Privatized Death Panels
In the conservative utopian fantasy world private insurance companies are warm, loving entities that have only your best interests at heart and can make bucketfuls of profits doing it. In the real world that I inhabit, insurance companies are entities that make money by taking your payments and denying you treatment when you become too expensive. They also deny coverage for pre-existing conditions, thereby making many people complete unisurable.
We’ve been hearing about the latest conservative misinformation campaign about government-run “death panels” that will euthanize people. It’s a complete and utter lie but when has that ever stopped dishonest politicians from repeating it? Perhaps we need to revisit the case of Nataline Sarkisyan. The short story is that 17-year-old Nataline Sarkisyan got leukemia and then got a bone-marrow transplant from her brother. Unfortunately, she had complications and needed a liver transplant to survive. Nataline was fully insured – her family was covered by Cigna.
After the operation, her liver failed and doctors referred her for an emergency transplant. Although she was fully insured and had a matching donor, Cigna refused to pay on the grounds that her healthcare plan “does not cover experimental, investigational and unproven services”.
Cigna’s rejection on December 11 led Sarkisyan’s doctors at UCLA medical centre, including the head of its transplant unit, to write a letter to protest that the treatment which they proposed was neither experimental nor unproven. They called on the firm to urgently review its decision.
In the absence of a response from Cigna, doctors told the Sarkisyan family that the only alternative would be for the family to pay. But they could not afford the immediate down payment of $75,000 (£38,000).
After protests by family, friends and nurses at Cigna headquarters, Cigna relented. However, it was too late, Nataline died just hours after getting the approval.
This was a person who was fully insured, her parents were employed. Private insurance did not cover the expenses because they made a decision that the treatment was too expensive and had too little probability of success. This is the status quo that conservatives are defending so much.
The provision that has generated this controversy is actually for living wills.
Living wills and other advance directives describe your preferences regarding treatment if you’re faced with a serious accident or illness. These legal documents speak for you when you’re not able to speak for yourself — for instance, if you’re in a coma.
The health care reform bill would cover voluntary counseling for living wills. This provision was authored by two Republicans: Susan Collins and Johnny Isakson. In fact, the misinformation has gotten so widespread that Senator Isakson had to speak out:
Ezra Klein asked Sen. Johnny Isakson (R) of Georgia, a long-time advocate of expanding Medicare end-of-life planning coverage, to help explain why this common-sense idea has suddenly become an attack against reform. Isakson responded:
“I have no idea. I understand — and you have to check this out — I just had a phone call where someone said Sarah Palin’s web site had talked about the House bill having death panels on it where people would be euthanized. How someone could take an end of life directive or a living will as that is nuts. You’re putting the authority in the individual rather than the government. I don’t know how that got so mixed up.
“It empowers you to be able to make decisions at a difficult time rather than having the government making them for you…. And it’s a voluntary deal.”
There are many people out there lying to you. From now on, when a Republican makes a statement about what is supposedly in the health care bill they need to provide the following evidence: the link to the bill they are referring to (the are 4 different versions right now), section, page and paragraph so that we can all read it for ourselves. Otherwise we’ll just have to assume this is more conservative misinformation.
Tags: Health Care Reform, Health insurance nightmares, Nataline Sarkisyan
Republicans want to preserve the status quo, no matter how large the HMO body count gets. No amount of HMO murder-by-denial is too much for them. We are all one organ failure away from choosing between death and bankruptcy as long as we hold private insurance or none at all. To conservatives, we only have a “right to life” before we are born – from the moment we enter the world, we are just dollar signs on a ledger to them.
And can someone please explain to me how “death panels” will kill “grandma” when “grandma” would already be on Medicare and thus not be elligible for the new public option plan?
Yes, X, good point. All those stories about waiting times for knee replacements – most people get knee and hip replacements in the U.S. paid for by Medicare.
Ezra’s interview with Rep. Issacson is very good indeed:
The provision currently in one of the bills says that they’ll pay for these end-of-life-directives AND defines what that is. Issacson sounds genuinely annoyed that his effort has been so thoroughly run over by his own party.
