Parsing The Sarkisyan Case: “They Want Healthcare That’s Always There”

A few days ago, after placing second place in Iowa, former US Senator and current presidential candidate John Edwards told the tragic story of Nataline Sarkisyan.  According to Edwards, Sarkisyan, stricken with cancer, was denied a last-minute liver transplant that could have given her an additional six months of life. Cigna, her insurance company, initially declined to cover the operation.  However, although Cigna later agreed to pay $75,000 cost of the operation, Sarkisyan died before the procedure could be scheduled and completed. 

Edwards used Sarkisyan’s tale to excoriate insurance companies for being greedy and unwilling to do what’s best for patients.  Cigna, responded by issuing two statements regarding the case on its Website.  Its message: no health insurance system, here or abroad, would have covered Sarkisyan’s transplant because there was scant clinical evidence that it would benefit the patient. 

Currently Edwards is campaigning with Sarkisyan’s parents, who have announced that they are suing Cigna.  In the meantime, Edwards is using Sarkisyan’s story to rally people and underscore his contention that insurance companies and other major health system players are putting profits before patients.

Over the past few days, people have had a lot to say about Edwards’ tactics and whether Sarkisyan could have benefited from a liver transplant.  However, there is another issue that is driving this debate: fear.  In 1993, when President Bill Clinton announced his healthcare reform coverage proposal his tagline was: “healthcare that’s always there.”  In the end Americans want peace of mind; precious little else matters. 

Yet, the question remains, what is the best way to provide people with their healthcare security blanket?  Another related question is: can consumerism help in this regard? In answering these questions, it may be instructive to look at other areas of our lives where insurance provides us with peace of mind.  For example, we buy home insurance to protect us if our home burns down.  This gives us some comfort.  In addition, we buy car insurance to cover our property costs if we get into a serious or minor accident.  This gives us confidence when we get on the road. 

However, people are a lot less sure of where they stand if they don’t read and understand their insurance policies.  In the case, of car insurance, most policies state that if you are negligent you are financially responsible.   With regards to home insurance, you're out of luck if your home is flooded.  You have to buy a separate policy. 

In healthcare, we have less of an incentive to get smart about what our polices really cover  because largely employers decide what coverage we will receive.  Many times they select plans that serve their best interests.  In addition, we assume that we’ll be covered – regardless of the circumstances.  However, we sometimes find out this isn’t the case if we have a serious illnesses or injury. 

Unfortunately, this will still be true even if Americans decide to make government fully responsible for paying for all health care. Cost will still be a concern and government will take steps to save money – or risk going bankrupt.  We’ve seen this with the Medicare program, which will inevitably go deep into the red.  In an annual ritual, physicians fight government tooth and nail when it decides to cut Medicare reimbursement rates.  This doesn't necessarily mean that people will be denied routine or evidence-based care.  However, when it comes to experimental or untested therapies, many times the answer will be no. 

There are no clear answers to these questions, but so far the ChangeNow4Health community has been providing some interesting solutions to some of these problems.  Learn more and contribute your ideas by clicking here.