www.dpw.state.pa.us/General/HIPAAPrivacy/003670787.htm * includes all reasonable and necessary medical aid, medical examinations, medical treatments, medical diagnoses, medical evaluations, and medical services. The term does not include vocational rehabilitation. http://www.uth.tmc.edu/safety/risk/definitions.htm * [SCOPE NOTE: Includes health services, comprehensive health care, private and governmental programs and services, public health, and medical care] cirrie.buffalo.edu/thesaurus/thesh.html * Care, services, or supplies furnished to an individual and related to the health of the individual. Health care includes the following: http://www.hipaa.state.sc.us/glossary.htm * "Health care" means preventative, diagnostic, therapeutic, rehabilitative, maintenance or palliative care, services, procedures or counseling, including appropriate assistance with disease or symptom management and maintenance, that affects an individual's physical, mental or behavioral ... janus.state.me.us/legis/statutes/24-a/title24-asec2204.html * is the provision of services that helps individuals achieve an optimal state of well-being, in any setting or stage in the human life cycle http://www.ihs.gov/NonMedicalPrograms/chr/vocab.cfm "

But hey, redefining terms and phrases is clearly in cultural vogue these days.

It should also be noted that 'a matter of who pays' actually is the main vector in determining your health care. If your health care provider denies a fifty thousand dollar transplant, and you most obviously won't be getting that money from anyone else, then in essence they are choosing your treatment path for you.

Having two options, but one being out of the realm of possibility isn't a choice but predetermination.

Quote :

" Perhaps because they're the ones that look at their paychecks each week and think that if only a little less was taken out of their check by the government, they could afford that visit to the doctor, or even afford that health insurance. I know I did. And you'd be a fool to think that taxes wouldn't go up. The government isn't going to cut funding from elsewhere to pay for it, they'll just up your taxes, again and again and again. "

This is a red herring argument thats not relevant to the discussion. Good governance and fiscal responsibility are their own important topics and shouldn't be confused with the fact that efficiently run government, as much of an oxymoron as that seems, would provide better health care then private company whose operating motive is profit.

12/27/2007 11:41:54 AM

Quote :

"For starters, lets not confuse health care and health insurance as two separate distinct entities. Health care encompasses health insurance, private or public. Personal care, if such a phrase exists, encompasses you taking care of yourself. Hence the general term 'health' vs a more specific term 'personal.'"

Note that none of the definitions you quote include insurance or method of payment as part of the definition of health care. Hence why I said, health care, which consists of caring for your health should be provided by the individual. The meathod of payment is and should be up to the individual and their doctor. Wheather that method is insurance, independant wealth or fried chicken is a decision that should not be up to the government.

Quote :

"It should also be noted that 'a matter of who pays' actually is the main vector in determining your health care. If your health care provider denies a fifty thousand dollar transplant, and you most obviously won't be getting that money from anyone else, then in essence they are choosing your treatment path for you. Having two options, but one being out of the realm of possibility isn't a choice but predetermination. "

So are you saying that negotiation with your doctor is out of the question? Again, what stopped the doctors from doing the surgery for free or the parents from going into debt and suing for reimbursment if they truely believed the insurance company should pay?

Quote :

" Good governance and fiscal responsibility are their own important topics and shouldn't be confused with the fact that efficiently run government, as much of an oxymoron as that seems, would provide better health care then private company whose operating motive is profit."

So find me an efficiently run government, and I'll reconsider my stance on health care. Also find me a government run healthcare system that won't lead to the inevitable laws over what a person can or can't do with their own body.

[Edited on December 27, 2007 at 12:05 PM. Reason : sdfgsfdg]

12/27/2007 12:03:40 PM

Quote :

"Health care should be provided by the individual, health INSURANCE should be provided by whomever the individual wants to contract with."

I can't speak for 1337 b4k4, but I believe he's referring to something along the lines of the individual being responsible for 'preventative maintenance' type health care (check ups, treatment of minor injuries, coughs, colds, etc) and insurance being responsible for catastrophic health care (massive bodily harm, diseases, transplants, etc). That is, health insurance should be more akin to car insurance--the individual is responsible for general upkeep and minor repairs, while insurance is used for exclusively for high-dollar repairs.

Quote :

"efficiently run government, as much of an oxymoron as that seems, would provide better health care then private company whose operating motive is profit."

Why does "efficiently run government" seem like an oxymoron? Perhaps because the government is not and has never been efficient? Sure, I'd agree that an efficient government would be wonderful, but an efficient government isn't something that's going to happen. Ever.

[Edited on December 27, 2007 at 12:08 PM. Reason : I type too slow]

12/27/2007 12:07:38 PM

Quote :

"the individual being responsible for 'preventative maintenance' type health care (check ups, treatment of minor injuries, coughs, colds, etc) and insurance being responsible for catastrophic health care (massive bodily harm, diseases, transplants, etc). That is, health insurance should be more akin to car insurance--the individual is responsible for general upkeep and minor repairs, while insurance is used for exclusively for high-dollar repairs."

This is understandable and agreeable as long as the preventative stuff is affordable for everyone as well. Also, you'd have to be guaranteed the large payouts for expensive surgeries. As it is now, basic healthcare is fine, its just the large things you have to fight the companies tooth and nail to get any payments because everything is 'experimental' or 'optional.'

Quote :

"Sure, I'd agree that an efficient government would be wonderful, but an efficient government isn't something that's going to happen. Ever."

