Yeah, I know it’s not likely that anyone will pay attention given the season, but I do feel that there are enough cases with which to bash insurers which are legitimate that John Edwards didn’t have to start politicizing one in which not only was the insurer’s argument pretty good, but about which a government-sponsored universal system would also have to make the same choices. So I’m up over at Spot-on about Just Saying No.
To separate himself from the Democratic front-runners former Sen. John Edwards has spent the last few days laying into insurance company, Cigna, for its failure to immediately approve a liver transplant for California teenager, Nataline Sarkisyan. That action, says Edwards, in concession speech after concession speech, is emblematic not just of the health care system’s break-down but of a failure of the current American political system.
Edwards like most Democrats wants a single payer health system and his plan is the closest of the three front-runners to providing one. But his advocacy of Natalie Sarkisyan’s case raise a question no one else seems to be asking.
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Peter, be prepared to shed a tear for CIGNA.
You wrote, “If there were evidence those savings were passed on to rate payers, or to subsidize those unable to afford insurance, or system efficiency controls, or any industry transparency, then I might find a tear.”
From what I’ve read, this was a self-insuring company, so they were paying only for administrative services. 100% of the savings from not doing the transplant went to the company, not CIGNA.
I’m kidding, by the way, about the tear.
I hope Cigna litigates this case rather than settles it for two reasons. First, I think they made the right call the first time and they stand at least a reasonable chance of being vindicated by an appeals court. Second, it would be extremely useful to the cause of systemwide reform if UCLA and the specialists who treat patients there receive a full airing of their well known across the board overly aggressive, extremely expensive, and cost ineffective practice patterns whether they are treating premature babies, the elderly at the end of life or anyone in between.
We often hear that if all doctors and hospitals had practice patterns in line with the most efficient providers like Mayo and InterMountain, healthcare costs would be about 30% lower than they are or 11.2% of GDP instead of 16%. I’ll bet that if everyone practiced like UCLA, our costs might be closer to 20% or even 25% of GDP. The sooner policymakers come to appreciate this and do something about it, the better.
As a supportor of universal all-in single-pay I agree with your assessment of this Edwards publicity campaign misuse. In a single-pay system I would also be concerned at better allocated dollars wasted on hopeless cases – the Mickey Mantle liver example. Single-pay systems seem to work through this and also provide half the costs. However I have no sympathy for this insurance company or the insurance industry when looking at these cases, justified or usually not. What is their motivation and ethical stance when deciding these cases and what would be done with the saved and “better allocated” insurance dollars? If there were evidence those savings were passed on to rate payers, or to subsidize those unable to afford insurance, or system efficiency controls, or any industry transparency, then I might find a tear. But the insurance industry keeps chugging along passing on those 6%-10% yearly cost increases with the added exec. bonuses and investor returns – but not one altruistic or community benefited endeavor of meaning.
I wish Edwards all the publicity he can get, deserved or not, because he is having to surmount a lobby behemoth just to get a fraction or the traction the money boys bestow on Washington. I can forgive a little campaign hyperbole to get an ultimate good result.