It took Isakson long enough to speak up. This talking point has been around for more than a week! Was he hoping it would go away. The “death panel” nonsense has now been amplified by Palin, Limbaugh, Hannity and the Club for Growth.
Spurious death panel arguments are why I keep urging people to look at Medical Futility Blog. In one post Dr Pope examines the taxonomy of end-of-life decisions (who is for, who is against extending treatment that is not working) and concludes in the end
In short, adamant surrogates use the threat of litigation to drive the provision of some non-beneficial treatment. But the far bigger driver of non-beneficial treatment is physicians.
If you really want to examine these issues seriously, try
http://medicalfutility.blogspot.com/2009/07/futile-medication-for-terminally-ill.html
And then go out from there and look at the whole blog.
The surreal part of this “argument” by the right is they should really be on the other side. Their 2 big points are what? — 1)More choice and 2)individuals, not government, making decisions. That’s what this does. The Living Will benefit is optional, not manditory. You have the choice to ignore it or have it paid for. And what a Living Will does is make your individual choice on how you want your treatment to proceed clear to everyone, even the government.
Writing a living will doesn’t mean a doctor or bureaucrat decides how you die any more than writing a regular will means a lawyer tells you who to give your money to. ITS YOUR DECISION!
Or most likely, they doctor does more things to keep your heart beating as long as possible. That is pretty much their job unless there is a document stating your preference to die without intensive measures.
The entire “death panel” discussion is just a diversion.
Anyone who opposes health delivery reform (which is what we’re talking about … not health care reform) should be asked:
Do you have an immediate or extended family member who is currently uninsured for any reason?
How much money do you have set aside to help this loved one should he/she get cancer or have a heart attack?
The discussion needs to get back on point quickly in this country, or the insurance industry and big business will win again.
THANK YOU!
THANK YOU!
THANK YOU!
UI, You’re wonderful.
This Sarkisyan case is EXACTLY what I was referring to in a comment I made late last night stating WE’VE ALREADY GOT DEATH PANELS! They’re called “MEDICAL REVIEW BOARDS” and every insurance company has them. They’re usually staffed with one or two nurses and then a bunch of UNQUALIFIED, NON-MEDICAL-TRAINED PAPER PUSHERS who make these decisions COMPLETELY IN FAVOR OF THE INSURANCE COMPANY’S PROFITS. I worked for a healthy insurance company for SIX YEARS and witnessed this shit first hand. Now, it never happened that much because the types of policyholders we had were simply accounts that we administered. Meaning, we (I worked for CIGNA International…which is a different company from the domestic CIGNA Healthcare) simply ADMINISTERED the plans for the Fortune 500 companies’ expatriates. We processed the claims, but the reimbursements came from the companies’ bank accounts. Because we were dealing with high-level, highly-paid VIPs who had to be moved overseas to work, all claims were generally paid to keep them happy. It was actually great working for an insurance company that DIDN’T give customers a hassle for filing claims.
Now, CIGNA Healthcare, as you point out…those fuckers are evil. Absolutely evil.
I’m really tired of this debate. So…so…tired. Not of what you’ve said, because everything just makes sense. But the lecherous right-wing and their god-awful spin machine are just so damn out-of-control. Like I said last night, “death panels” are OK when they’re products of the free market. Fucking hypocritical whackjobs.
You’re welcome. The Sarkisyan case is only one of the more prominent ones. Decisions on denial of treatment are being made everyday by health insurance companies.
Thank you Mike for pointing out the difference between administering a plan and controlling benefits. In a more perfect world the decisions would be made by doctors and patients.
Republicans would rather blindly follow ideology than do the moral and right thing.
Republicans have amnesia. Everyone no matter how old you are needs a living will. You could get hit by a bus, have a car accident and unable to tell your immediate family what you want. We should all remember Terry Schivao when the lunatic republicans intervened in a private matter.
Do you want some MBA grad with no medical background telling your doctor you will deliver this procedure or some generic drug that your doctor knows will not cure your ailment? These beancounters are getting huge commissions by the insurance companies to over rule your doctor.
