Why Cigna’s Stance is Suspect

Cigna has apparently decided to stand by their decision to override her doctors and deny a teenager a vital liver transplant.  The teenager later died.

Initially, they reversed course at the very last minute.  It was too late by that point to save the girl.  Now they are saying their decision was the correct one:

Philadelphia-based Cigna HealthCare has a record of approving coverage for more than 90% of all transplants requested by its members, as well as more than 90% of the liver transplants, company President David Cordani said in a memo addressed to employees and distributed to members of the media.

Nataline Sarkisyan’s request was evaluated on an expedited basis using “evidence-based guidelines published by independent physician and medical organizations, as well as expert scientific journals,” Cordani said.

Funny how the doctors charged with her care thought she should get the transplant, and the bean counters using “evidence based guidelines” and “expert scientific journals” charmingly decided on denying the costly procedure.

What do we expected when we mix private corporations with public health care?  Profit at the cost of human life is an extreme, the kind of theoretical example one brings into a debate to make a point.  Not with the expectation one might come face to face with such a callous disregard for human life.  Cigna President David, by making the denial of care an official point, has made the cold, greedy nature of himself and Cigna blazingly apparent to the world.

And this is the story we heard about.  How many other patients were denied coverage, didn’t protest, and simply died?  How many were denied procedures, and continue to live with debilitating medical problems?   All for Cigna’s profit.

Removing “for profit” from Health Care, and recognizing Health Care coverage as a fundamental human right, is one of the cornerstone issues facing humanity.  For what cynical joke is the “right to life” if that right can be denied to balance a spreadsheet?

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47 Responses

  1. amen, dan!

  2. To be honest, I’m not entirely sure if you can designate “health care” as a human right. Perhaps a derivative of another right, but not a primary right.

    That’s not really the issue though. You’re right, for profit insurance has been a disaster of millions of Americans, and any meaningful reform of the system must include a removal – preferably gradual – of insurance companies from the equation.

  3. Insurance companies are backed by the government, limit the bureaucracy and you’ve limited the thieves with the badges. I know someone who fell 30 feet off a roof. A commercial property none the less. He had to be life flighted as his rib punctured his spleen. Also there were undetermined head and neck injuries. First he got screwed by workers comp insurance by making him wait months to collect a check and sending out investigators to spy on him, then he got screwed by whatever insurance that was dictating the payment of the life flight as they deemed the life flight as unnecessary. He’s still to this day, 6 years later receiving bills for it. But compared to the poor liver transplant at least he’s alive.

    Now in the beautiful socialist republic of MA you have your example of how socialized medicine will strip the people even further. Mandatory health insurance is a monster. People that couldn’t afford health insurance prior to Deval Patricks insidious populous betterment now can look forward to being fined up to 50% of the premium per month for not having it. Yea great idea governor. The idea that insurance companies are helping health care is preposterous. They don’t want to give money back. And work mans compensation is a good concept but an utterly corrupt one. I know I was forced to pay for it for my company (before I went sole proprietor) and it didn’t cover me, and it was a monumental task to have it cover my workers if they got hurt. So I paid 18% of the payroll to the pirates and they were reluctant to pay for a nail shot into the foot of one of my guys. Another employee hurt his back and couldn’t work so the wonderful process proceeded to bleed him dry by making him wait almost two months for a payment and that was only 60% of his pay. In both instances I personally took care of my guys. Point is that insurance companies with the backing of the government are lawless moral lacking thieves. Socialized medicine is a bad idea. House calls worked back in the day (not too long ago). Personalized medicine works.

  4. Word, Dan.
    I have noticed that many Americans are acculturated to capitalist propaganda to such an extent that talking about socialised healthcare is akin to talking about light switches to a child raised in the woods by wolves. They just have problems grasping the basic concepts. The red herring of retaining insurance companies is a hilarious ruse by the corporations and the politicians they own to use their weaknesses to smear a proposed system that would in fact mean they no longer existed. Socialised medicine is your govt. controlled by you providing healthcare funded by progressive direct taxes, no part of it operates for profit, even if third party NGO’s or trusts are involved. Anything less is a fake by bought off technocrats and conservatives (whichever party they may nominally belong to). Michael is rejecting another fake & corrupt version, good, but he seems to have been informed that is the model of socialised medicine. That is the perception insurance and associated political & media interests have engineered.

    It is problematic only to the extent your govt. is corrupt, inefficient and owned by corporate interests (and that is the people’s responsibility, democracy takes work and paying attention to the people you employ to serve you, voting every so often is NOT democracy) and to the extent the witless ideology of wealth rejects human community. We’re all in this together, you pay into a common pot, you look after each other. Although until poverty is seen as a cultural, social and economic failing not as an individual’s moral failing there is little hope of emerging from the dark ages. And in the macro perspective this is about the fundamental question- do you want to live in a society where you serve the economy, or the economy serves you? I would also note many women understand this ontological question far better than men, they after all do the bulk of caring, working and nurturing. Which is also why data from experiments where women consistently contradicted free market theory and the psychological modelling upon which it is based was destroyed…by men working at for profit corporations and associated universities.

    But fine, it is sort of fun laughing at lovers of the US establishment, anytime you feel like not dying so a business can increase its profits let us know.

  5. RickB:

    “Which is also why data from experiments where women consistently contradicted free market theory and the psychological modeling upon which it is based was destroyed”

    Destroyed and ignored to break up the family unit and tax the other half (women) of the population. There is no question that being a mother is one of if not the toughest jobs going. But it is also one of if not the most important aspect of raising a child. The results of having a nurturing mother or mother figure are not contested either, just ignored.

