Deliver Us

         I have followed with interest the story of Nataline Sarkisyan, the leukemia patient denied a liver transplant by Cigna. As has been extensively reported, she died just hours after the insurance company reversed its decision. I am not a doctor, and I certainly do not know all the details of the case – none of the people offering opinions on it do. But it seems like everyone is looking at the case without considering the medicine and legalities behind it.

         One of the major misconceptions about this case revolves around the initial denial of the claim. Cigna called the liver transplant "experimental," which seems to scream scam: organ transplants are a common and accepted procedure across the country, and have been for many years. For viable candidates, this is certainly true. Ms. Sarkisyan, however, was not the prototypical liver transplant candidate, and for patients in her situation, such a procedure would be experimental. It is not backed by the same clinical history and, more importantly, it does not have nearly the same expectations on survival rate.

         According to many of the doctors involved, including the Chief Medical Officer of Cigna and two independent contractors, Ms. Sarkisyan did not fit the minimum criteria for a liver transplant. To begin with, she had been in a vegetative state for some time, and her immune system was severely compromised due to cancer treatments. Liver transplant recipients generally must demonstrate a substantial period of relative health, an indicator of the likelihood that they will survive and recover from the procedure. If she did recover from the transplant itself, she would have to contend with anti-rejection drugs that actually work worsen cancer by reducing the body’s ability to register foreign cells: if white blood cells are instructed not to fight the liver, they will not fight cancer, either. This further reduces her long-term survival rate.

         Several editorials in prominent newspapers have framed the decision as a moral dilemma, that the insurance company’s cold, calculating, and compassionless moves should have been tempered with kindness. Now, I’m fairly certain I don’t want to give an insurance company the leeway to start making moral decisions, but I’ll humor the argument. It seems to me that with a limited number of livers to transplant, the ‘moral’ thing to do would be to give each to someone who can use it to the fullest. That means a high survival rate, a high recovery rate, and also a measure of long-term viability.

         What I find most troublesome about this case, indicative perhaps of the litigation-happy society of the modern age, is that the family attorney has said he will file criminal charges of manslaughter against the Cigna corporation. Such a charge implies that Cigna intentionally, perhaps maliciously, killed Ms. Sarkisyan. But the girl was taken off of life support by her parents. Not only does this indicate the severity of her condition -- so severe that she was unlikely to successfully qualify for and survive from a liver transplant -- but it means that Cigna does not bear criminal responsibility.

         John Edwards, presidential candidate and professional panderer, has begun using the situation to make the case for government-run universal health insurance. According to Mr. Edwards, this would never have happened under socialized healthcare coverage because Ms. Sarkisyan's claim would not be denied and private companies would not make decisions. Aside from how the above medical facts would remain true, his assertion that socialized medicine would fix situations such as these is patently false.

         Some proponents of universal government insurance think that such a program would eliminate private insurers and case-by-case claim analysis. The government is not going to run a massive new program (Edwards’ plan is projected to cost upwards of $22 billion) itself; it will contract insurance out to existing private insurance companies – just as it does now for most Medicare and Medicaid plans. Insurance companies have lobbied for years for universal health insurance because it would require a whole new demographic of citizens to purchase their service.

         It’s not going to change the fact that some things make medical sense, and get approved, and some things don’t. Because there will always be a degree of subjectivity in deciding which is which, there will always be people who think they’re getting shifted -- always. Universal health coverage, good or bad, won't change that. It certainly wouldn't have saved Nataline Sarkisyan.