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A look at the reality of Universal health care December 23, 2007

Posted by The Armchair Economist in 2008 Election, Health Care, Medicine, Politics, Ron Paul.

When it comes down to a persons life, it is easy to make a knee jerk reaction and blame it on the insurance company. If you’ve read some of my older posts, you should be familiar with my stance on why for profit insurance companies are a inherently flawed concept. However, the recent case of Nataline Sarkisyan illustrates the reality of resource management that would be necessary under a universal payer system of health care.

A 17-year-old died just hours after her health insurance company reversed its decision not to pay for a liver transplant that doctors said the girl needed.

Nataline Sarkisyan died Thursday night at about 6 p.m. at University of California, Los Angeles, Medical Center. She had been in a vegetative state for weeks, said her mother, Hilda.

“She passed away, and the insurance (company) is responsible for this,” she said.

“They took my daughter away from me,” said Nataline’s father, Krikor, who appeared at a news conference Friday with his 21-year-old son, Bedros. more on this case here

It is easy to automatically point the finger at the insurance company and blame them for the death of the girl. However, there are several considerations we need to think about. The primary issue being, would a liver transplant have saved her life? I do not have access to her medical records so the only thing I can do is postulate. In this case, the patient had leukemia and complications arose from a bone marrow transplant. She was already in a vegetative state for several weeks prior to the surgery. Would a new liver have improved her life in any significant manner? The insurance company originally denied her liver transplant based on the absence of any evidence that a liver transplant would improve her condition (The current trend in health care is something called “Evidence Based Medicine”, where treatment is only rendered if it is shown in clinical studies to therpeutic). In the absence of any evidence that this would prove therapeutic, should insurance companies be forced to pay? The alternative view is that the patient’s doctor felt that the liver transplant was necessary, so the question arises, is the doctor or the insurance company responsible for making medical decisions? One argument can be made that although the insurance company refused to pay for the operation, the doctors had a responsibility to give the transplant to the patient regardless if they will be reimbursed (this is consistent with how medical malpractice decisions have been rendered in recent cases). I would not be surprised if the patients family or insurance company brought up point in the ensuing lawsuit, but this is a whole other blog.

As a response,

John Edwards tonight cited the case of a 17-year-old California girl who died after her insurance company refused coverage on a liver transplant to save her life as a call to action to change the current system of healthcare in America.
“Are you telling me that we’re gonna sit at a table and negotiate with those people?” asked a visibly angered Edwards, challenging the health care companies. “We’re gonna take their power away and we’re not gonna have this kind of problem again.” More here

Why is this case relevant to national health care? John Edward’s platform on health care (as with the other Dems) is to transform America’s health care system and provide universal health care for every man, woman and child in America (cited directly from his candidacy webpage).

In any type of universal health care, there are limited resources and tough decisions need to be made on who deserves to use these resources. For all the ills of insurance companies, there is still one thing that they do well: manage resources. In this case, Cigna (the insurance company in this case) is a perfect metaphor for a national payer in universal health care. For example, should more money be devoted to treatment of cancer in a 65 year old patient who has smoked 2 packs of cigarettes a day for 40 years, or for preventative health care for a 6 month old infant? Consider the fact that one major limitation of organ donation is the dearth in supply of organs relative to demand of organs. According to the OPTN, there are 16,679 patients on the Liver Transplant waiting list (Source). Where a liver is so highly valued, should the liver be used on this particular patient where the outcome is uncertain.. or should the liver be used in someone with a diagnosis that is expected to have a more proven outcome?

These might seem like preposterously extreme decisions, but in universal health care rules will need to be made to clearly delineate who should and should not receive care. In this case I am confident enough to bet my degree that in a universal health care setting, that this patient would NOT have gotten her liver transplant.

While it is noble to want to give everyone in the country free health care, one needs to understand the ramifications of universal health care on an individuals choice and true effect on quality of health care. digg story

Why Ron Paul? December 15, 2007

Posted by The Armchair Economist in 2008 Election, Politics, Ron Paul.

Ok. I’m coming out of the closet to officially endorse Ron Paul for the GOP nomination.

Why Ron Paul?

This man is the epitome of integrity, he votes exactly what he believes in (not what is the flavor of the month).
I challenge you to the following:
a) Understand his platform, its quite revolutionary (and you may disagree with some or all of it, and even if you disagree you will have a better understanding of our constitution and how it relates to our country) In brief.. its noninterventionalist, constitutionalist, personal freedom (not bush’s version of freedom which requires war mongering and nation bankrupting tactics to achieve) http://www.ronpaul2008.com/, http://en.wikipedia.org/wiki/Political_positions_of_Ron_Paul

b) Look at his voting record (http://www.vote-smart.org/voting_category.php?can_id=296). (He’s actually known as ‘Dr. No’ on the hill.) I challenge you to find ONE other candidate that votes as consistently with his beliefs and I’ll recant my support for Ron Paul immediately.

2) This man has good judgment . He is the only GOP candidate that voted against the Iraq war, and believes that we don’t belong. And don’t tell me you are not COMPLETELY dissappointed in the little the Dems have done in ending the war/funding since they have taken control of the senate and house? Ron Paul is the sole candidate that is a man of his word.

3) Don’t be scared by his party affiliation. I’m a (former) Democrat, and Ron Paul actually ran for the presidency as an Independent in 88, but I feel out of all of the candidates (of any election in recent history) he has the firmest grasp on what our nation SHOULD be (ie: as defined by the constitution). *depending on what state you are from you NEED TO CHANGE YOUR PARTY AFFILIATION TO REPUBLICAN BY SPECIFIC DATES TO VOTE IN THE GOP PRIMARIES*.. otherwise a crook like Giuliani will get into office and will make bush and cheney look like mother teresa and gandhi.