Desperately Fighting Big Insurance

Sally Satel’s New York Times story about her search for a kidney donor and her conclusion that we should set up a process for selling organs led to a fascinating debate. (Check out the ‘comments’ section for ‘Desperately Selling a Kidney’.) Ms. Satel never addressed the role of health insurance, or lack of it.

Today’s ABC News brings a story of a young woman who had a matching donor for a liver transplant, had the medical team, and had insurance.

Nataline Sarkisyan, a 17-year-old from Glendale, Calif., died Thursday just a few hours after her insurer, CIGNA HealthCare, approved a procedure it had previously described as “too experimental.”

Nataline’s supporters, including a good number of nurses, took it public, which seems to have influenced the insurance company to change its decision.

Geri Jenkins of the California Nurses Association said the Sarkisyans had insurance, and medical providers felt comfortable performing the medical procedure. In that situation, the insurer should defer to medical experts, she said.

“They have insurance, and there’s no reason that the doctors’ judgment should be overrided by a bean counter sitting there in an insurance office,” Jenkins said.
Doctors at the UCLA Medical Center actually signed a letter urging CIGNA to review its decision.

Whether the delay was the cause of her death will probably be established in court.

In a free market you try to get the best deal, and the seller tries to get the best price. That’s fine when you’re shopping for a pair of shoes. When you’re sick your bargaining power is zip, and making critically ill people fight with insurance is a disgrace.

However, there is no perfect system. I agree with the nurses that the insurer should have let the doctors judge whether the transplant had a chance of success. A girl is dead because CIGNA denied, and then granted coverage when the publicity became an embarrassment. But there is no system we can construct that won’t have to use some form of triage.

Right now we cannot claim that we have a health care system that offers fairness and transparency. It’s a hopeless bureaucratic maze with multiple vendors all trying to make a buck and millions left with inadequate, or no coverage. Denying service brings rewards, promoting health is not a priority. It’s a screwed-up system that steers normally decent people into inhumane, immoral behavior.

Some of the people who oppose universal health insurance warn that we would lose ‘choice’ and that there would be ‘rationing’. Well, there already is rationing, and it’s not done on a fair or medically defensible basis. The Sarkisyan family paid their insurance and thought they had coverage, but found they had no recourse when time was of the essence. Nataline Sarkisyan was not the first and won’t be the last young person to die while we argue about how to make a health care system that works.