AlterNet: Is 'Cookbook Medicine' Crippling the U.S. Health System?

[marmar]

Is 'Cookbook Medicine' Crippling the U.S. Health System?

By Christopher Moraff, AlterNet. Posted February 25, 2008.

The recent death of Nataline Sarkisyan exposes the tragic consequences of a health care system that values profit over patients.




By now, the case of Nataline Sarkisyan has garnered so much media attention that there's likely few people who haven't heard the story of the 17 year-old California girl who died five days before Christmas after her insurance company refused to approve her liver transplant.

Sarkisyan, who was diagnosed with Leukemia when she was 14, was undergoing treatment at UCLA Medical Center when Philadelphia-based Cigna HealthCare ruled her much-needed transplant "experimental, investigational and unproven."

Sarkisyan spent three weeks in a vegetative state before Cigna bowed to pressure from the girl's doctors and offered to pay for the transplant itself. But by then it was too late.

Whether a transplant would have ultimately saved Sarkisyan's life we will never know. But that's not really the point. After all somebody has to say no; the problem, says David Senoff -- a Pennsylvania attorney who represents patients who have been denied care by their insurance company -- is that the people saying no are the very same people who profit from the answer.

"Health insurance by definition covers some things, and not other things it's the same as any other policy: there are some things that are in and some things that are out and somebody has to be the one who's outside of coverage; but you don't want those people who decide to be the ones who are in the company making additional money by denying care," Senoff said.

"The last person on earth that should be making a determination is the person that's going to be making money off of the decision," echoes Steffie Woolhandler, an associate professor of medicine at Harvard University. "No one that's involved in that decision should stand to gain or lose based on the decision." .......(more)

The complete piece is at: http://www.alternet.org/healthwellness/77763/

[Indy Lurker]

1. How do other Insurance companies handle this?

Say auto, who arbitrates when the insurance company doesn't want to pay?

[xchrom]

2. recommend -- and this is why we have an adversarial legal system

-- we need lawyers to battle this stuff out continuously so we know where the lines are.

no, it's not the only reason we need this system -- but it's a good one.

[Pooka Fey]

3. K&R

[knitter4democracy]

4. This is why we need a national health care system.

We need to remove middlemen from the decisions and the profit motive. If the doctors had had their way, she would've gotten the transplant. It's the dang insurance middlemen that screw it up so darn often. We need national health care now!

[grasswire]

5. that was my first thought

Take the profit out, and immediately the problem is solved.

[yellerpup]

6. THE Point exactly.

Convert health insurers back into non-profits and take away their ad budgets but allow PSA's and that will go a long way to relieving the ridiculously high costs. I know people have invested in health insurance providers but their investment means little conpared to the greater good. Investing is gambling and always bears a risk.

[grasswire]

7. eliminate the middleman

That was an old advertising slogan for dealers. It's apt in this scenario.

[yellerpup]

8. So true. n/t