    When I was raising my children I worked first shift early to late then came home and cared for the children to bedtime. I was not envious of my wife having them from early to late shift then working 3rd shift. We had to work to pay our bills. We had to work to pay taxes for social programs and wasteful government spending and corporate subsidies and pirate insurance companies and deficit spending and past police actions (not wars). And today the men and women that served and still served get slapped in the face by receiving a death benefit from dying in Iraq of 6,000.00 while 911 survivors receive a minimum of 250,000.00 to over 4,000,000,000.00 I guess depending on what your existence can be sold for to the courts. We serve the economy at this point and it’s not a new situation. Politicians have been consistently proposing and promising change for many years and the change has been for the worse. We have been promised clean renewable energy for many years and we are addicted to oil like crack junkies 30+ years latter. We can put lasers on every convenience store counter but we can’t even make a move on a hydrogen engine that gives off only water as a by product. (been in the works for years) No car company or oil company or worst of all politician will even look at the concept. Guess why. Same reasons the don’t want doctors that make house calls or home schooled children. There is too much budgetary overspill and bureaucracy to gain by not having what’s good for the people. As a matter of fact at this point in time I am confident that if the federal government is for it then it must be bad for the citizenry. All common people that is, not just a select bunch. The record is there for so many election promises that were ignored or worse just plain opposite results were perceived.

    “But fine, it is sort of fun laughing at lovers of the US establishment, anytime you feel like not dying so a business can increase its profits let us know.”
    huh?

  6. I agree. It is disgusting to me that our entire health care system revolved around having to be employed in the first place. What started out as a benefit to attract workers from corporations has become the defacto model in the U.S. So, if you are unemployed you are not worthy of basic health care? I am a conservative. I believe in supply side economic, but my fellow conservatives have got to realize that basic health care is, indeed, a government responsibility no different than “providing for the common defense”. There is another part to that, and it is “the general welfare”.

    A nation that cannot provide for its own citizens is not a healthy nation. Now, my fellow conservatives will point out that the vast majority of Americans have excellent health care, HOWEVER, they miss the fundamental point that health care should not be tied into your employer in the first place. How about we leave our national defense to weather or not we are employed?

    Sure, a government program will be costly. There will by default be waste and abuse. But, we need to come up with something anyways. Maybe offset the cost by privatizing social security, or revamping the tax code? It needs to be a holistic approach. And, yes, we need to get the “profit” motive out of health care,

    Sorry for the rant…but this story had me mad 🙂

  7. I’ve made health care options and coverage parameters an important factor in deciding to take a job or not. We like to blame corporations for everything and it’s easier than looking into the mirror. We demand change on behalf of all other entities but when will we change ourselves ? We enjoy pension plans that prosper but will we take a hard look and demand no investments in health care companies and only good steward producers of other commodities ? The answer is such a loud and resounding NO that I can’t hear the tears,laughter or gnashing of teeth. Why is that ?

  8. I can’t afford health care coverage as a self employed construction worker. Most non union construction companies cannot afford to supply health care coverage for their workers. If you do find a job that has bennies in this field your take home pay is significantly reduced by premium sharing never mind the copay. Pension plan? wtf is that? I’m diving off the tallest gable when I have social security as my only means. The system is broke I tell ya.

  9. My comment was more along the lines that as a society we invest in companies such as CIGNA and get happy with the returns. Then how is it people think the same people will turn and bite the hand that feeds them. It wasn’t about any given individual having pensions as a benefit. I’d also echo the thoughts of many in Mass. that are now mandated by law to have insurance. We’ll see how that all works out.

  10. […] Saw these two posts on walkabout around the WordPress community. Hysterical Raisins and FitnessfortheOccassion both had  posts on how CIGNA has allowed a 17 year old California girl die. The premise is that […]

  11. You miss a lot.

    Doctors do not have any duty to ensure that health care remain affordable. They don’t even have a duty to ensure that the care they give terminal patients is likely to work. Consider this: a patient is dying. A procedure has a 1% chance of extending his life for another year, at a cost of $1 million. If the procedure fails, the patient will be no worse off. Doctors are totally within their rights to approve this procedure and deem it “medically necessary.” The calculus is to weigh benefit to the patient and potential harm to the patient, nothing more or less.

    That’s the type of situation we are seeing here. The employer who is paying for this (and, likely, the reinsurance company who picks up such high costs) have a LOT better ways to spend $300,000. $300,000 is over a thousand life-saving appendectomies, or several courses of chemo, or thousands of extra mammograms.

    There are an unlimited number of ways to spend money to extend life; there is an unlimited amount of money that can be spent on improving our medical care. There is not, however, an unlimited supply of money.

    What if this procedure were approved, and the employer decided that it is too expensive to have these procedures? It has a certain amount of money that it can spend on health insurance, and it will just shift the extra costs to the employees. When you start kvetching about corporate America denying care to this young lady, think about this: the people who pay for her care are ultimately the employees – the janitors, secretaries, and receptionists will all take a pay and/or benefits cut when procedures are approved.

    There is a pot of money that CIGNA has a fiduciary duty to manage. The duty extends to ALL the employees of the company, not just this one person. As much as you liberals like to say, “It’s about profit!” it’s not – it’s about ensuring that everyone has access to a basic level of medical care. Procedures like this can drain that pot of money very, very quickly, and should only be used when there is a very high likelihood of it saving her life and improving the quality of her life.

    If you don’t like how insurance companies these days deny care, you’re more than welcome to go back to the good old days, and the technology available during the good old days.

  12. The problem is that a) not everybody gets the health care, even if they work, b) it is about the money, or have you forgotten what a company is and why they have investors in the first place. Its not about going back to something that existed before, its about upgrading the system and punting it outside the “for-profit” area. This is but one example, and not a rare one I may add.

  13. Oh and nice touch with the “you liberals” bit. Very charming.

  14. Michael D,
    I think it was a roundabout way of saying the change required is so radical, revolutionaty in fact that outside help would be needed, import best models, best practice. End debate within the box provided by corporations and the wealthy and build a healthcare movement free of those hidden agendas.
    But I understand the immediate dilemma, basically no good way of getting healthcare as current systems are faulty (insofar as they are actually designed to generate profit via the healthcare field which does not equal good healthcare). And mistrust of the federal govt. is wise…but that is also what the ruling class has engendered, Reagan’s joke about the most terrifying words “I’m from the government and I’m here to help” was a cunning tactic to breed hatred of the govt simply so they could get support to gut any regulation or oversight a democracy should have. Then they raided the treasury and funded wars both legal, illegal & covert (let’s hear it for Iran-Contra) to further corporate profits and imperial dominance, Clinton’s policies were just slighlty less conservative obscured by some social liberalism and charisma. But neither gave a shit about the working people to the extent they would inconvenience the elite accruing and concentrating more wealth. Govt. per se is not wrong, govt. that is not by and for the people is wrong. At the moment the govt serves the top 2%, it relies on the middle class for revenue and it ignores the working class other than building jails (for profit). That picture is repeated throughout the world right now. At least Warren Buffet was honest when he said there is a class war and his class is winning.

