Monday, October 12, 2009

Defending the Undefendable

Let me start off by saying that I am well aware that the following post will offend and/or enrage many people who are more prone to be led by their raw emotions rather than temperament and reason. But after prying into the story I am about to discuss, and witnessing the overwhelming amount of sheer ignorance regarding the general public on the issue, I decided that I just couldn't let this one go by. I may be the lone voice in the wilderness on this one, but I've absolutely had it with unruly mobs who sit and wait with torch and club in hand, waiting to burn every perceived witch that might enter their periphery.

The aforementioned story is that of Nataline Sarkisyan. Nataline contracted Leukemia at the young age of 14. Over months and years, she had endured several medical procedures which seemed to push her ailment into remission. But around age 17, things started to again look bleak for the young woman. It was decided that her condition was terminal, and that her only real chance for survival was a liver transplant. As the story goes, a battle ensued between the Sarkisyan family and their insurance company, CIGNA, regarding coverage. Eventually, CIGNA came to the table and agreed to cover the procedure. But it was too late; young Nataline had tragically passed away shortly before Christmas in 2007. Her death triggered a lawsuit, brought forth by the family, against CIGNA for murder.

The lawsuit was initially struck down by California courts but the family has pressed forward. They have united with various medical labor unions in California in lobbying for health care reform and have organized various protests against insurance companies, like CIGNA, who they claim "deny" medical coverage and therefore kill people. And there is no end to the amount of similar sentiment that has been shared by news outlets, especially online. A quick Google search for "Sarkisyan death panel" will lead you to an almost inexhaustible trail of sympathetic coverage. More recent outrage has been generated by a protest in front of CIGNA corporate offices in which exchanges between the protesters and employees of CIGNA devolved into fanatical jeering at one another. At one point, an employee was purported to have even flipped off the protesters after an escalation between the two groups. And of course, news outlets, as they so often do, have turned this story into additional publicity for the cause by insinuating (in headlines) that the gesture was made specifically at the mother of the young deceased woman.

Let me preface my statements on the matter by saying that I, by no means, actively support any of the quasi-municipal insurance companies found around the country today. I believe they are in bed with government. I believe they use government regulation and mandates to essentially monopolize the health insurance markets and as such, I believe that they, along with government, are primarily responsible for the egregious inflation in health care costs today. That being said, the predisposition of the public to damn and condemn CIGNA as murderers is absolutely outrageous to me. Do insurance companies ever fraud their customers? Given the enormous volume of customers that any given company may serve, I'm sure that happens now and then, whether intentional or not. I may pick up a loaf of bread at my grocery store that is moldy and not notice it. Now, it may be unclear as to whether the store knowingly sold me moldy bread or if it was an oversight, but fraud has occurred nonetheless, and I should certainly get another loaf or at least get my money back in this case. Very few of us would disagree with this. But is every unsatisfied customer the victim of fraud? Can customers be wrong? According to public sentiment, no. Only businesses can be in err.

What amazed me when I was trying to get to the bottom of this story is that every single liberal-leaning publication provided almost NO INFORMATION about the original case brought against CIGNA. Instead, it felt like they were giving just enough surface detail to lead the public to believe that a heartless insurance company had killed a customer by denying coverage. I had to dig a lot deeper to find anything of substance. The first questions that occurred to me were those regarding the details of the family's medical coverage. It seemed to me that every single story just claimed "insurance denial" and never went into what kind of plan and coverage they had in the first place. If, hypothetically, her family's plan did not cover transplants of any kind at all, would these detractors still see CIGNA as being at fault for denying such coverage?

My short answer is "Yes." If all of these people who have been up in arms were even remotely concerned about the truth, they would dig deeper to ask these questions. But instead we're left with an angry mob that just parrots the rage directed at large insurance companies by so-called victims...and they never seem to want to know why a service had been denied or if IT WAS EVEN PAID FOR! If I went to the store and only bought bread, and later I died from dehydration, would my family be allowed to sue that store for murder because it "denied" me water? Or does the fact that I never paid for water even enter into the equation for these people? I honestly don't even think that it does. I think, ultimately, people who react in this way simply feel that the circumstance of human need justifies some egalitarian notion of slavery...that I "owe" my labor or the product of my labor to another human simply because they have human needs. This point may be somewhat tangential but I just wanted to highlight the fact that I don't believe the point of contention for these people even hinges on the existence of fraud.

But if you actually obtain some of the hard facts surrounding this case, it starts to become even more ridiculous. It turns out that the family's coverage comes through an employer group plan that contracted an ASO account with CIGNA. And for those who don't work in the medical reimbursement field, I'll help clear this up; Many employer based insurance plans are actually constructed by the employer or intermediary groups...this includes everything from the payments to the terms of coverage. However, often the employer or group does not want to administer the coverage themselves for various reasons. So they will set up an account (kind of like a savings account actually) with a large insurer like CIGNA, AETNA, or Anthem (OH-KY-IN BCBS) to actually administer the coverage and billing aspect (ASO- Administrative Services Only).

