When I talk to liberals about how government healthcare really works, there's one objection I encounter regularly: We already have "death panels." Insurance companies act as death panels already, denying "experimental" or costly procedures.
Consider the case of Nataline Sarkisyan. In 2007, the California seventeen-year-old died after a relapse of leukemia which had originally been diagnosed when she was fourteen. Her liver had failed, apparently due to a clotting complication following chemotherapy and a bone marrow transplant.
Cigna HealthCare, Nataline's family insurer, initially refused to pay for a liver transplant on grounds that it would not save Nataline in her grave condition. But the family took the case to the media and, after enlisting the support of a powerful nurses' lobby, persuaded Cigna to consent to the procedure. It was a public relations disaster for the company.
Unfortunately, by this point Nataline's condition had deteriorated even further, and the family terminated life support the same day Cigna acquiesced.
The left grabbed onto this tragedy from the beginning as a case study against private, "for-profit" health insurance. John Edwards campaigned on the story, and today there are over 1000 matches when you Google "Sarkisyan" and "death panel." The standard thesis is that Cigna allowed Nataline to die after concluding that she couldn't be saved, and therefore private-sector insurance is really no better than the bureaucratic rationing of a government option.
But is it? The American Enterprise Institute issued a point paper refuting John Edwards' depiction of Nataline Sarkisyan's death:
...A study published in 2004 in the journal Liver Transplantation compared the relative severity of liver disease in transplant recipients in the United States and the U.K. The results were striking. No patient in the U.K. was in intensive care before transplantation, one marker for how sick patients are, compared with 19.3 percent of recipients in the United States. Additionally, the median for a score used to assess how advanced someone’s liver disease is, the “MELD” score, was 10.9 in the U.K. compared with 16.1 in the United States—a marked gap, with higher scores for more severe conditions. Both facts suggest even the sickest patients are getting access to new organs in the United States.
On the whole, the United States also performs more transplants per capita, giving patients better odds of getting new organs. Doctors here do far more partial liver transplants from living, related donors but also more cadaveric transplants (where the organ comes from a deceased donor). In 2002—a year comparative data are available—U.S. doctors performed 18.5 liver transplants per one million Americans. This is significantly more than in the U.K. or in single-payer France, which performed 4.6 per million citizens, or in Canada, which performed ten per million.
Based on this data, it seems even less likely that Nataline would have screened for surgery in a public healthcare system. And in several articles about this case, it's been asked why UCLA, which does not generally refuse transplants over patients' ability to pay, was not willing to do Nataline's procedure without authorization from Cigna. It could be that her condition was so poor that even the transplant team would not risk a liver on her unless the procedure offered the hope of a profit -- not a compelling argument for government healthcare.
Nataline Sarkisyan's family has since sued Cigna. This was no doubt an outcome Cigna considered when it made its decisions, creating a powerful incentive in Nataline's favor. But when you're dealing with a panel like Britain's NICE institute, it's a different dynamic. And even if Cigna prevails in court (very likely, considering that most of the claims have been dismissed already), every claim is handled with the conviction that these decisions do sometimes have to be defended before a court.
And we are all better off for it.
Are we getting so caught on healthcare that we're about to be blindsided by the implications of new powers to be given to the Federal Reserve? It seems to be that all roads lead to Rome, and Rome is utilitarian control not freedom, liberty and safe guarding the rights of Americans.
Every passing day it feels like the people of America are being coaxed into fighting symptoms rather than being allowed to relax long enough to acknowledge and counteract the root of the problem.
[note: Apologies for a somewhat offtopic response. Your post though was quite insightful.]
Posted by: J Green | 09/14/2009 at 09:03 AM
Your post signifies one of three major points in this issue:
1) Yes, insurance providers deny claims on occasion; but they have limited legal protection from the consequences of doing so Q.E.D. The same could not be said of a government rationing body.
2) Sure, if you're a liberal you may trust Obama. However, he’ll only be in office for eight years (max). Do liberals really want to risk Republicans taking over that power? This is why I didn’t want the Patriot Act to pass. I may vote Republican, but that doesn't mean I trust them with limited power of attorney over my healthcare decisions.
3) If people want to reform the health insurance system, they need to do it on their own terms instead of turning to the government (Rosa Parks style). The people, not the government, need to be pushing the insurance companies to provide the services they need at prices they can afford. Then the insurers will be forced to lobby on behalf of their customers instead of their stockholders.
Posted by: Hank Rearden | 09/14/2009 at 11:32 AM
One of the issues that is often lost in this discussion is that while, yes, insurance companies may indeed ration or act, in essence, as "death panels," you're still free to seek treatment. You can go to the free market and take out a loan to pay for the treatments, sell a house and pay for the treatments, everyone else in the family can take a second job and pay for the treatments. The problem is that there is such a disconnect between the paying for healthcare and the delivery of healthcare that the vast majority of people have come to assume it is indeed a right. And so when the insurer fails to deliver on that "right," people go into their victimhood and learned helplessness routines rather than take the care of their loved ones as a personal responsibility. The problem with a government takeover (or rather, one of the many problems) is that the option to not be a victim will be gone. You won't, at least not easily, be able to seek care outside the system. You could offer to pay for that transplant out of pocket, but, it won't matter. The government takeover will simply be the nail in the coffin of the creeping (or not-so-creeping) infantilization of the American populace. It is kind of pathetic the family had the initiative to go to the media, but couldn't find the initiative to pay for their own loved one.
As an aside, if we truly had a free market and could purchase health-status insurance in addition to regular health insurance, none of this would have been an issue. The girl's health status insurance would have kicked in, Cigna wouldn't have had to foot the bill, and she'd have gotten a transplant.
Posted by: TQ | 09/15/2009 at 08:46 AM