    Politically I’d look at this
    http://www.pnhp.org/publications/the_national_health_insurance_bill_hr_676.php
    but it doesn’t end there, you have to retrieve the money stolen and being stolen from the commonwealth by the wealthy. And end any for-profit involvement in health.

    As far as I can see in the Presidential race only Kucinich and Edwards offer any hope politically. The libertarian approach to healthcare simply does not work (as in most respects, it is a personal ethos not a macro societally viable ideology, its real consequences are to actually further embed the ruling elite even if it denies them Empire) given the costs of training and medical treaments, a common approach is simply the only workable approach, after all that is how insurance companies make profit- a large client base spreads risk, what they in fact are arguing against is that model being used for human welfare not profit. A fundamental political question. With a responsive government of, by & for the people socialised medicine works, the struggle is to ensure that comes about, both the healthcare and retaking the government.

    Realistically, I would check means of travel to countries with socialised healthcare and also the means of buying prescriptions from them.
    Survival after all is important (I honestly would be eyeing Canada pretty keenly myself) and Rome wasn’t built in a day (I heard the plasterers came in on the second day to finish the Coliseum).
    And if you ain’t seen Sicko yet, isohunt dot com, that’s all I’m saying.

  15. thanks nonnie!

    Jamelle,
    Good point. I’d say that the right to life is realized partially through access to health care. So if life is the right, healh care is part of its application.

    Removing insurance companies from the equation is indeed vital.

    Michael D,
    Mandatory health insurance isn’t universal health insurance. Don’t be fooled. It does suck.

    Saying “personalized medicine works” doesn’t make sense. What about hospital visits whose cost exceeds yearly salaries? We do need to drive costs down, but at the same time, as “do it yourself” mentality isn’t at all practical for health coverage.

    (btw, calling MA socialist is just silly).

    RickB,
    Thanks! There is a huge perception gap when it comes to understanding socialized healthcare. Of course our government is corrupt, inefficient and owned by corporate interests. But if we took “for profit” out of the equation, as Jamelle notes, we’d be a big step in the right direction.

    Michael D,

    “But fine, it is sort of fun laughing at lovers of the US establishment, anytime you feel like not dying so a business can increase its profits let us know.”
    huh?

    We Americans embrace a for profit system that is literally killing us. Its kinda funny.

    Health Freak,
    Thanks!

    I am a conservative. I believe in supply side economic, but my fellow conservatives have got to realize that basic health care is, indeed, a government responsibility no different than “providing for the common defense”. There is another part to that, and it is “the general welfare”.

    Right on!
    Now, my fellow conservatives will point out that the vast majority of Americans have excellent health care, HOWEVER, they miss the fundamental point that health care should not be tied into your employer in the first place.Well put. It would have a fantastic effect on the economy, if health insurance didn’t play such a big role in selecting a job. Also there are the working poor, those who have jobs, but no insurance. Many companies will institute health care for those who work 40 hour weeks, and schedule people for 39. I know, my last employer did.

    There is already waste and abuse in the private system. The difference in accountability (in theory mostly, unfortunately). Perhaps we liberals and conservatives could brainstorm some ways to reduce government waste? I would love to find a think tank that does that.

    in2thefray,

    I’ve made health care options and coverage parameters an important factor in deciding to take a job or not.

    It shouldn’t be. We shouldn’t have to turn down an amazing and productive job because that corporation picked a shitty insurer. And how would we know, anyway? Would you have known about Cigna before this hit the news?

    We like to blame corporations for everything and it’s easier than looking into the mirror.

    That’s bullshit. The problem is systemic, and even epistemic. As an employee, I don’t know which insurance companies are bad. I know Cigna is pretty awful, and I’ve heard some nasty things about Blue Cross Blue Shield in California, but looking at a new entity, do I know for certain I can trust them with my life? They are looking out for their profits. My health, my life, is protected by a mere service they provide, so long as it meets their profit goals. That isn’t right.

    Michael D,
    The system is broken.

    in2thefray,
    What change in ourselves are you advocating? Stop getting cancer? Save half of every pay check into a “health fund”, and watch it all get drained in a month of un-covered treatment, and debt start racking up? Or do you mean telling our employer to switch insurers during a medical procedure when we find out we are stuck with a Cigna?

    Your position lacks practicality.

    theobromophile,

    You miss a lot.

    Doctors do not have any duty to ensure that health care remain affordable.

    Ironicly, you’ve missed a key point. No one is saying Doctors ensure health care is affordable. What I am saying is that we must ensure people aren’t turned away so the company paying for the procedure can save money.

    Doctors are totally within their rights to approve this procedure and deem it “medically necessary.”

    But that is what happened. The doctors approved the procedure, and the insurance company shot them down.

    There is a pot of money that CIGNA has a fiduciary duty to manage. The duty extends to ALL the employees of the company, not just this one person. As much as you liberals like to say, “It’s about profit!” it’s not – it’s about ensuring that everyone has access to a basic level of medical care.

    The whole situation, a limited pot overseen by an insurance vendor, arises because of a lack of socialized medicine. This vendor is concerned with profit, in addition to managing the artificially limited pot. This is yet another argument for socialized medicine.

    If you don’t like how insurance companies these days deny care, you’re more than welcome to go back to the good old days, and the technology available during the good old days.

    That is a useless thing to say. Just because we are not satisfied with what we have today, does not mean our only option is to regress to the failures of yesterday. We can make progress, we can move forward, innovate, and find a way to help more people.
    You don’t have to be a progressive to see the possibility for progress.

    ralfast,
    Right on, and noting it is “not a rare one” is important. How many times has this happened and been below the radar?

