Stories like this don't get enough publicity. Apparently a 17-year old girl named Nataline Sarkisyan from California was denied funding for a medically necessary transplant by her insurance provider Cigna up until a couple days ago when it was finally approved, but she died on Thursday night. The liver was available 6 days ago but only after a public outcry did Cigna reverse its decision. Now, to be fair, the insurance company could have been correct that there was no medical evidence that thew transplant would have helped. There is also no proof that had she received the transplant when the liver first became available, she would have lived (she was in pretty bad shape to begin with).
But I've always been surprised that so many Americans seem so deathly afraid of big government making health care decisions yet there's not much outrage about big soulless corporations concerned only with profit making those very decisions. The key is that someone has to make decisions about what procedures should be covered (because no body is going to cover everything, and very, very few can afford to pay for medical procedures out of pocket). I just don't understand why anyone would feel more comfortable with a system where companies fight tooth and nail not to cover procedures so they can pad their profit margins rather than a government body that looks out for the public interest and actually fights to cover procedures that are cost effective and save lives.
The girl's father is now suing Cigna for negligent homicide. I don't imagine they'll be having a very Merry Christmas...
But I've always been surprised that so many Americans seem so deathly afraid of big government making health care decisions yet there's not much outrage about big soulless corporations concerned only with profit making those very decisions. The key is that someone has to make decisions about what procedures should be covered (because no body is going to cover everything, and very, very few can afford to pay for medical procedures out of pocket). I just don't understand why anyone would feel more comfortable with a system where companies fight tooth and nail not to cover procedures so they can pad their profit margins rather than a government body that looks out for the public interest and actually fights to cover procedures that are cost effective and save lives.
The girl's father is now suing Cigna for negligent homicide. I don't imagine they'll be having a very Merry Christmas...
14 Comments:
very good points regarding the contradictory nature of medicine in the US. However, I would also like to point out that no one is commneting on the fact that the hospital nor physicians were willing to do this "life saving" operation for free either. Let's not forget that insurance isn't the only one padding their profits here as well.
Well, the problem is very basic: supply can't meet demand. If doctors were to have their orders all met, the US and in fact the whole world would go bankrupt in a year.
I as an MD used to be very anti-insurance companies, until about 5 months after I started to work for one about a year ago. In my job, I learn that many physicians demand medications / procedures to be used for "off-label" purposes which are not approved by the FDA. Some are just careless, some are driven by kickbacks from drug companies by form of "talking fees" and many other ways. The scheme goes like this, once a physician has prescribed an X amount of a certain drug, that drug maker would "invite" that physician to talk to a group of medical students, nurses, or whoever they could find. Sometimes the talk is at a fast food restaurant with 1, 2 medical students attending, just for the pizza. Then the physician speaks a few words, then pockets anywhere from a few hundreds to a few thousands if he/she flies in from other state.
Don't anyone tell me the doctors in this case won't make any money if their request had been granted. Out of the $75,000 they asked the family to put down, they must have made off enough to buy a new BMW. They didn't do it for free, so stop being so saint-ful. C'mon people, we live in a very greedy society, with very greedy people, doctors are not exceptions. In fact, they are among the greediest of all. I am sick of hearing some nurses, some doctors "speaking out" for patients as if they didn't profit from it somehow, some way, at least from the attention they attract.
People have to come to terms with the sad fact that we are in a lifelong tug-of-war with diseases, deaths, calamities, accidents. Many a time we simply lose. Out of 300 million Americans, 5 million of us WILL die from car accidents, for example. We just have to accept that before they happen, so that when those bad things happen we're well prepared.
As for me, I live everyday preparing for my death. Nobody comes out of this tug-of-war alive.
I have two thoughts on this. One is the health aspect of the girl.She had Lukemia and a bone marrow Transplant. In the medical world that is two strikes.
But to not give her a liver is uncomprehensable! Now adays you have people in the third world countries selling thier vital organs for money. At least give her a chance.
For sports fans, it may not have been as prevelent as now, but when "Chicgao Bears" Walter Payton was looking for a liver why did he not get one?
Free medicare equals communism. But there are so many using the system, one can evaluate Justice from Injustice.
Geragos is a dirtbag just like all the other lawyers in this country. He says "the insurer maliciously killer." I suppose the doctors and hospital that handled the marrow transplant which caused the "complication" have no culpability. Throw his ass in jail for slander since there's no law against being scum.
I dont want to appear like a monster or unsympathetic to the situation of this family and loosing a child, but I dont understand why Cigna is getting the entire blame. Let's face it, Cigna is a business and as such makes money (although too much) but so do the doctors and hospitals. Did either offer to take care of the patient at no charge or did they deny services because there was no one to pay for them? there is plenty of "blame" to go around
The Insurance Companies don't deny they are in it for the money; but why were the Doctors who gave an oath to "do no harm" setting on their hands WAITING TO BE PAID while they watched her die???
