A Friday funeral was set for the Northridge teenager who died last week after her insurer refused to pay for a liver transplant and then reconsidered. Meanwhile, the girl’s health plan stood by its initial decision Monday. Philadelphia-based Cigna HealthCare has a record of approving coverage for more than 90% of all transplants requested by its members, as well as more than 90% of the liver transplants, company President David Cordani said in a memo addressed to employees and distributed to members of the media.
Yes, I can understand that CIGNA, like any organization, has rules and procedures in place for evaluating and making difficult decision. Unlike most organizations, though, CIGNA deals in what are often literally life-and-death decisions. While no one expects an insurer like CIGNA to spend themselves dry on procedures that show little or no chance of success, when doctors treating a 17-year-old girl certify that she needs, and will benefit from, a liver transplant, how can they reasonably say no? How do they tell the girl’s parents that a collection of insurance adjustors are effectively handing their daughter a death sentence?
In a sense, I suppose we should be grateful to CIGNA, for it’s their greedy corporate, bottom-line-oriented cold-heartedness that adds an exclamation point to everything that is wrong with the American health care “system”. Yet CIGNA’s CEO seems to think that they did exactly the right thing. Yeah, like creating a PR nightmare by denying a life-saving liver transplant to a 17-year-old girl could possibly be justified as “doing the right thing”. What if Nataline Sarkisyan had been David Cordani’s daughter?
A Christmas Eve editorial in the Houston Chronicle summed up the clusterf—k that is our health care system:
As California and the nation debate how to institute universal health insurance coverage for citizens, the Sarkisyan case indicates that more must be done than simply covering everyone with a policy. All too frequently, insurance company bureaucrats are making medical judgments that should be left in the hands of a patient’s physician
If the staff at the UCLA transplant unit approved Nataline’s procedure, that should have been the end of the discussion. For universal health coverage to be meaningful, such decisions must be taken out of the hands of insurance adjustors and placed with an impartial arbiter whose interest is the welfare of the patient rather than a corporation’s balance sheet.
Call me a dreamer, but I cannot see how any reasonable person could argue with the reality that affordable health care should be a basic right for ALL Americans, regardless of income or social station. If we cannot provide quality health care that is blind to economic or social status, then what claim to humanity do we really have? We can develop military technology sufficient to depopulate the Earth, but we can’t provide access to health care for all Americans? What’s wrong with this picture?
When insurance company employees can deny life-saving medical treatment in defiance of the judgement of trained medical professionals, something is horribly rotten in Denmark. There could be no rational or justifiable reason for those with their eye firmly on the bottom putting profit over patients. Nataline Sarkisyan and her family deserved better.
CIGNA dawdled and fiddled for long enough so that when they finally caved and decided to do what they should have done originally, it was too late. Ms. Sarkisyan died later that same evening in spite of her family’s Pyrrhic victory.
Personally, I hope the Sarkisyan family wins their suit, breaks up CIGNA into little pieces, and drowns it in a bathtub. If it were up to me, someone who be charged with murder by neglect. It will never happen, of course, but the people who made the original decision to deny their responsibility to pay for the liver transplant are guilty of murder. Their focus on profit over patient is what ultimately killed Ms. Sarkisyan…and yet somehow CIGNA’s President feels that things were handled exactly as they should have been.
Anyone care to explain to me why this country doesn’t need- and deserve- a single-payer health care system? Go ahead; I’ll wait….
Oh, and by the way…if this diatribe hasn’t convinced you that health should be a right guaranteed to ALL Americans, this story should. Mazel tov, y’all….
In my concept of a fair system of health care, millions of people would have read about this and immediately picked up the phone and said, "SCREW YOU Cigna! I'm switching to Aetna!" The financial hit to the corporation would have been swift and severe and (the best part) no lawyers would make a dime.
But sadly, most of today's consumers of health care don't have a lot of choice about their insurance carrier, health care provider, or medications, to name a few.
Our health care system clearly needs a better mousetrap. The trouble I have with the plans I've seen is that they only have one door, and the new and improved mousetrap is being designed by the same crew of rats that profit from the current system.
Affordable access to quality health care services is a destination we can all agree on. I just don't think were likely to get there if we let the insurance companies, the doctor's union, big pharma, and the government do the driving.
"...if we let the insurance companies, the doctor’s union, big pharma, and the government do the driving." Though I agree with my friend Bob more often than I used to (and might even in this case), leaving out the insurance companies, docs, big pharma and government doesn't leave too many players left to manage health care.
My guess is that it may well take another ten years, and perhaps the bankruptcy of GM, Ford and some other major corporations before we see major changes in health care access. And I just don't see any way around the single-payer system, which in fact will require some arbitrary rationing of health care. Unless someone makes a mousetrap that prints new legal tender, there will just not be enough money in our economy to provide all of the health care we think we need. Not all of us will be able to get new high tech tests or treatment or extended stays in hospitals when we are terminally ill. Some of us will have to be put on that boat and sent out into the lake adrift.
Get around most of the money issue by having health services provided in part by National Service and the military.
Yes, but somebody still has to pay the bills. None of those people work for free. Hospitals cost money, lots of it, to operate. And medications still cost money to produce. Probably 25-30% of our economy is based on health care - that money has to come from someone's pocket.