    (heh, “you liberals”)

    RickB,
    We need to repeat these words again and again. The government is supposed to be US. When we put health care under its stewardship, we are saying we the people should run health care. That is a sense we’ve lost, thanks to the savy and relentless psychological positioning of conservatives in this country. Our government should be ours.

    And Sicko has some rather good ideas.

  16. The point of my statement
    “personalized medicine works”
    Is this, personalized in the form of the doctor I had when I was a kid, that came to our house if need be, that knew the family as well as the family history, that could ask “what really happened” when the parents were in the other room and get the real answer and not turn in my parents for neglect. Those are what I mean by personalized medicine. So how in the world can you say that “doesn’t make sense” unless you didn’t get my point in the first place in which case I hope you do now.

    Having to choose which benefits package best suits your needs to choose a job is indeed unfortunate but not nearly as damaging as not having the option in the first place. This is where the majority of construction workers are thrown under the bus. The market and rates are so bad at this point and factoring in cheap illegitimate companies (illegal immigrants with no overhead that can underbid a legitimate company) makes the situation dismal at best for the average construction company to stay in business never mind provide health care for employees.

  17. Michael D,
    I think I get your point? In that medical doctors who know the family are better than those that don’t, correct? That’s all well and good, but, how does it relate to whether or not we have socialized medicine?

    Agreed, having the option in the first place is essential. And whether or not liberals and conservatives agree on having health insurance without any job, if you work, you should be covered.

  18. If we have socialised medicine, there is STILL a limited pot of money. Get it? You cannot tax people for all they are worth. You cannot tax companies for all they are worth. People simply will not work – we are already at the situation where dual-income couples are essentially working for free due to our tax structure.

    Guess what happens with socialised medicine? The GOVERNMENT refuses treatment, or delays it, and then you can’t sue. Sovereign immunity ought to be a part of your vocabulary.

    The private system is better. With socialised medicine, you either ration care (with no recourse) or raise taxes. We can barely pay for our rationed care now; what drugs are you on that make you think we can pay for unlimited care for everyone?

  19. theobromophile,
    Yes of course, there is still a limit, but it would be far easier to manage edge cases with a larger pot. And yes you can fight the government when it refuses treatment.

    But again, we can make those rules. With a private enterprise, we can’t. Thats a key point.

    We can barely pay for our rationed care now; what drugs are you on that make you think we can pay for unlimited care for everyone?

    Well captain manners, whatever it is, I suggest you pick up a prescription. Because you seem to miss what I, and most everyone else in this thread can see clearly. That we need to put a stop to profit before people.

    As an aside, of course we don’t have unlimited resources to through at health care. But we can do a better job when compassion is our calling. Outsourcing to profit motivated private enterprise is a fantasy of conservatives, and it is quite literally making our country sick.

  20. “Sovereign immunity ought to be a part of your vocabulary.”

    Oh yes, and the fact that it is not absolute should be part of yours. You can sue City Hall, and you can also fire the Mayor as well.

    theobromophile

    Did yo get that question wrong on the exam, or was it multiple choice?

  21. Lol .. Captain Manners… Lol..

  22. SovIm lesson: you can sue municipalities, as they are not exempt under the Eleventh Amendment. You may sue states for things that do not result in damages under Sec. 1983 (enacted pursuant to the XIV Amendment, Sec. 5), but Congress has limited ability to abrogate state sovereign immunity (Seminole Tribe). Likewise, you may sue private individuals acting in under the colour of law (i.e. police officers or FBI agents), but those actions are limited. Furthermore, the Supreme Court has held that Congress must speak clearly when it intends to abrogate sovereign immunity; consider that sov. im. is something that can be denied.

    Furthermore, ERISA preempts state causes of action (there is a limited exception under Sec. 514(b)(2)(A), off the top of my head). The idea under ERISA is that the administrators act as fiduciaries to all those who receive benefits, not just the complaining party. It does not allow for punitive damages or any remedy aside from the cost of the treatment, if the plaintiff is successful.

    Of course, ERISA would not govern a plan administered by the state, but we can be pretty sure that Congress will use similar legislation. So as things stand now: one cannot sue for denial of such claims (even substantive due process wouldn’t apply), and, if Congress were to enact socialised medicine, it would certainly enact a system that would prevent a cause of action in federal court for denial of benefits, in order to administer the plan in budget and reduce expensive litigation.

    Several years ago, there was a promising experimental treatment for cancer that involved removing bone marrow, hitting the patient with high doses of chemo to kill the cancer, and reintroducing the bone marrow. Doctors recommended the expensive treatment. Patients sued for it. Courts demanded that insurance companies pay it. Years later, it turns out that this wonderful treatment that insurance companies were denying was… ineffective. Totally ineffective at reducing cancer and improving mortality rates.

    Feelings don’t pay bills. When you talk about compassion, who is it for? For the person right in front of you who pulls on your heartstrings with their need for a half-million dollar treatment, or the ten thousand women who could use that same money for life-saving early detection of breast cancer? When you care about the one person, which radically drives up the cost of insurance and makes it too expensive to provide (and the fact that the government could pay the bills doesn’t make it cheaper, because the government gets every red cent it has from “the people”), but if you care about the five thousand high-risk women who could get early mammograms, you are “profit-driven?”

    Limited amount of money. No way you slice and dice it, that pot is LIMITED. It can be a bigger pot, a pot that covers more people, or whatever, but it is LIMITED. If the government is in charge of the pot, the money in it still comes from the taxpayers. In an interesting twist, that which is currently an untaxed benefit (employer-based health insurance) that, if you think about it, makes those big evil corporations earn less money will become a tax that the middle class will have to absorb.

    Frankly, I have no desire to buy into the idea that socialised medicine will save us, because the involves removing at least 50% of my brain – and the part that covers knowledge of law, economics, and medicine.

  23. theobromophile,
    Sovlm lesson? How about a Civics one?

    if Congress were to enact socialised medicine, it would certainly enact a system that would prevent a cause of action in federal court for denial of benefits, in order to administer the plan in budget and reduce expensive litigation.