Government doesn't have to be efficient to fulfill its duties to its citizens. It's ideal for it to be efficient but its also ideal for everyone to stay healthy until the day they die.

12/27/2007 12:15:22 PM

You know what dudes, I give up.

Continue to think 250$ checkups and 700$ Xray's aren't absurd.

12/27/2007 12:54:34 PM

^^^ yep

^ They are absurd, and do you know why they're absurd? Because everyone has fucking insurance to cover all the little things. Do you really think your doctor could survive charging $250 for checkups if everyone had to pay out of pocket for them? Hell no. But he charges high so that when the insurance company pays out 30-50% of what he charges, he still gets his high paycheck. Even worse, if god forbid he lowered his prices, the insurance companies would lower what they paid since lower prices brings down the UCR for his services.

And the prices sure as hell won't go down when it's the government footing the bill. Call a suplier up, any supplier and tell them you're interested in a bulk purchase of something and ask about pricing. Then call up and say you're asking about a bulk purchase for the government. You'll pay more the second time. The government always pays more in the long run, because in the end, there's more paperwork, red tape and processes and procedures for the government.

12/27/2007 1:02:58 PM

...

LOOOOOOOOOOOOOOOOOL

I'm glad you have such a solid grasp on the overhead most Doctor's have.

12/27/2007 1:08:35 PM

Well, then. Explain the overhead doctors have.

Then explain how the current health care system (government/private) distorts those prices.

Then explain how a 100% government run health care system would fix our health care problems.

Then explain how a 100% private health care system would fail to fix our health care problems.

12/27/2007 1:28:30 PM

Quote :

"... LOOOOOOOOOOOOOOOOOL I'm glad you have such a solid grasp on the overhead most Doctor's have. "

Knowing doctors in several fields, medical malpractice insurance accounts for a good 20-25% of their salary. Another 10-20% goes toward med school loans.

Because of this, they make a lot, and pay an absurd amount more in tax as a result. They get shit on from all sides and end up making not-all-that-much.

12/27/2007 1:32:42 PM

For what it's worth, I don't begrudge doctors their large paychecks. They charge what the people (or in thise case, the insurance companies and the government) will pay, and they certainly have large expenses to pay, but it's extremely ignorant to think the the current way the insurance industry pays for everything doesn't inflate the prices that are paid.

12/27/2007 1:48:49 PM

Quote :

"Right, but in the end, you still need to work out with your insurance company which services they will cover and which they will not."

Except this isn't really possible, in any meaningful sense. The insurance company presents you with a limited set of options, all written in contracts of their own very careful design by people with the resources to scan your life meticulously for the slightest technical error that would justify them denying service.

So no, you don't get to "work out" a damn thing. You have your choice between several steaming piles of shit.

Quote :

"Furthermore, nothing at all stopped this family from taking on debt to the hospital"

How do you know this? From the information provided we have no reason to believe that the hospital (or anyone else) would have loaned this family money or let the operation be performed on credit or some such.

Quote :

"No, but they certainly have the money to do the occasional life saving operation for free."

You're saying the doctors are in the wrong for not performing an act of charity.
I'm saying CIGNA is in the wrong for not doing the job for which it is paid.

And hell, CIGNA undoubtedly has a lot more money available than UCLA's doctors do, it was a lot more capable of being charitable. By this logic, every man, woman, and child in America is at fault for not being charitable.

Do you even realize how ridiculous all this sounds?

Quote :

"And what makes you think a public healthcare system will do any better?"

First and foremost, comparing such systems to our own, and seeing that their health is better across the board. There's only so much you can do to explain away the fact that America has worse health statistics than any modern country with socialized medicine (which, incidentally, is all of them . . . except us). I'm afraid I tend towards the pragmatic, and find ideology a poor substitute for results.

Quote :

"Every single customer of CIGNA could today, switch to another provider if they wanted."

The difference between the insurance providers is negligible. All you've got is the illusion of choice.

Quote :

"What happens when it's the government denying transplants for little girls?"

It will, invariably, happen. However, I believe it will happen much less frequently due to a broadening of covered treatment options, as well as a fundamental change in motives. The goal of the bureaucracy in charge of the system will not be to make money, but rather to spend it.

And I've never once said that I opposed the existence of private insurance companies alongside the state payer. I doubt they'd be widely used, for obvious reasons (you're going to be paying the state either way), but you'd have your choice.

Quote :

"How do you stop supporting an evil system like that when the money is taken from you before you even get a chance to see it?"

At the ballot box.

Quote :

"It's just a matter of who pays. "

Again, an illusion of choice. If you are incapable of paying for something then it isn't really an option, is it?

Quote :

"Wasteful excessive spending means more money paid in but less money paid out for everyone. By contrast, low balling just means that you pay out of pocket and sue for reimbursement."

Couldn't disagree more on the first point. For one, citizens of countries with socialized medicine pay less, per capita, for their healthcare than we do. For another, they seem to receive superior care, if we are to trust such foolish barometers as life expectancy and infant mortality.

And suing for reimbursement? Jesus, we've got a person who's already in debt because they had to pay for the procedure out of pocket, and you want them to somehow come up with the money to fight a legal battle against a large corporation?

Man, you libertarian types cannot get enough of that illusion of choice.

Quote :

"The government always pays more in the long run, because in the end, there's more paperwork, red tape and processes and procedures for the government."

Then why haven't we seen this is any of the other countries that have socialized medicine? Why aren't their governments paying a thousand dollars an x-ray? Why no $500 checkups?

12/27/2007 2:40:28 PM