Can Private Health Insurance Kill You? 2nd Edition

by nanute | October 10, 2009 at 10:14 am

167 views | 32 Recommendations | 14 comments

Note: This story was removed yesterday for spam content. This is an honest attempt to fix it.

A story written by Susie Maldrake tells the saga of one family's ordeal with private insurer, SIGNA.Nataline Sarkisian was 17 years old when she died. Her health insurer denied a request for a liver transplant as "experimental." After public embarrassment, and negative publicity SIGNA relented. Unfortunately, it was too late for Nataline; she was dead by this time.

Her parents sued SIGNA for damages, only to find out that under ERISA (The Employees Retirement Insurance Security Act of 1974), individuals that receive health insurance through employment, are not permitted to sue for damages. The cost of denied coverage is all that may be awarded. source: crooksandliars.com

We've been hearing a lot about tort reform during the current health care debate. Maybe while congress is considering tort reform, a closer look and possible change to this provision of ERISA needs attention.

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Rory Cripps

at 11:32 on October 10th, 2009

Nanute: In my comment yesterday, to your original post, I said that this is a tragic story. As you know, I've got a special needs daughter. And as you know, my heart breaks anytime someone's child dies because he or she didn't get the proper medical attention. I don't believe that I'd ever get on a jury that was presiding over a child's death due to medical or insurance issues no matter who caused the death--I'd be too prejudicial. What happened to this young woman is an outrage in my opinion.

I am totally and completely against any kind of tort reform when it comes to medical malpractice suits. And I am totally and completely against any restrictions or caps put in the way of citizens suing private health insurance companies and HMOs. Why is it that private citizens can sue each other for any amount, yet private citizens are limited (through governmental legislation) when suing certain business and governmental entities? The answer is obvious: America's law makers (i.e., the House and Senate) are more beholden to the corporate lobbyists than they are to the voters that elected them. They have nothing but utter contempt for average Americans and both political parties are equal in their contempt. American politicians and corporate executives are different sides of the same coin . . .and they are both equally repugnant in my opinion.

Obviously, I place no faith or trust in the American government. And faith or trust in America's corporate masters is irrelevant--corporations are just there to suck as much blood from the American consumer (and the rest of the world) as they can get away with and to convince the consumer to buy their absurd and unnecessary wares. Both entities, in light of recent economic events, are despicable and both entities are completely (and equally) to blame for the current economic crisis.

With the above said, why would anyone place their faith and trust in the U.S. government to overhaul the nation's health care system? Politicians and corporate "leaders" have always been in bed with one another. But at least there was somewhat of a legal and legislative dividing line, as it were, between political and corporate interests. If government sponsored health care legislation is enacted, the lines between corporate and governmental interests will blur. There's a name for that--it's called facism.

Roy C

at 11:39 on October 10th, 2009

We don't need to reduce torts. We can just make it where if you lose, you have to pay some part of the expenses of the people you have sued, as in the UK.

Pain and suffering is very subjective, though. Some guidelines would be OK with me.

sara star

at 12:03 on October 10th, 2009

Nataline had been battling leukemia and received a bone marrow transplant from her brother. She developed a complication, however, that caused her liver to fail. Doctors at UCLA determined she needed a transplant and sent a letter to CIGNA Healthcare on December 11, 2007. The Philadelphia-based health insurance company denied payment for the transplant.

Are we in a third world country? How can anyone place a death sentence on a young sick girl? This is short of murder.

nanute

at 12:09 on October 10th, 2009

Thanks for the linked quote. How can anyone place a death sentence on a young sick girl? Because under the law as written the company can't be held accountable. It is cheaper to deny the coverage with no threat of punitive action.

Rory Cripps

at 12:51 on October 10th, 2009

Sara:

Are we in a third world country? How can anyone place a death sentence on a young sick girl? This is short of murder.

I share your sentiments. I guess that the liver transplant would have broken the CIGNA piggy-bank and the share-holders would have taken a .0000000000000000000001 % hit on their returns. I personally have no problem with capitalism per-se. My problem is with the assholes that can't maintain a capitalist system due to their myopic and pleasure-principle greed. Their behavior is no different from a six-year-old that is given free reign throughout a candy store. In other words, there is no self-control within the ranks of America's corporate leaders. They take and they take and they take. They have no shame. They have no scruples. And they have no regard for human life let alone regard for their country. And the assholes in the Republican party continue to wonder where they went wrong in the 2008 presidential election.

nanute

at 12:02 on October 10th, 2009

I'm not a proponent of tort reform, I was merely making reference. I don't like the idea of "loser pays" either. It sounds good in theory, Roy. The problem is that big money can hire much better counsel that the average working stiff. Most good attorneys, (now there's an oxymoron), won't take a case that doesn't have merit. The court system is very capable of dismissing suits that fall into this category. Courts have discretionary power to reduce jury awards that are "excessive." If a jury can't determine a reasonable amount of compensation for pain and suffering, you want the government to impose limits? I'm not buying that argument. As we are seeing in the economy, business interests have trumped individual citizen's interests to the breaking point.

Rory Cripps

at 12:06 on October 10th, 2009

Roy: Lawyers are pretty good at filtering and weighing the evidence before they take on a contingency case. We often hear talk about all the frivolous lawsuits out there. I think that it's an exaggeration. Not only does the attorney not want to waste his or her time pursuing a weak case, but a judge is also involved in filtering and weighing the evidence before the case is even accepted to go to trial. In my opinion, the incompetents out there (of which there are way too many) would like nothing better than for caps to be placed on malpractice awards.

nanute

at 12:19 on October 10th, 2009

I agree 100% Rory. I did want to respond to your original post up thread: There was a time in this country when citizens placed a great amount of trust and faith in the government. I know you and I have had differences of opinion on FDR, but the fact is that his administration was a contributing factor to people having faith and trust in the government. Generally speaking this lasted up until the 60's and the Viet Nam war. Student protesters and radicals started questioning the validity of the war, and uncovered outright lying and spying activities being conducted in our name. It culminated, for some, with the Watergate break-in and the subsequent resignation of Tricky Dick.