    Your argument is not against socialized medicine, but a particular way of enacting it.
    And I agree, it should not be done in a way that leaves patients with no recourse.
    So that is what we push for.

    Several years ago, there was a promising experimental treatment for cancer that involved removing bone marrow, hitting the patient with high doses of chemo to kill the cancer, and reintroducing the bone marrow. Doctors recommended the expensive treatment. Patients sued for it. Courts demanded that insurance companies pay it. Years later, it turns out that this wonderful treatment that insurance companies were denying was… ineffective. Totally ineffective at reducing cancer and improving mortality rates.

    So what? It was experimental. Some work, some don’t. Sometimes access to experimental
    treatment saves lives. Most every treatment we now know today was once experimental.
    But what does that have to do with whether or not we have socialized medicine.

    Feelings don’t pay bills. When you talk about compassion, who is it for? For the person right in front of you who pulls on your heartstrings with their need for a half-million dollar treatment, or the ten thousand women who could use that same money for life-saving early detection of breast cancer? When you care about the one person, which radically drives up the cost of insurance and makes it too expensive to provide (and the fact that the government could pay the bills doesn’t make it cheaper, because the government gets every red cent it has from “the people”), but if you care about the five thousand high-risk women who could get early mammograms, you are “profit-driven?”

    No one is saying feelings pay bills, that’s just your straw man.
    As is the choice between the two patients you give. This problem
    is workable in countries where socialized medicine is a reality.
    It is one we can solve. Right now, the question isn’t one of medical need.
    The question is “can you afford it”, and affluence determines who gets covered.
    Why should wealth determine something as basic as health?

    The pot would be limited, as it is now. Agreed. But we are not taking on an unknown
    and undue burden by changing who pays. We’d just be expanding who is covered.
    And if we put more resources into preventative care, and take them out
    of the corporate medical beuracracy, we’d be able to lower health care costs significantly.

    because the involves removing at least 50% of my brain – and the part that covers knowledge of law, economics, and medicine.

    What would that leave?Judging by your arguments, you’ve already made some headway there.

  24. Thanks for the none lesson. No guarantees that Congress will act one way or the other when it comes to immunity. Lobbyist could swing legislation either way. I was merely using an old cliche. The limited pot argument is interesting, and it works if we don’t know the size of the pot. Its a matter of priorities really. It seems the pot is big enough when it comes to the Pentagon and so called Homeland Security (never heard of anyone saying there is not enough money to buy another aircraft carrier). I need numbers to make an accurate comparison. It seems that many other do very well and they have smaller “pots” to play with.

    As for compassion, I am talking about everybody, especially those who get inadequate coverage within the established system.

    Michael D.

    Your right…

  25. Why should wealth determine something as basic as health?

    Well, it already determines where you live, what type of education you get, and what type of food you can buy. Is there a Constitutional and/or fundamental right to organic produce? If not, then why is there a fundamental human right to the most advanced medical care available?

    Hello, where you are born in the world already determines most of the medical care available to you. Should our government supply health care to everyone?

    What money you make determines what size house you live in, what clothes you wear, what car you drive, whether you shop at Whole Foods or Wal-Mart SuperCenter. Guess what? People make money – the profit motive! – so that they can do those things. Once you remove the benefit, you are removing the incentive to make money. Guess what? People will stop educating themselves, working long hours, and contributing to our system because it will no longer benefit them.

    Currently, doctors make ends meet by charging more to those who can afford it than to the government. Med school loans, after tuition, room, board, fees, and the interest through residencies and internships, is closing in on a half-million dollars. Do you really expect that the best and the brightest will take on that type of debt to work at a government salary? To suffer through four years of undergrad, four years of med school, working until the wee hours of dawn, then doing 80-hour-weeks for the next twenty years so that the government can underpay them? I’m sorry, maybe you don’t care if our doctors are the ones too dumb to do anything better with their lives, but I don’t mind paying the best people.

    Ditto for pharmaceutical companies. The fantastic, life-saving drugs we have were produced because of profit. Profit. Money. It’s saved my life and it has saved many lives, and companies do it for money. Remove the money, and we will have 2008 technology in 2050, because there will be NO incentive to make new drugs. Currently, the wealthy (Americans with private, expensive insurance) subsidise the $800 million cost of producing a new drug. This enables those evil pharmaceutical companies to give discounts to Medicare and Medicaid patients and to sell their drugs abroad for less money. Someone has to eat that cost.

    We understand that with flat-screen TVs, the cost is high, the rich pay for the technology development, and, eventually, we all reap the benefits. The same exact thing happens in health care, but you seem to believe that the government, which inadequately reimburses doctors and pharmaceutical companies under their own health insurance programmes, would suddenly do a better job when in charge of the entire country.

    Health insurance does NOT equate to coverage, on both sides. A fair percentage of people who lack coverage earn more than $75,000/year – i.e. they are more than able to pay for coverage, or expenses out-of-pocket, or catastrophic coverage, but choose not to. I’ve written quite a bit about this subject; you are more than free to peruse my archives under the “health care” category.

    By the way, do the math on funding these things. Right now, companies pay health insurance as a benefit to many of their retirees. We would be taking a benefit that big, bad, evil companies pay for and make the middle class pay for it out of their taxes. Smart idea…. not.

    Finally – there is sovereign immunity. The only other option is out-of-control litigation, with corresponding out-of-control costs, by people who have nothing to lose.

    It seems the pot is big enough when it comes to the Pentagon and so called Homeland Security (never heard of anyone saying there is not enough money to buy another aircraft carrier).

    Ya know, next time you debate someone about government spending, don’t debate an engineer who did government contracts who is now in law school. You’re just asking to get your butt kicked into next week.