As Rachel Maddow or Olberman pointed out last night…the President of United Health care gets $128 million in salary plus bonus. That means this greedy pig gets over $100,000 an hour!!! He has 8 or 9 mansions, thats where our tax payer dollars are going to keep these greedy pigs at the the public trough.
Nice try but the Insurance Companies may have an image problem but the government is inept at everything they do. Obama today said so when he talked about competition and he mentioned FedEx and UPS.
Let me paraphrase the President- UPS and FedEx are competing just fine, it is the Post Office which is having all the problems. DUH?
So, I am supposed to feel enlightened by that analogy. The Post Office is not able to deliver a basic service and the private guys are? Then, we should still fund the government option while we know it is substandard.
The more you attack people and insurance companies the more obvious it is Obama’s health plan is toast as no one can say what the positives are with his plan-none. Ask the CBO and ask the Mayo Clinic.
Mike Protack
Mike,
Anytime you start a post with “Nice try…” I immediately move on. Seriously, you bring nothing but static to any debate when you continue to bring up your non sequiturs and off-topic rants. How about debating the point I make above and then tell me your hero Sarah Palin’s comments were rational.
WE ALREADY HAVE “DEATH PANELS” AND THEY’VE BEEN USED FOR DECADES BY INSURANCE COMPANIES.
So, the issue isn’t the “death panels.” Because if the issue were “death,” then where were you sanctimonious conservatives years ago when liberals were bitching about these denials of service to CONTRACTUALLY INSURED INDIVIDUALS?!?! I’ll tell you where you were…the same place you’ve always been: Espousing the joys of unfettered free market capitalism, “health care” be damned.
“DUH!”
That about sums up all of Protack’s comments for me. They are about as substantive as that. Hello, knock, knock, it’s Republicans who are pushing the line that the public option will kill private insurance. Obama has rightly pointed out that the USPS didn’t kill FedEx or UPS. I would add public schools haven’t killed private schools either.
Are people still reading Protack’s nonsense? He’s nothing but spam. Scroll past his drivel.
If you think that a government bureaucrat will be less likely to deny a procedure that private industry, you are in a dream world. Good luck trying to sue the government. Additionally, you can expect business, who now insures 70% of the population to start dropping insuring coverage for their employees. If you think that the proposed fines are going to matter, try collecting fees from offshore employees.
Hey folks,
Let’s be rational here. I hear what you are all saying and agree that this is a major issue which cannot be won on party lines. Yes, the Republicans are more for private business and are more pro-insurance than Democrats.
I’m not sure who is more of the villian – the Government or the Insurance Industry. Right now, I would lean towards saying the Government is. I think State Governments (I’m from California unfortunately) as well as the Federal Government are causing more problems than what they are fixing.
I think the private sector is more responsible, more accountable and better suited to address this major issue. I also feel the U.S. Government is going to have to own up to the fact that it is not suited to create a solution on its own to this problem. They tend to screw things up while attempting to make them better. There is always some group that gets the raw deal when governments get involved. Look at the US Postal Service, Medicare Fraud, VA Hospital issues, Freddie Mack and Fannie Mae, and the SEC. Do you really want the people behind the creation and administration behind these organizations trying to solve the multitude of problems we face concerning health care?
I’ve seen a lot of good ideas on different aspects of how we can reform health care, from purchasing insurance across state lines to getting rid of malpractice suits to demanding more personal health accountability from individuals. This is only a start, but I feel we can pull together all of these smaller components to cut out all of the OBESITY we currently face with our health care crisis.
This is a complicated, multi-dimentional issue and you can’t fix it by having one committee, person or party dictate what the eventual outcome should be. You have to attack it piece by piece and fix the smaller components to attack the entire problem. That is how we will tame this beast we call runaway health care costs.
