This story from the Courant adds a bit of fuel to my concerns in the debate on universal health care:
The case of a Los Angeles 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, Bloomfield, Conn.-based CIGNA HealthCare, for the teenager’s death Thursday. A leukemia patient, Nataline, 17, had been in intensive care at UCLA Medical Center about three weeks after complications set in following a successful bone marrow transplant Nov. 21, relatives said. She was covered under the policy of her mother, a real estate agent.[...]
Doctors had qualified Nataline for a transplant Dec. 6 and a liver became available four days later, the family said. But a transplant was not performed, they said, because CIGNA officials had refused to approve and pay for the procedure.
CIGNA turned the transplant down, saying it was experimental and not supported as safe or effective in such cases by enough medical literature. 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.
It’s a tragic situation. And, stepping outside the natural sympathy towards the friends and family who experienced such a horrible loss during the holiday season…why is Nataline’s death viewed as seemingly CIGNA’s fault?
Speaking from experiences in the wake of my wife’s disability, I can completely empathize with the frustration of having to deal with administrators and the appeals process at health insurers.
However, CIGNA wasn’t the only party here that said “no”. The hospital and staff could have opted to perform the operation and worry about the financing later. The parents also could have agreed to take the financial gamble, and done battle with the appeals process later.
(Believe me, I’m aware of those options. I’ve been there and am going through the aftermath now.)
However, the public “knows” that insurers, particularly health insurers, are evil. Therefore insurers get the blame.
It is truly amazing what medical science can achieve today. New procedures become available with great regularity offering some new hope to folks suffering with various chronic or even terminal conditions.
However, for various reasons many of those new advances are g-dawfully expensive.
As a society, Americans believe we have a fundamental right to have access to those treatments, and to have someone else pay for them.
Health insurers are charged with greasing the works…to facilitate the financial side of health care, providing access to effective (and hopefully cost-efficient) treatments in a manner that is hopefully affordable to their members/customers. The balancing act between access and affordability is a tough one.
There’s been much public debate in recent months about increasing access to health care and health insurance. I still say there hasn’t been anywhere near enough discussion about the long-term costs about such access. And, until we come to terms with the expense, either by deciding that access to all the sexiest treatments isn’t an inherent right, or by finding some effective way to control medical cost inflation, we’re going to have an ugly situation on the universal health care front.