    The idea that there is “enough money for an aircraft carrier,” regardless of budget, is disingenuous. Military aircraft is fundamentally different from, say, a Toyota Camry. You cannot simply order more off the lot when you need them, nor crank up the assembly line. The time it takes to build an aircraft carrier – and, more importantly, the time it takes to develop the technology – means that the most cost-efficient way to supply the armed forces with carriers is to keep a constant supply. Once the supply chain is interrupted, it would take far more money to start it again. When an incident like 9/11 occurs, you cannot simply say, “Well, let’s develop a new, ULO Stealth bomber, decrease the electromagnetic cross-section, and have a few dozen of them by next week.” You need to constantly develop the technology, to build them regularly, and to outfit the armed forces as needed. I mean, you wouldn’t sit there and say, “Well, the government always finds money for concrete for roads!” as it were an option for the government to build roads without concrete.

    Read Art. I, Sec. 8, 9, and 10 if you have time. The “troops” and the “militia” are mentioned several times, but I see absolutely nothing about Congress providing for health care. In fact, when I read the Ninth and Tenth Amendments in conjunction with the negative implication of Art. I, Sec. 8, I’m pretty darn sure that it’s unconstitutional for Congress to enact universal health care.

    I think you are also missing the fact that the government is not there to provide for our every need – it is not the parent to our infantile state. It is there to protect us from aggression (internal, through the criminal and civil justice systems, and external, through the military), to allow us to live in a peaceful group that can improve its lot (through the economic and monetary system), and to build infrastructure (roads, highways) that could not be done by an individual or a private corporation. Government is not God, although several atheists seem to look to the Feds the same way that Christians ask the Lord for their daily bread. It is the same magical thinking, the same mysticism, that presumes that it is the job of another to provide for one’s basic life functions – that humans are not even at the level of wild animals, who sustain themselves.

    Finally, if you have trouble comprehending fairly straightforward arguments, supported by some pretty freakin smart people (nothing I am saying is out of the mainstream of economic or legal thought), then the problem is with you, not me nor my mind. I have not gotten where I am today by not having brainpower.

  26. theobromophile, You rock!! Glad to see Ron Paul can count on your informed vote as he appears to represent all your points and concerns to a tee. You are voting for him aren’t you? If you don’t it doesn’t mean that you haven’t proven yourself to be quite learned. Thanks for the fresh air.

  27. Yes, I needed to be informed of the research/development/cost curve. Of course you forget that one thing is to have a militia and another is to have 2,000+ F-16 Block 60s. Not the same. You also make an wrong assumption that when it comes to lawsuits, its all of nothing, a common mistake among the Federalist crowd, which I came know very well in many a class hour.

    You yourself say that goverment should provide for basic infrastructure, there is nothing more basic that health care. Nor should doctors work exclusively for the goverment (show me where that happens, please). Nor has anyone called for turning private companies (such as pharmaceuticals) into public corporations. You also seem to forget that a lot of research is powered by goverment grants done in public universities. If anything, big pharma merely “harvest” this basic and ongoing research already payed for by the taxpayers (although to be fair, many a private company does doll out money through research grants).

    Your scenarios sound impressive, but do you have any proof to support that? Do doctors in England, France or Canada die of starvation, are they the worse of the lot or are pharmaceutical companies going broke in those markets?

  28. @ Ralfast. There are any number of links I could provide re: NHS doctors and MD’s in Canada lacking desire to stay.In fact leaving. Starving to death ? No but that’s your straw man isn’t it ? As for doctors working for the government. It is only recently that many of the Euro nations have reorganized the health services into “private” entities. If you want to parade a system France may be a model you’d like to look at.R&D is such a big beast yet I find it likely the private investments outweigh the grant system by a margin. Lastly I wanted to say kudos etc. to the commenters and Dan for assembling an interesting and thought provoking item.

  29. Interesting point I think is the cost of malpractice “INSURANCE” The doctors could afford another summer home for the price they pay due to trial court lawyers like John Edwards. hmmm Address that with insight and fairness then we can start the whole discussion about accountability with respect to some bloated CEO or politician that wants their son or daughter to go to medical school, so they “buy” their degree and the unqualified brain surgeon is born. There is a lot to this discussion. Lobbyists do not have the answers. Neither does the government.

  30. Please do provide the links. I would like to see them.

  31. ralfast,
    Of course we don’t have enough money for war.
    The pentagon is always scaling back projects, and hitting up Congress
    for more war funding. (Small wonder, what with all the waste).

    theobromophile,
    Here we disagree. I don’t think it is right that some people have access to a
    shitty education, are denied care or recieve substandard care, because they
    don’t sit in a boardroom all day and make executive decisions.

    Should our government supply health care to everyone?

    Yes.

    You know, I might by the cynical greedy doctor argument if that weren’t also under our control.
    We could pay teachers more, we could pay fire fighters more. That we don’t says that those who have
    the most are greedy, and that our society is too fucked up to care about what is important.
    Well, I think we could move as a society towards a brighter future where we do pay well for valuable
    jobs, and there is no reason to leave the medical field out of that.

    However that misses the point of single payer health care.

    Doctors could still charge, it would just be the government footing the bill
    where it makes economic sense, so that no one is uncovered.

    Ya know, next time you debate someone about government spending, don’t debate an engineer who did government contracts who is now in law school. You’re just asking to get your butt kicked into next week.

    You keep citing your “credentials” but I have yet to see them make an impact.
    You spin yourself as an expert, but your arguments don’t live up to the hype.

    Yes, ralfast was wrong about a bottomless Pentagon budget. They have to take the tedious step of
    asking Congress for billions more. But his central point stands, that if we can find a way to buy bombs,
    to pay to take lives, then we can find a way to pay to save lives.

    If people can afford coverage, they should get it. But if they can’t, they should not be left out in the cold.

    You keep mentioning “where you’ve gotten today”. Do you feel you need to prove your worth?
    Let your arguments do that.

    Government is not God, although several atheists seem to look to the Feds the same way that Christians ask the Lord for their daily bread.

    What a loaded statement. I certainly don’t think government is infallible or god-like in any way.
    Read my site and see my criticisms of the current administration.
    I think we have more potential for change with our government than with a large multinational corporation.

    Michael D,
    Where do you see theobromo supporting Paul?

    ralfast,
    Thanks for the heavy artillery backup.

    Nor should doctors work exclusively for the goverment (show me where that happens, please). Nor has anyone called for turning private companies (such as pharmaceuticals) into public corporations. You also seem to forget that a lot of research is powered by goverment grants done in public universities.

