Editor's Notes

A transplant of the cerebral cortex?
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tredmond@sfbg.com

So you want the heartwarming Christmas story, and it almost happened: A 17-year-old girl in Los Angeles girl was dying of leukemia. She'd received a bone marrow transplant, and for some complicated and unexpected reason, her liver began to fail. The doctors at the University of California at Los Angeles Medical Center said she'd die without a liver transplant.

As it turned out, a liver was available and the operation could have gone forward — except that the girl's insurance company, Cigna, refused to pay. This set off a furor — the California Nurses Association organized a protest, word got out on Daily Kos (thanks to blogger Eve Gittleson), and hundreds of people jammed Cigna's phone lines, marched in front of company headquarters, and generally made such a stink that after 10 days of delay, on Dec. 20, the insurance giant caved and approved the operation.

But there's no happy ending here: on Dec. 21, Nataline Sarkysian died. The nurses say that if she'd had the transplant as soon as possible, the outcome might have been different. I'm not a doctor and I wasn't there, so I'm not going to wade into that one.

Here's what I'm going to say:

Anyone who thinks it's possible to reform our health care system while leaving these kinds of decisions in the hands of private, profit-seeking insurance companies needs a transplant of the cerebral cortex.

There are cases like this one all the time — people who suffer because health insurance has become a big business that's all about the bottom line. It's not news that these big companies routinely reject valid claims and pay their employees bonuses based on how many people are denied health care.

There is no perfect way to provide health care for the entire population of the United States. Any structure that we create will by its nature be large and prone to bureaucratic snafus. There are always going to be limits on resources and hard decisions: Should an insurance pool cover liposuction for an actor who needs to lose 10 pounds for a starring role? (Probably not.) Should it pay for the same treatment for a morbidly obese person who is at risk of heart failure? (Probably so.) Should an 80-year-old person get a kidney transplant while a 23-year-old is left waiting? (I don't know; do you?)

But I do know that if you leave those decisions in the hands of people who will make more money if they choose one path, then the path of one of the most important public policy issues in the nation will be selected on the basis of greed. That's the fundamental flaw in our health care system.

I thought the comments of Rose Ann DeMoro, the head of the CNA, regarding the Sarkysian case were right on point. "Every politician who thinks the answer to our health care crisis is more insurance should stop and think about Nataline Sarkysian," DeMoro said. "Insurance is not care."

That's exactly what's wrong with the plan the governor and the State Assembly have passed.

Sure, it's better to have people insured than uninsured. Universal insurance means fewer people getting very sick and dying for lack of primary care. It means fewer people jamming public hospital emergency rooms. But it doesn't mean everyone's going to get adequate or decent medical treatment — not as long as health insurance is in the hands of people who consider it first and foremost a big business.