A Medical Case Becomes Political

[EV_Ares]

By VANESSA FUHRMANS and LAURA MECKLER
January 7, 2008; Page A1

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Edwards getting some flack about this incident where her family has come out in support of him which should be no surprise as he has been fighting on this front for some time.
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John Edwards has been bashing big health insurers in recent days with the story of a girl who died waiting for a liver transplant. But the details of the case suggest the Democratic presidential candidate may be oversimplifying the tale.

Nataline Sarkisyan had been battling leukemia for three years. Insurer Cigna Corp. rejected coverage for a liver transplant, then reversed its decision and said it would pay. The 17-year-old died before the operation could take place.

By pushing the case so hard on the campaign trail, Mr. Edwards is raising the emotional tone of the debate on health care, which has already emerged as perhaps the leading domestic issue in the campaign. Mr. Edwards and Sen. Hillary Clinton are among the Democratic candidates attacking health insurers.

"We need a president who will take these people on," Mr. Edwards said at the Democratic presidential debate Saturday night. He said Nataline "lost her life a couple of weeks ago because her insurance company would not pay for a liver-transplant operation."

Nataline Sarkisyan, who died last month.
In New Hampshire yesterday, the candidate's wife, Elizabeth Edwards, put her arm around the girl's mother, Hilda, before Mrs. Sarkisyan spoke at a campaign rally.

Cigna defended its handling of the case. "I'm perplexed that this has become a campaign issue," said Jeffrey Kang, Cigna's chief medical officer. "It is highly unlikely that any health-care insurance system, nationally or internationally, would have covered this procedure." (bs and nothing to support their claim about that).

Insurers are highly unpopular with many doctors, who complain about insurance-company bureaucracy, and with patients who don't like having medical claims denied. Left-leaning critics of the U.S. health-care system say it isn't appropriate for some insurers to be making billions of dollars in profit while tens of millions of Americans go without insurance. They would prefer the "single payer" type of system in many European nations, where the government takes the leading role in paying for care.

Link for entire WSJ article (req a subscription): http://online.wsj.com/article/SB119967240787671395.html?mod=hps_us_inside_today

[Triana]

1. TWO things about this bullshit story:

FIRST, John Edwards isn't "USING" that family. THEY ASKED HIM if they could join him on the campaign trail to tell their story so that this type of thing wouldn't happen to anyone else.

SECONDLY, IT SHOULD BE STRICTLY UP TO THE DOCTORS what treatment Nataline received. NO INSURANCE COMPANY should have had ANY say in it at all. INSURANCE COMPANIES HAVE NO BUSINESS DECIDING WHAT CARE PATIENTS OUGHT TO GET. That is the DOCTORS - and ONLY the doctor's job.

And THAT is the point of all this.

I don't care if Nataline had leukemia. If she was YOUR DAUGHTER - wouldn't you want her to have EVERY CHANCE available to survive? I'm sure you would. And you would NOT want an insurance company DECIDING FOR YOU and for her DOCTOR what treatment or procedure she should get in order to live.


JOHN EDWARDS GETS THAT.


Do you?


I CERTAINLY don't expect the WALL STREET JOURNAL to get it - and if they DID get it I'd expect them to DENY it and trash John Edwards.

We're talking about WALL STREET here. Puhleeeeeeze.

CONSIDER THE SOURCE of this story. THEN look at the slant and how it COMPLETELY IGNORES the issue at hand.

Pfffffffffffft!

I call utter smear and bullshit on this article particularly considering the source.

[Sadie4629]

2. Except that

you get the coverage you pay for. An insurance policy is a contract. Quid pro quo. In exchange for paying $XXX per month you get XXX in coverage. It may not be right, but that is the way it is.

And if you think that she would have gotten a liver transplant under any form of universal healthcare, well--think again. Such procedures, due to the cost as well as the lack of organs, would be rationed. And probably her chances of recovery would be so slim that she would be denied anyway.

[Triana]

3. insurance companies shouldn't be involved: period. Bottom-line, regardless

Do you have case histories or data to support what you said? How many cases of ntl healthcare denying care in this or other circumstances do you know of? What were the circumstances?

Without an apples to apples comparison even that point is moot.

[Sadie4629]

7. Don't know about an 'apples to apples' comparison

but this article seems to indicate that rationing exists, and is a very real problem in Britain. If they are rationing fertility treatments, obesity treatments, etc., then I think it is safe to say they aren't handing out livers like candy. And, apparently the docs aren't making the decisions there, either; instead it the government. I don't think they would be any better at deciding who should have which procedures than the insurance companies.

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NHS rationing rife, say doctors

Doctors say resources are finite
Rationing of NHS treatments is becoming more widespread, a survey of GPs and hospital doctors suggests.
Doctor magazine asked readers about rationing. Of 653 answering questions on consequences, 107 - 16% - said patients had died early as a result.

More than half - 349 - said patients had suffered as a result. This compared with one in five in a similar survey conducted nine years ago.

The government said decisions had to be made on which treatments to provide.

http://news.bbc.co.uk/2/hi/health/7010413.stm

[zalinda]

5. You are right, to a degree

Yes, it is a contract, but that contract changes when the insurance company says it does. That goes for credit card companies too. Just because you sign up for a credit card that "guarantees" 9.9% doesn't mean that somewhere in the too fine print, it says "unless we decide to raise it because we want to". The same is true for the insurance industry. They say that they cover such and such, but when it comes right down to it, they have the final say on what they will or won't cover, no matter what it says in their policy. Because in every insurance policy is the too fine print "unless we decide we don't want to cover that". It's the "Act of God clause".

zalinda

[ellacott]

8. I agree, many hospitals appeal medicare/insurance company denials

Many times they are successful.

I'm going to have to read more about her case because her brother said yesterday, at Edward's rally, that he had just given her a bone marrow transplant. Most of the time they will pay for an organ transplant before they will pay for a bone marrow transplant. You also don't usually receive a bone marrow and liver transplant so close together.

[Sadie4629]

9. You are mostly right

I just don't know that it is as arbitrary as 'unless we decide we don't want to cover that.' Most insurances don't cover experimental procedures--and that is for the good of the patient, as well as their own bottom line. While a liver transplant per se may no longer be experimental, it probably is experimental in the treatment of leukemia.

I haven't read much about this case, but would be interested to know what the docs told the girl and her family. Were they promising a cure? Were they buying time? Where does the question of quality of life fit in?

Could that organ have better benefitted someone who didn't have leukemia?

[Mass]

4. Not a medical case. An insurance case.

There were no question on whether the intervention was needed or not. The only question was whether the insurance company would pay or not.


The US has the best medical system in the world for those who can afford it. For the average person, it is far below many of the other occidental countries.

[baldguy]

6. US healthcare is a diamond in a pile of shit.