    Compelling points.

    in2thefray,
    There are a host of reasons to move to or leave Canada. But is this exodus of doctors
    a common problem for countries with socialized medicine (or hybrids)? Is it for the UK?
    France? Norway?

    (Sure thing, I love the debate, and although I like to be sharp and don’t hold punches,
    the differing viewpoints and back and forth are heartily welcomed, especially when
    folks get wonky and detailed).

    Michael D,

    Interesting point I think is the cost of malpractice “INSURANCE” The doctors could afford another summer home for the price they pay due to trial court lawyers like John Edwards.

    He made his money fighting for people who were hurt, and taking on corporations. His record as a lawyer is a proud one.

    The thing some conservatives forget about malpractice is the number of cases where the doctor was willfully negligent!

    Lobbyists do not have the answers. Neither does the government.

    Heh. Lobbyists do have answers, just incredibly biased and potentially damaging ones.
    But to discount the government out of hand leaves … what? Corporations? The market?

  32. “Doctors could still charge, it would just be the government footing the bill
    where it makes economic sense, so that no one is uncovered.”

    I have one question and I’ll give you the answer to this one. You ever hear of eliminating the middle man to get a better price? The government (us) footing the bill (taxes= our money) does not make economic sense, it makes hundreds of middle men to skim off the top of our money and unnecessarily inflate the prices. Please rethink that line of reasoning.

    My comment about theobromophile supporting Ron Paul is that for the points made by theo, Ron Paul addresses in a similar fashion the possible options and solutions.

  33. Michael D,
    If health care is administered, someone would be in the middle. The only way to avoid it is have everyone foot their own bill. Because right now, its a corporation in the middle.

    I wonder who theobromophile actually is supporting.

  34. As for who I am supporting – well, my state does their primary after Super Tuesday, so it’s a moot point until then.

    My three big issues are judges, immigration, and health care, in that order.

    Michael D – good point about the middleman – I missed that one among the obvious flaw. Doctors don’t decide how much they are reimbursed by Medicare and Medicaid. The government pays a fixed amount for each procedure, with multipliers for geographic area. Good doctors don’t get a cent more than crummy ones.

    Any discussion about national health care should begin with an examination of our current government-sponsored health care system. Absent a fundamental change in that system, or a radical, sudden change in human nature, any system will resemble that. Currently, Medicare and Medicaid underpay doctors; less than half of them accept Medicaid, because they LOSE money off of it.

    Fitness – you want to eliminate greed? Is it greedy for people who spend 15 years after high school training and studying for a profession to make money? Do you propose to enslave doctors to get them to charge what you want? Enslave medical professors?

    Read a book called “Atlas Shrugged.” It makes the point that you CANNOT force people to work.

    The way I put it: quality, price, or person – pick two of the three, if you are lucky. You cannot get the people you want, at the price you want, at the quality you want (without giving said person any say in items #2 and #3) – such is slavery. You can dictate the price and attempt to dictate the quality, but that’s usually difficult. The best you can do is to get the person you want and the quality you want, but you have to pay for it.

  35. theobromophile,
    Either you have missed my points entirely, or are trying to talk past them. I think its fine for doctors to make money. Strawmen aren’t substitutes for good arguments.

    I don’t think its fine for insurers to deny people essential care.

    I don’t much care for Ayn Rand, or her “literature”.

  36. Neither. You aren’t making valid points.

  37. theobromophile,
    Come on over to my side of the fence. You don’t need to be a liberal, just stop putting baseless faith in the free market and ayn rand, ann coulter, and all that other clap trap.

    My point is that we need to care for our sick, and letting people die from conditions we as a society know how to and can afford to address is unethical.

    I can understand the appeal of every man for himself, but I also understand its cruel and inferior nature. If we work together, we can achieve more. Think of what that girl might have accomplished with her life had her insurance company not refused payment. Now think of all the lives snuffed out because of the lack of medical care we can afford to provide.

    The liberal position on healthcare for all is compassionate and practical. The two principles are together far more often then one is lead to suspect.

  38. baseless faith in the free market and ayn rand, ann coulter, and all that other clap trap.

    We can’t have a discussion if you call faith in the free market “baseless.” We cannot have a discussion if you do not acknowledge that all people do not think like you do, and, heaven forbid, they might be right about a few things.

    I disagree. Who says we can afford to provide that care? Have you seen what happens when people get all the care they can have and don’t have to pay for it? They begin making decisions that have no basis in good medicine, do not improve their condition, and basically use every resource that is available to them. Does the tragedy of the commons have no meaning for you? We have known for centuries that there is a moral hazard involved in the scheme you propose.

    Your fundamental assumption is that we can afford to provide this health care. I disagree. Now, let’s move on, and stop patronising people who use logic instead of warm fuzzies to think.

  39. Rather, let me elaborate: you have ZERO desire to pay for this yourself. None whatsoever. You want other people to pay for it, and you’ve deemed them economically fit for the purpose. IMHO, we cannot afford universal health care in ANY sense – as a matter of economics, policy, or health care.

    If we work together, we can achieve more. Think of what that girl might have accomplished with her life had her insurance company not refused payment.

    Think of how many lives are saved by reallocating resources that would have gone to her futile care.

    There is this thing called “cost-benefit analysis.” Doctors look at only one thing in cost, which is the side effects to the patient. Money never figures in. Insurance companies weigh the cost of the treatment against the benefit to the patient and the potential uses for that money. That is the ONLY way to provide affordable care. Your method would have us spending every cent possible on health care – hoping that someone will keep working to give money to the coffers for all of this – without any examination of the results. That is not practical nor compassionate – it is senseless to the extreme.

  40. theobromophile,
    Of course I know people think differently, and have excellent opinions where my own are not. Red herring much? The faith in the free market is indeed that, baseless. Now a reasoned belief that some regulations hurt markets rather than help, that’s another thing. But the fact is both too much and too little regulation fail to account for destructive behavior. Markets self regulate naturally, and not always in beneficial ways. So yes, I don’t ascribe to the wonder of an unregulated market, and if that stops our discussion, that’s really too bad.