I can empathize with your cynicism, regarding government, especially with the current upper hand and corrupting influence of corporate interests. How we as citizens restore faith and trust in government is an open question, but the alternative is anarchy.

I think you need to take a closer look at the definition of fascism.

Rory Cripps

at 13:36 on October 10th, 2009

Nanute: Yes! FDR gained the trust of the American people. He was undoubtedly one of America's greatest politicians. And that Andrew Jackson book that you turned me onto also indicates that "Old Hickory" was equally adept at gaining the trust of the American people. In FDR's case, a depression was well underway, yet he kept the country together. In Andrew Jackson's case, a civil war was brewing, yet he held the country together. Hopefully President Obama can hold the country together for there is a terrible shit-storm brewing.

Fascists explicitly promoted their ideology as a "Third Position" between capitalism and communism.[129] Italian Fascism involved corporatism, a political system in which economy is collectively managed by employers, workers and state officials by formal mechanisms at national level.[130] Fascists advocated a new national multi-class economic system that is labeled as either national corporatism, national socialism or national syndicalism.[21] The common aim of all fascist movements was elimination of the autonomy or, in some cases, the existence of large-scale capitalism.[131]

Fascist governments exercised influence over the economy differently than that of communist-led states, in that individual private property was controlled but not nationalized.[132] Nevertheless, like the Soviet Union, fascist states pursued economic policies to strengthen state power and spread ideology, such as consolidating trade unions to be state or party-controlled.[133] Attempts were made by both Fascist Italy and Nazi Germany to establish "autarky" (self-sufficiency) through significant economic planning, but both failed to make the two countries self-sufficient.[134]

Fascists declared their opposition to finance capitalism, interest charging, and profiteering.[148] Nazis and other anti-Semitic fascists, considered finance capitalism a "parasitic" "Jewish conspiracy".[149] Fascist governments nationalized some key industries, managed their currencies and made some massive state investments.[citation needed] Fascist governments introduced price controls, wage controls and other types of economic interventionist measures.[150]

Other than nationalization of certain industries, private property was allowed, but property rights and private initiative were contingent upon service to the state.[151] For example, "an owner of agricultural land may be compelled to raise wheat instead of sheep and employ more labour than he would find profitable."[152] According to historian Tibor Ivan Berend, dirigisme was an inherent aspect of fascist economies.[153] The Labour Charter of 1927, promulgated by the Grand Council of Fascism, stated in article 7: "The corporative State considers private initiative, in the field of production, as the most efficient and useful instrument of the Nation", then goes on to say in article 9: "State intervention in economic production may take place only where private initiative is lacking or is insufficient, or when are at stakes the political interest of the State. This intervention may take the form of control, encouragement or direct management."[154]

Fascists thought that private property should be regulated to ensure that "benefit to the community precedes benefit to the individual."[155] They also introduced price controls and other types of economic planning measures.[150]

nanute

at 14:21 on October 10th, 2009

See what I mean? (per your first post.)

Rory Cripps

at 15:02 on October 10th, 2009

Nanute: I don't see what you mean . . . .What are you referring to?

nanute

at 01:43 on October 11th, 2009

If government sponsored health care is enacted, the lines betwee corporate and government interests There's a name for that, it's called fascism.

I don't see how government sponsored health care legislation leads to, or can be defined as fascism. Senior citizens, military veterans and poor people already have government sponsored health care. Are you in favor of maintaining the status quo?

Rory Cripps

at 05:29 on October 11th, 2009

nanute: Depending on the health care legislation that's ultimately passed, there's a good chance that many private doctors and private insurance companies will pack up their tents. And the doctors and insurance companies that remain "private" will be subjected to such a high level of government control that they will be "private" in name only. There's no doubt that private insurers will ultimately stop providing health care coverage. Look at what the insurance industry has done in places like Florida in the case of homeowners. There were a number of hurricane damage claims a few years back and as a result, many insurers dropped coverage or left the state, and in other cases pursued other forms of insurance coverage that were less risky and more profitable. The same scenario will occur in health care insurance. I have no doubt that the economic realities of government sponsored health care will ultimately force private doctors and insurance companies out of the market. Again: If I thought that the government was capable of providing, maintaining, and sustaining high level/quality coverage at reasonable prices without going further and further into the red and at the same time increasing the tax burden on workers, I wouldn't have as big a problem with the concept as I do. There are many things (such as lowering prescription drug costs) that can be done to lower costs and the savings from that could be used to provide coverage to those that can't afford it. In the U.S., we pay thirty to forty percent more than other countries for the same exact medication.

ranter22 (not verified)

at 15:21 on October 10th, 2009

Considering the advice Mr. Obama has been getting from zeke the oncologist,we are all headed for a a bad prostate ordeal. I am normally a shy and very quiet individual, however I find my blood boiling very routinely lately. I am seriously considering going on a public crusade to oppose the health care rape and medicare rip off. I suppose if many people start withholding from paying taxes, then this issue may impact the same revenue which they plan to use to fund their maligned campaign against the tax paying citizens. Politics has not been my strong suit, although lately I have been learning some things. What are the chances of impacting this reform and its reformers by means of deliberate refussal to pay up using large numbers of voting protestors?