Please stop holding Nataline Sarkisyan up as the poster child of all that is wrong with insurance companies. I’m very sorry for her parents to have lost their daughter. Thank you Mike Matthews and Unstable Isotope for pointing out there is a difference between administering a plan (ASO arrangement) and controlling benefits. Has anyone ever bothered to fact check that Nataline’s coverage was fully-insured? Hate to break it to you but you are wrong to blame CIGNA. Nataline’s coverage came from a SELF-FUNDED plan. Meaning that her health coverage came from either her Mom or Dad’s employer. That employer (also known as the Plan Sponsor) had an agreement with CIGNA to act as their claim payer. As the claim payer they have a contractual obligation to only pay claims that are covered as described in the Plan Document/Summary Plan Description. Therefore, at any point, it was the plan sponsor AND ONLY THE PLAN SPONSOR that had the right to make an exception to pay for the liver transplant.
Just a question…why are “Medical Review Boards” the sum total of all that is wrong with insurance companies according to those in favor of the House plan, but that same group supports “Evidence-Based medicine”? A rose by any other name…
AD’s oh so subtle, but so bullshit!
Health care and the free market are incompatible.
I wonder if Andrea and I have worked together before…! Hmmm…
Andrea is clueless though…
Von Cracker,
Call my comments what you want, but health care and the free market are not only compatible but the only way that health care can be delivered to the American people. If you are in favor of socialized medicine, you know where you can go…..
yes, because that has been proven in our country that they are compatible.
I could throw stats at you. Like where we are ranked. Costs. Mortality rates….but you wouldn’t listen.
Please expand cassandra_m. Your drive-by insults do very little to advance the discussion. My point: just as Sarah Palin is wildly wrong to equate Living Wills with Death Panels, blaming CIGNA for Nataline’s death is also wrong.
really? we should blame God then I guess Or Nataline for not getting a different plan, taking better care of her self, knowing that she was going to die?
Please expand Andrea? How isn’t it Cigna’s fault?
Whether it is wrong to blame CIGNA or not,I have no idea, but you don’t have much knowledge of how self-insured employers use their administrators. Self-insured just means that the employer has the pool of funds that is drawn on the pay medical expenses. Any plan worth its salt will have some kind of stop-loss or reinsurance to minimize or cover entirely very large claims — like transplants. The employer approves the terms of coverage and hires people like CIGNA to administer it. So the faceless cubicle-dwellers are still making decisions on the care you get. Not your employer.
Sign me,
Someone with Employer Self-Funded Insurance
Please read Unstable Isotope and Mike Matthew’s comments.
Bottom line, when CIGNA cited the Plan’s provision (Employer’s policy) that medical services considered experimental, investigational and/or unproven to be safe and/or effective for the patient are not covered, CIGNA had nothing to gain. When Nataline’s claims were paid they were not paid with CIGNA’s money. They were being paid either by her mother or father’s employer.
I suggest if you don’t like this provision, you make sure and speak to your representatives in Congress because “Evidence-Based Medicine” is part of the health care agenda.
Cigna had nothing to gain? Right, by not paying for a several thousand if not hundreds of thousands in medical bills, they had nothing to gain…
uh huh
AD the water-carrier doesn’t know what he/she/it is talking about.
A free market cannot exist in an environment where the participants’ overriding goal is to try to avoid doing what they were designed to do, which is to pay-out claims.
It’s nothing less than collusion, treating those on basic plans as if they were a captive audience, meaning the insurance corps can inflate prices across the board and you have to pay because you absolutely need the product (ie – chemo). Wudda gonna do, shop the fuck around?
But you think it’s the free market? Either you are a dishonest hack or nothing more than an bullshitter, with a mild, wordy style.
There are two kinds of people involved in the health care reform debate. People who want reform because they have had to deal with insurance companies, and people like Andrea who have never had to seriously contend with our broken system who think the the status quo is fine.
This is your problem right here:
experimental, investigational and/or unproven to be safe and/or effective for the patient are not covered
Kidney transplants aren’t exactly experimental anymore — especially when yours has failed.
I don’t see anyone defending the status quo except maybe Rush. We all know that there are serious problems. On the other hand, we now at least have some options. With a single payer system, you have no options. I don’t care whether that monopoly is granted to the government or Bob down the street.