Now, granted, if a coverage issue should arise, on-staff doctors and various physicians at these companies are responsible for determining if reimbursement for services falls within the means of the contract for the employer or group, BUT it is the employer or group that determines the outline of the plan...not the insurance company. In the case of young Nataline, physicians at CIGNA had determined that the risk of the operation pushed it outside of the bounds of the coverage outlined by Mr. Sarkisyan's employer. CIGNA's critics, and the public at large, have, in a knee-jerk reaction, lashed out at CIGNA for the denial, claiming they deny such coverage because they only care about profits. All this even though, ironically, the issuance of such a claim would have come at NO COST to them at all as they simply disperse reimbursement from the ASO savings account of the employer. They were in no position to lose or save ANY of their own money. And even worse, although their attempt to make an exception and cover the procedure was ultimately made too late, this actually would have been money coming out of their own pockets (profits) to provide an expensive service to someone whom they had no such agreements with...and they STILL come out of it all as villains in the public eye.

The family and their lawyer, Mark Geragos (who is best known for defending upstanding citizens such as Scott Peterson and Michael Jackson), have continued to press on with legal proceedings against CIGNA. Let me be clear that my main contention isn't with the family itself...I don't pretend to know the kind of grief they must be going through and I most certainly couldn't tell you that I'm privy to every single detail, or that if I felt their overwhelming loss that I couldn't ever be found taking a similar path. My contention is with the masses, whose predisposition to vilify private industry and whose genuine dearth of curiosity has led them to use this family's plight as a whipping post for their perceived enemies. I can tolerate people who are dead-set in their beliefs, but I cannot tolerate people who are this way simply because they refuse to be critical and ask important questions.

Constantly we hear the incessant mantra that insurance companies are just out to make profits. CIGNA brings home an average, after taxes, of 4.1% profits annually. That means even if you took every single penny of return away from those "fat-cat" CEOs, your $1,000 procedure would still cost you $959. So great...maybe your ego would be satiated but your wallet still takes a kick in the pants. The problem with our system is the cost of the care itself...not insurance company profits. Meanwhile, companies like Dell pull in over 10% profits annually. Are the prices of computers skyrocketing or dropping? Is the quality of the modern PC getting worse or better? Does Dell deliver a good with better quality and lower prices every year out of the goodness of their heart? Or does competition and profit drive them to provide customers with a better product for a better price? To anyone who is in the know in the slightest regarding economics, profits are certainly not the problem. Yet, not only because these reactionaries do not understand the fundamentals of the free market, but because they don't even understand the fundamentals of this particular story, they are led to believe that corporate greed killed this young woman.

And it's not only their misconception of the role of profits or even the fact that they are seemingly ignorant of how the family's plan was set up that really disturbs me. What disturbs me is that their INITIAL tendency was to make a shoot right at the insurance company. Why? If they would dig a little deeper into the story, it seems as if they should really be lobbing their claims towards Mr. Sarkisyan's employer, who created the plan in which such services were ultimately denied. We bash CIGNA for sticking to his employer's outlines but we don't seem to focus on the employer at all. Did they approach the employer and ask for an exception? Why is that somehow on the back of CIGNA? And probably even more disturbing to me; where were the doctors at UCLA on all of this? You're telling me that these doctors would not provide LIFE-SAVING treatment to a 17 year old girl until CIGNA agreed to compensate them for it? How are these people LESS culpable than ANYONE else in this matter? It seems to me that if you're willing to attack CIGNA for not providing coverage that wasn't paid for in the first place then I couldn't understand why you wouldn't attack the providers or the hospital for not fronting the same bill or at least carrying forth with the operation in lieu of an agreement being met in the interim.

And yet comment after comment, I see people slamming private insurance companies and holding this story up not only as political fodder for a "public option" but for single-payer care! I wonder how many of these people are aware of the tens of thousands of people that get denied care by the government every year through our own Medicare and Medicaid systems. No altruistic intentions or softly spoken rhetoric can deny economic realities. All resources are scarce...this translates directly to the medical profression as with any and every other profession. There is nothing the government can do, short of enslaving its people and drastically decreasing our standard of living, to fundamentally alter the price structure that results from the reality of scarcity. In fact, their attempts to do so have served ultimately not to decrease costs or or provide more coverage, but rather to raise costs and provide less coverage. At best, they can only mask the realities of scarcity with the facade of "free health care" and progressive taxation. But government cannot play god. It cannot provide services of unlimited number and quality to the masses. It too, as it always has and will do, rations the care it has no options. It's bad enough that supporters of such moves are hyper-critical towards private industry without asking any questions, but it's even worse that they could be hyper-supportive of government industry without asking some questions as well.

Regardless of one's opinions on public policy, the points outlined above should be on the minds of anyone interested in the Sarkisyan case. To me, these are all very important questions that I don't see being asked by anyone publicly. Surely we can all agree that there are specifics about this case that none of us are privy to. But for that reason alone, shouldn't we not be so quick, as a society, to slam CIGNA? Outside of the specifics, even some of the important general questions I brought to light in this post have not been answered yet. Have we gotten to the point, as a culture, that guilt simply isn't predicated on the facts anymore, but instead on the emotional disposition of the masses? I've often pointed out in my writings that this is exactly what is wrong with democracy. For all its praise and glorification, if democracy has simply become a vehicle of force to be controlled by the whims of an irrational and thoughtless public in order to burn witches at the stake, then I want nothing to do with it.

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