Calif. teen's family sues Cigna over transplant - page 3

calif. teen's family sues cigna over transplant 2008 the associated press dec. 26, 2008, 5:56pm los angeles — the family of a 17-year-old leukemia patient has sued health insurance... Read More

  1. 1
    Quote from withasmilelpn
    So, would you do any transplants? I agree that health care does require rationing, but the main determination should be quality of life and success rates in my mind. I've already said that I think you are right, the poor girl probably would not been a good candidate.
    What about those who are? I took care of a woman who had a kidney transplant, she lived 11+ years with it and had an active, productive life.
    Of course I don't have any problem with transplants. But when you have a limited supply, you ration resources out to those who will make the best use of it. This wasn't it.
    talaxandra likes this.

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  2. 2
    i for one trust nataline's mds to make the decision of whteher or not the transplant is appropriate. i think that it's safe to assume that the transplant mds are quite aware of the scarcity of livers, but still fought on nataline's behalf to get her on the list.

    on tiredmd's assertions about the relationship between paying for procedures and the rising costs of premiums:

    then at the same time we turn around and expect insurance companies to spend hundreds of thousands of dollars on a transplant patient who already had a bmt and suffered a recurrence. do people think insurance money magically grows on trees? doesn't anyone recognize that the money paid out by the cigna gets recouped through premiums on everyone else?
    this article says a lot: cigna bemoaning that its 2008 profit fell to between $920 to $950 million.

    but, no worries, 2009 profit is forecast to be $1.07 billion:
    "analysts polled by thomson reuters have forecast 2008 profit of $983.1 million and 2009 earnings of $1.07 billion, on average."

    the reality is that insurance companies like cigna make such profits by taking in far more in insurance premiums than they pay out in claims.

    cigna will raise its prices as high as they can get away with while remaining competitive with other insurance companies that are operating with the same profit motive.

    the amount that insurance companies pay out in claims has little to nothing to do with the high costs of insurance! if you're worried about the rising price of healthcare, single-payer health care is the obvious answer.
    lindarn and herring_RN like this.
  3. 1
    Quote from jsrRN
    The amount that insurance companies pay out in claims has little to nothing to do with the high costs of insurance! If you're worried about the rising price of healthcare, single-payer health care is the obvious answer.
    It is laughable that you think a single-payer government-sponsored "insurance" would have paid for this procedure.

    But I think your post explains why the local nursing unions were so involved in this case: it was part of the political push for government-funded health care, it wasn't about the health and welfare of the terminally-ill girl.
    haras regnurps likes this.
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    I for one do not want this country to begin "rationing" anything. Especially not healthcare.
    Cost is an issue. You cannot effectively manage anything without considering cost. There is a cost in not spending money too. Sometimes you have to spend money to make money and that goes double for the insurance companies. I do not want a "suit" sitting at a desk to decide if my parents are too old to get their blood pressure medicine anymore, nor do I want them aborting babies of unwed mothers under the age of 18 because it is cost effective. DO YOU? Doctors and other healthcare workers need to be making decisions with the patient. There is alot of "stuff" that never makes it into a chart. Like what a patient actually looks like. Some hospitals are starting to take pictures of the patients on admission so everyone has something to go by.
    When you are all alone reading charts it is nice to have a face to put with the "story" in writing in the chart. I think this patient was not a good candidate for a liver transplant; that is fact, but she was never even on the list. This was because the insurance co. said no. She probably wouldn't have been transplanted but shouldn't the family feel like they did everything that they could for her. They don't feel that way because they did not have a chance. That is not a place that a grieving family needs to be in. If the HMO had said sure she can have a liver we will pay for it, the doctors would've been the "bad guys" for not proceeding. What I am saying is that the insurance companies take premiums and render a service for that money. They need to followthe guidelines of the policy that they sold. It is usally very clear if experimental trx is covered, if transplants are covered etc........if the policy states it is a covered event then it is a covered event and the company is obligated to pay. Many people have recieved organs that shouldn't have gotten them. Healthcare unfortunately is not immune from rackiteering and organs rank at the top of the list. Bribes are not unheard of anywhere. Resources should be more valued than they are but most folks in N.America have this sense that everything is there if and when they need it no matter what it is. In many parts of this wonderful planet we all live on this whole post would be laughable. In many places this little girl wouldn't have gotten the BMT let alone a liver too especially with leukemia but the issue is WHO IS MAKING THE DECISION.
    lindarn and herring_RN like this.
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    [color=#333333]physicians for a national health program (pnhp) has a useful answer on rationing:
    [color=#333333]won’t this result in rationing like in canada?
    [color=#333333]the [color=#333333]u.s.[color=#333333] already rations care. rationing in [color=#333333]u.s.[color=#333333] health care is based on income: if you can afford care, you get it; if you can’t, you don’t. a recent study by the prestigious institute of medicine found that 18,000 americans die every year because they don’t have health insurance. many more skip treatments that their insurance company refuses to cover. that’s rationing. other countries do not ration in this way.
    [color=#333333]if there is this much rationing, why don’t we hear about it? and if other countries ration less, why do we hear about them? the answer is that their systems are publicly accountable, and ours is not. problems with their health care systems are aired in public; ours are not. for example, in canada, when waits for care emerged in the 1990s, parliament hotly debated the causes and solutions. most provinces have also established formal reporting systems on waiting lists, with wait times for each hospital posted on the internet. this public attention has led to recent falls in waits there.
    [color=#333333]in [color=#333333]u.s.[color=#333333] health care, no one is ultimately accountable for how the system works. no one takes full responsibility. rationing in our system is carried out covertly through financial pressure, forcing millions of individuals to forego care or to be shunted away by caregivers from services they can’t pay for.
    [color=#333333]the rationing that takes place in [color=#333333]u.s.[color=#333333] health care is unnecessary. a number of studies (notably a general accounting office report in 1991 and a congressional budget office report in 1993) show that there is more than enough money in our health care system to serve everyone if it were spent wisely. administrative costs are at 31% of [color=#333333]u.s.[color=#333333] health spending, far higher than in other countries’ systems. these inflated costs are due to our failure to have a publicly financed, universal health care system. we spend about twice as much per person as canada or most european nations, and still deny health care to many in need. a national health program could save enough on administration to assure access to care for all americans, without rationing.
    lindarn and herring_RN like this.
  6. 1
    Quote from TiredMD
    Of course I don't have any problem with transplants. But when you have a limited supply, you ration resources out to those who will make the best use of it. This wasn't it.
    Thank you for your response. I'm always interested in what your perspective as a MD is and you have often helped clarify things by your posts.
    lindarn likes this.
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    Cigna pays more than most commercial insurers. They monitor their care and often deny, but reverse if the request is the standard of care. What this family wanted was extreme care with no scientific background with little chance for meaningful recovery.
    TiredMD and lindarn like this.

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