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Post 0

Saturday, December 22, 2007 - 4:50amSanction this postReply
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Is your point in sharing this that the murder charge is absurd on its face, or did you wish for us to focus on some other aspect of this story?



Post 1

Saturday, December 22, 2007 - 10:52amSanction this postReply
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The murder charge is absurd, but this episode does make me want to review the fine print on my Cigna health insurance and possibly go with another carrier.

Jim




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Post 2

Saturday, December 22, 2007 - 4:18pmSanction this postReply
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Luke, is it absurd?  There is a question of facts, like whether the insurance really covered the operation or not.  But if it did, would criminal charges be appropriate?

If I prevent you from accessing your own property, which you need in order to save your life, wouldn't that be criminal?  If you needs some pills for your heart, and I physically prevented you from getting them, it would be the same as killing you directly.  Similarly, if I prevented you from accessing your own money, in order to pay someone to operate on you, I'd be killing you just the same.

If the insurance company took the girl's money, under the contract that they'd pay for specified medical care, they are obligated to pay.  If they don't, they're responsible for the outcome.  It's not simply theft.  It's murder (or some legal variant).  That seems to be the argument in this case.  So I don't think it's absurd.  It depends on the facts.

What would be absurd is to claim that this big company, who happens to be an insurance company, could have saved her life, and so was morally obligated to.  In that case, every company and even every person would be guilty of murder.  But the argument offered wasn't just that they had the means, but that they were contractually obligated to provide those means.

A few years ago, I saw one of those CSI shows.  In it, an insurance company was delaying making a decision on an expensive procedure, in the hopes that it would become unnecessary (i.e., the patient would die).  It could be a tempting method, especially given the connection between significant costs and necessary procedures.  Just a little delay in the system could save a lot of money.  Similar thinking is applied to the social security system.  If we delay when we start paying out, we reduce the total liabilities.  In both systems, an early death will reduce the overall costs.

I read somewhere the the British national healthcare wanted to add minimum delays to the system.  The motivation was different.  Some hospitals, despite being part of a nationalized healthcare system, became relatively efficient.  It allowed them to see many more patients and reduce the waiting time.  That ended up being more costly, as people could go there more often given the efficiency.




Post 3

Saturday, December 22, 2007 - 5:52pmSanction this postReply
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I would consider it a "wrongful death" suit subject to recovery of damages rather than an outright criminal case, especially given its nature as a contractual dispute, but I am not a lawyer.

Perhaps Jonathan Fauth can share with us his motives for posting this story.




Post 4

Saturday, December 22, 2007 - 5:57pmSanction this postReply
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What if there was evidence that it had been intentional?




Post 5

Saturday, December 22, 2007 - 9:27pmSanction this postReply
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From what I understood, from the article, even with the transplant, the girl would have only gained another six months of life anyway. What would the point of the transplant have been?
   Murder? I feel they did that girl a favor. A miserable life of suffering has ended.




Post 6

Saturday, December 22, 2007 - 10:32pmSanction this postReply
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As I said, there is a question of facts.  And the facts are pretty light in the article, while the accusations are heavy.  So I don't want to imply that I think the accusations are true.  I'm just questioning how "absurd" they are.

But I certainly hope my health insurance company doesn't think it's their job to do me such favors.  Personally, I'd be more willing to treat it as murder if I thought they were doing it "for her own good".  That's not their decision to make!




Post 7

Sunday, December 23, 2007 - 2:42amSanction this postReply
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Yeah, well, I see Joe's point regarding the intentional aspects.  Murder charges get tricky because, well, how do you accuse a whole company of intentional murder?  Whole companies get sued all the time for wrongful death mainly to discourage them from the practices that supposedly made those deaths profitable.  Look at the Ford Pinto for an example of this.

It is conceivable that specific decision makers in the company did choose unilaterally to end this girl's life.  Those specific decision makers could face murder charges.  There is also nothing to stop both a criminal and a civil trial against the company, either.  Double jeopardy would not apply as the O.J. Simpson criminal and civil trials demonstrated.




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Post 8

Sunday, December 23, 2007 - 7:00amSanction this postReply
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Maybe to enlighten Joe and others a little bit, I don't know for sure (as the article doesn't say), but I think the policy was probably an HMO, which often requires approval from the insurance company before any procedure can be done. That's why the hospital called to see if they would pay for the transplant.  HMO's are cheaper policies, but that sometimes means putting your life into the hands of people who don't value the outcomes.

If the policy was an HMO which required carrier approval, the family has no claim, and prosecutors have no evidence.

James, if your policy is an HMO, I encourage you to upgrade to a PPO, (or even a prepaid with catastrophic coverage) if you can.

David, medicine is more often than not an issue of odds and statistics.  Who knows what six more months could have brought this young woman, or the world.




Post 9

Sunday, December 23, 2007 - 7:26amSanction this postReply
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Luke, just found the story interesting and wanted to generate some discussion. I agree with Joe that we need more facts... but one thing is for sure, this incident will be fodder for the Dems in their push for "universal" health care.



Post 10

Monday, December 24, 2007 - 3:10pmSanction this postReply
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No doubt they will try to this as fodder for universal healthcare, but one only need to counter that propaganda by pointing out government controlled healthcare would just be worse. If you look at any socialized healthcare in another country and you'll see far more instances of waiting for medical treatment at the expense of people's lives.

P.S. David, the article said people in similar situations have a 65% chance of surviving past 6 months. Who knows how that percentage plays out after such a time period.
(Edited by John Armaos on 12/24, 3:12pm)




Post 11

Tuesday, December 25, 2007 - 10:40amSanction this postReply
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Back to the Future

Tersesa has the underlying issue right.  The insurer doesn't simply have to cover everything.  There are approved procedures and those for which a cost-benefit analysis done.  If statistics show that further treatment is unlikely to be successful/beneficial,care will be denied, regardless of individual circumstances.

I myself opt for a full insurance plan with excellent high-end and catastrophic coverage, but a large up-front deductible.  This girl's parents may not have had such an option.  And one can challenge the HMO's decision-making policies in court.  (This and publicity is apparently why they reversed their decision, alas,(or intentionally) too late.)  But it seems preferable for those who can to avoid putting such decisions in the hand of a bureaucrat paid to deny claims in the first place.

Of course, some people are of the opinion that if it weren't for insurers (and doctors, and pharmaceuticals) and were presumably left up to politicians none of us would ever get sick, die young, or even age in the first place.  Indeed, liberals believe that it was the advent of socialized medicine and free lunches at public schools which led our missing-link ancestors out of the cave in the first place.

Ted Keer      




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