As someone who lost her father to cancer two years ago, while my heart goes out to the family and friends of this girl, I know from personal experience that taking extraordinary measures to prolong someone's life only mere months isn't always the best option. By no means do I wish this on anyone, but having watched my father suffer with a terrible disease for a year, relief was coupled with the sadness we felt when he passed. His suffering ended when he died and no matter how much we fought to prolong his life, he would have suffered. This girl had a 65% chance of surviving only another 6 months. What everyone fails to mention is that she had multiple other organs failing along with her liver. What kind of life would she have had in those six months?
The parents are using a big name lawyer to sue CIGNA in hopes of alleviating their suffering but in the end, will it bring her back, will it make it easier for them? I understand their grief but in the end they're looking for someone to blame because blaming nature or God isn't tangible. I agree with the comments about the doctors and hospital not offering to perform the surgery pro bono. Stop pointing a finger at CIGNA and start trying to figure out why so many kids are getting sick with these terrible diseases in the first place.
The interestng issue no one talks about is that what the insurance company did is what universal health care would be doing. The cost of the procedure vs the likelyhood of survival is a real issue that no political person or advocate of universal health care talks about. Rationing of health care is a needed evil if we are to provide universal health care. The emotion aspect of this story is horrible but can not be factored into the universal health care decisions, because the basis behind universal health care is to provide the greatest amount of good for the whole population based on evidence that it works, media pressure should can not factor in for universal health care to work.
This is not a judgement but a reality no political debate mentions only the sound bite that sounds good to the population not really knowing what is going on.
I am an armenian bone marrow transplant survivor having received my donor's cells over ten years ago and understand the emotional nature of this. I am also a nurse practitioner. I get very upset seeing the subject of universal health care/health insurance simplified to tell the people what they want when the truth is nothing comes without a price. I pray this family finds comfort and I hope someone has the courage to talk about the relaity of this, it will certainly not be the california nursing asscoiation.
This story just doesn't make sense to me. Active malignancy is an absolute contraindication to transplantation. If she had received the organ, the immunosuppressive medications would have caused her leukemia to go haywire, and that would have killed her. The article doesn't make it clear if her leukemia was active. I could not ever side with an insurance company on anything, but I don't think we are getting the whole story here.
ryan,
it's kinda scary how serious some of these people are. let's do the math:
1. none of them have ever commented here before.
2. they reference medical terms that either give them knowledge of insurance, the medical profession, or perhaps pre-med status.
3. they talk about agreeing with other comments that were not yet approved by our comment moderator.
1+2+3 = 6?
6. Are CIGNA employees are posting on our humble blog to try and save their rotten corporate image? Please someone tell me that I'm blowing this out of proportion...
Something does certainly seem to be questionable here Mr. Kiefer...
I agree with Mr. Kiefer as well. Perhaps someone has a Google blog alert on Cigna to measure the pulse of the district...er...the blogosphere. :)
An interesting read for all (including the MD, Nurse Practitioner, transplant recipient, et al. who have commented on here) is The Truth About the Drug Companies by Marcia Angell, former Editor-in-Chief of the New England Journal of Medicine. It is a comprehensive look at the pharmaceutical industry; however, many of the revelations that Angell makes are applicable to the insurance companies, especially in reference to doctor/industry relationships.
Anon 6:02 am: "Supply can't meet demand." In this case, there was a supply (the organ was available) and there most definitely was a demand. They appear to have met, yes? The only roadblock was the middleman of the insurance company. I don't believe that Cigna was attempting to save the world from bankruptcy by denying the claim. And why should insurance company claims adjusters make the call on a patient whom they have never seen, when the doctor who sees the girl and sees her dying has already made the call?
Also, we are in a world where death is inevitable, but it doesn't mean that we need to expedite it.
Anon 6:29 am: "Free medicare equals communism." There is no such thing as a free lunch, or so the saying goes. We are all paying for healthcare in some way, even if that is indirect. However, although we all pay, it is not accessible to all (and insurance companies play a role in this -- Sicko, anyone?) - and that is where the problem lies.
For every dollar paid for healthcare the insurance companies pocket 35 cents or more.
For this money what do they do?
Have they come up with any cures lately?
Have they helped anyone get better?
No - they are simply gatekeepers who profit from their position.
How big was the bonus paid to the Cigna CEO this year?
It would be prudent to ask an Oncologist or Hematologist their objective opinion. The only doctors who have supported recommending this procedure were the ones trying to get the billing approved. (Incidentally, those doctors have had "no comment".)
There are plenty of resources providing free medical information as it relates to Leukemia and liver transplants. (Mayo Clinic, Cleveland Clinic, Johns Hopkins, etc.) Reading clinical facts can add some logic to this emotional debate.
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