    The tragedy of the commons has much meaning, if correctly invoked.
    Are your extreme and shrill examples of edge cases replicated in the countries that have socialized medicine?

    I am merely stating a practical fact. For many if not most cases of uncovered care, we as a society could afford to provide that care if we choose to. Only greed prevents us and covers our eyes from an unbiased weighing of the facts.

    The thing is you don’t use logic. You market yourself as someone who uses logic (“I’m in law school!”), but you supply half formed arguments which assume a very different world from the one we live in. The fact that these arguments lack compassion on top of it is just another reason they fail to impress.

    Rather, let me elaborate: you have ZERO desire to pay for this yourself. None whatsoever. You want other people to pay for it, and you’ve deemed them economically fit for the purpose.

    How do you know? I am perfectly happy with my taxes going up to pay for health care for everyone.

    Think of how many lives are saved by reallocating resources that would have gone to her futile care.

    Now you are playing remote doctor, just like the Republicans did when Terri Schiavo’s life support was being removed. Are you saying her doctors where wrong? They didn’t think it was futile. And since degrees are so important to you, they have(are not pursuing, actually have) medical degrees.

    And again, you are stretching and distorting. If we must regulate limited resources to determine who gets critical care, I agree, tough choices must be made. Let’s move beyond that point. In the event we could have enough, and simply need to raise taxes… I’m talking lives or an across the board tax bump here, are you still going to take the money over lives?

  41. I am, fortunately, healthy (knock wood) and never go to the doctor. Is it fair that I am forced to pay for all these people that need care? Is it a matter of fairness? If it is a matter of fairness then maybe I should use the health care system to my advantage? But wait I don’t have a health problem at the moment. So ok if I am a compassionate individual I could donate to the cause of my choosing. That would be my choice and be indicative of freedom. Having the money taken from me by force, whether I can afford to give it or not is theft. So Dan you’re ok with stealing as long as it’s a for a good purpose. And as long as you dictate what the good purpose is. Robin Hood would be proud of you. I laugh at the “simply raise taxes” line. So in essence we could have anything you decide is good and righteous if we just stole more from people. Like your buddy George Carlin says “the kid that eats too many marbles doesn’t get to grow up to have kids of their own”. It’s called natural selection. Deal with it, don’t attempt to force others to deal with it. When my brother died, in my mothers arms, in the waiting room of a hospital our family dealt with the pain and the system. It was avoidable but not because of universal health care. It was caused as a result of universal health care. Government oversight is a bad idea. Like RP says “if you assign the government to regulate something, you get more of it. You just don’t deal in reality Dan. It’s all in your idea of a perfect world that the problems of reality shatter your dreams.

  42. Dan/Fitness (which do you prefer?),

    If you would pay for SOME of this out of your taxes, you are not paying for it yourself. You are paying for a portion of it yourself, and forcing everyone else (with the threat of imprisonment if they do not pay their taxes) to subsidise your charity.

    That is objectively wrong.

    If people are smart enough to make their own money, they are smart enough to spend it. It is not for you to impose your views upon others (Random query: are you pro-life?) about how they should properly spend their money.

    If you are all about health care, donate to charitable causes that help advance health care for the less fortunate. Otherwise, you are simply outsourcing your “compassion” by forcing others to bear the burden you do not want to bear for yourself.

    As Michael D. said, you must acknowledge reality. Reality is this: you can spend literally every single cent you have on health care. We can develop new technologies to help people. After all, people die for lack of technological progress – why do we spend money on movies and baseball games when people are dying for lack of research dollars? Your rationale does not impose any meaningful or principled limit upon health care spending. The logical consequence of your rationale is that we would convert every job in the country into advancing health care and saving lives and spend all of our disposable income on it.

    Second, you fail to acknowledge that people are responsible for themselves.

    Third, you fail to acknowledge that “greed” can be a good thing. I am NOT spending $5,000/month on law school tuition so I can be poor. I know I will have to work for my salary, but I’m working for the money (and, of course, the fact that I absolutely love this stuff). The passion, however, would not be something by which I would enslave myself. When you command the money of other people without their consent, you are enslaving them. When I convert part of my life into money – longer days, late nights studying for my degree- and you take my money to save another person’s life, you are deeming his life more meaningful and worthy than mine. Money is the medium by which we sell our labour, and through said labour, our lives.

    Finally, I never meant to imply that socialised health care systems act in a certain manner. Thing is, they WILL act in one of two ways: limiting health care access, or raising taxes without end (to the point that you will get a brain drain). The socialised medicine systems do, factually, act in one of those two manners. You seem to advocate for the second one, as the first would merely change the entity who denies experimental care.

  43. Michael D – your link does not work. Is that supposed to happen?

  44. No it’s not supposed to happen and I’m supposed to be smarter than that.. :-/ My page is just as new as I am and I’m still working out the postnuke CMS stuff as well as the actual content. It’s a slow process as I venture into the unknown (php).

  45. Should work now.

  46. theobromophile
    (Either works, Dan, Fitness)

    Taxes are not objectively wrong. If we abolish ALL taxes, then we abolish the very notion of collective living. You know, civilization. Do you think having a military is wrong? Having police and fire? How about public schools? I suppose if you are willing to part with all of them (or pay the true cost for ALL of them yourself, then your point might have a shred of consistency).

    You carry my argument to an extreme I myself do not advocate, and while I admire the rhetorical fleetness of foot required to do so, such a point does not pass muster here. I am not saying stop everything and focus on health care alone, nor would any rational mind suppose I am. I am simply saying we can afford to do more, for more people. We can cover everyone. We can save more lives.

    You are talking about taking a small portion of your check in exchange for a service you yourself will benefit from. You are not being enslaved to work to feed poor people. That is ridiculous.

    There will be some limit on health care, but by changing the way we insure people, we can cap that limit and save far, far more lives than we do today.

  47. Dan you need to look into what taxes pay for what programs first of all. Police and fire are not paid with income taxes, neither are schools. The department of education is not schools it is a bureaucracy.

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