History has proven over and over that the competitive market, private enterprise provides the greatest number of goods and the highest quality of goods at the lowest cost. It is not a perfect system. It is just better than anything else.
The government is good at making one group of people pay for services provided to other group of people (e.g. medicare), but it is lousy at containing costs. The only way a government solution can reduce health care costs is to ration health care. It has to pay out less than insurance companies now pay. Health care will be more uniform, but worse for anyone currently with insurance.
It is easy to point at excesses, failures and cases that seem outright evil, but the prescribed cure may be worse than the disease. Let’s work on fixing some of the problems w/o destroying all that is good about our current system.
Thinks about it. If we are already paying for emergency care for people w/o insurance, how much more could it cost to provide them with insurance? The problem cannot be as big as it appears.
So are you thinking Obama’s health plan is okay? Go to the Huffington post expose today and see how that little secret deal with Big Pharma works for ya! We dont have a progressive President, we have a “catering to big business corporatist as President”. While I absolutley abhor the birthers/deathers-fascist dumbed down, I am in opposition to all four or five of the House and Senate plans. By the time this thing gets “worked”, it wont be worth the paper its written on. But you all keep thinking we are getting “health care reform”, its pathetic. What we are getting is “more business for the private insurance companies”, called pooling or the new buzz word….”the exchange”!.
While we can all agree we need a “living will” no matter how old/young you are, I dont think we need to spend $200 billion to Doctors for it. Doctors already ask you that question during your visit. When you go to the hospital one of the first questions is “do you have a living will”? If not, would you like one? Do you need help filling it out? A hospital social worker will bring you the forms and explain each question and help you fill it out. Isnt this just another giveaway to Doctors? Already done, don’t need fixin..
Von Cracker: Medicare, Medicaid and VA are “socialized programs” didnt you get the memo! Why not expand “medicare to all”, why not have standardized forms to cut down on paperwork? Why not have all medical records on computer? Why not stop the greedy for profits from throwing you out, if you get sick? Why not have the government “administer” the program to keep costs down? Why not force Big Pharma to reduce their for profits costs of 300-500% for a drug you can buy in Canada for affordable prices? In Japan, they have a group of doctors who estimate what doctors can charge for a particular procedure, so doctors/hospitals dont gouge the public charging whatever they feel like. Get the for profits out of the system and we can have all the health care we need for everyone…everyone in, nobody out…single payer.
“Bottom line, when CIGNA cited the Plan’s provision (Employer’s policy) that medical services considered experimental, investigational and/or unproven to be safe and/or effective for the patient are not covered,”
…whoa….sophisticated talking point alert!!! (insert two Drudge flashing lights here)
No employer writes these guidelines. They come directly from the administrator, in this case, CIGNA. CICGNA can tell the employee “talk to your employer” and the employer can say “we didn’t write the rules, the administrator did.”
Please — these rules are insurance industry rules straight from the mouth of the TPA. Not the employer.
Nice try, though. The talking points are moving up a notch.
Doctors already ask you that question during your visit.
Go ask s real nurse who actually works with seriously ill people.
Yes, they “ask the question,” and there are lots of checkoff forms for it.
But the doctors don’t have time to do the counseling. On a good day it can take about an hour to explain the options to a seriously ill person and his or her family.
Doctors are NOT doing this couselling now, not often anyway, because they don’t have the time for non-billable procedures (another triumph of private health care!)
For a disease like cancer for example, the counseling is a very technical question, where you need to be educated about how your level of disability and your quality of life is likely to change as the disease progresses. You don’t want to be thinking about it while you are 85 lbs and drowning in your own blood while grown men are breaking your ribs and jamming tubes down your windpipe.
This is a hard conversation and not one that you should have to confront by checking a box on a clipboard by yourself, without serious medical and nursing support.
We dont have a progressive President, we have a “catering to big business corporatist as President”.
Just like Clinton
Doctors are NOT doing this couselling now, not often anyway, because they don’t have the time for non-billable procedures
And it doesn’t have to be a doctor; it could just as well (if not better) be done by an RN or NP.