Health Insurers Needed As Political Scapegoats
Natalie Sarkisyan’s family and friends want Cigna Corp. charged with murder in her death because the medical insurer was slow to approve coverage for a liver transplant for her. Thus this case is the latest metaphor for rapacious insurance companies.
It may be great television, especially as it happened near Hollywood, but that may be all it is. For while there are rapacious insurance companies and insurance practices necessarily discourage claims, Cigna may not have been so wrong.
Natalie, 17, had leukemia as well as liver failure, and the Associated Press report on her death quoted a liver transplant expert as saying that the medicine that must be taken by transplant recipients drastically worsens leukemia. In leukemia cases, this expert said, transplants are “futile.” Natalie had four doctors at the UCLA Medical Center who gave her a 65 percent chance of surviving a liver transplant for six months, but a 65 percent chance at six months of life does not instill confidence.
Having first refused to cover the transplant on the grounds that it would have been only experimental, Cigna reversed itself when Natalie’s family, friends, and a nurses group held a loud protest. But when the girl died a few hours later, the insurer’s attempt to minimize the bad publicity by reversing itself served only to impugn its original judgment.
Providing insurance may be the first purpose of insurance companies but providing politics with scapegoats is a close second. For Cigna was not alone in responsibility for Natalie’s medical treatment. Her doctors could have chosen to operate on her without guarantee of reimbursement. California state government could have provided coverage, as the federal government could have. Natalie’s family and friends could have sought to raise the necessary funds; disgraceful as such necessity is, it happens all the time with hard-luck cases in the United States.
But in any event someone would have had to make a choice in Natalie’s case — if not the insurance company, then the government, the doctors, the hospital, her family and friends, or the public.
And that is just what the country long has been refusing to confront with the medical insurance issue — the necessity of choosing what coverage is to be socialized and what is not, to choose how much medicine society can afford. Elected officials, especially those in Connecticut, have been good at requiring insurers to provide particular benefits in private policies, driving up private insurance costs, but not good in appropriating the money so that the state itself can provide those benefits to people without private insurance.
Connecticut’s medical insurance systems for the poor have been so badly funded lately that few doctors have been willing to provide timely appointments and treatment. Until this year state government had not increased reimbursement rates for state welfare patients for 18 years, though of course during that time state government often increased medical insurance coverage for its own employees.
And while Natalie’s case was a sensation, there was little sensation around an American Cancer Society report that was issued simultaneously with the protest against Cigna. The cancer society found that uninsured cancer patients are twice as likely to die within five years of their diagnosis as insured patients are. Reporting this finding, the Associated Press estimated that about 20,000 people in the United States die each year of cancer while uninsured.
The problem with cancer patients — and all sick people — is that the uninsured are both slower to seek care because of cost and slower to be given care because of doubt about ability to pay.
That is, with cancer alone there are about 55 cases worse than Natalie’s in the United States every day — cases where insurance would have meant a far better chance of long-term survival than Natalie would have had with a liver transplant amid her leukemia.
The other day Governor Rell stood up for both the poor and the taxpayers when she terminated the contracts of the insurance companies state government had hired to provide medical insurance to poor children. The companies had refused to disclose their reimbursement rates and prescription allowances in accordance with freedom-of-information law, so their service to the poor children could not be evaluated well. Now the state Social Services Department will determine the reimbursement rates and prescription allowances, with the insurers handling only claims processing.
But with the state now paying directly for coverage for the poor children, the insurers no longer will be available as political scapegoats. How happy will people be about that when the bills come in?
Chris Powell is managing editor of the Journal Inquirer in Manchester, Conn.
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