Matthew's Mom Responds
Let's narrow the debate again. Matthew's case is not about end-of-life decisions, quality-of-life decisions, or experimental treatments and long-shot outcomes. This is about life or death for a baby with an otherwise bright future. It is also about a fundamental policy decision about what risks we share collectively and what risks we leave to each little family. And it is about whether an insurance company, the government, or someone else decides who will get care. I want to give Matthew's mom a chance to respond:
No doctor ever said that we shouldn't/couldn't save Matthew. There was never a question. We were always told that he could be fixed, but he would need multiple heart surgeries. We certainly could not/would not let him die when everything you are told is that he has a great fighting chance of survival. Even if we had ever said.."Oh wait, we can't afford that ... just let him die" ... that would have never ever happened!
This is one of my biggest complaints ...... Stanford was paid $14,500 to $21,262 per day.. that was at a 40% discount, just for room and board ... this is not including critical care doctors, surgeons, assistant surgeons, labs and X-Rays... that is just insane. Who can pay that?? ... it's no wonder we ran out ... we spent 3 months at Stanford... Stanford was like a giant vacuum and sucked away approx 1.7 million of our 2 million in just 3 months.
We spent 3 months in a Las Vegas hospital in the Neonatal Intensive Care Unit and they were paid $1600 a day. That is certainly more reasonable... remember, we had no choice where Matthew could go for his life saving surgery.. our only choice was Stanford.
We tried to purchase private insurance when he was close to running out of insurance w/ the police department. We were told by the Nevada Insurance Commissioners office that we were ineligible to purchase private insurance, even though there is supposedly HIPPA protection .. we fell thru every hole.
What choices did we have?? Our choices were to manipulate the system ~ such as divorce, adoption etc.... We refuse to do that.
When we heard about the Family Opportunity Act ... we were thrilled....we would be MORE THAN HAPPY to pay the state for affordable healthcare for our baby.
What are people like us supposed to do when you run out and you can't even buy more insurance?? It's not like we are looking for handouts... we would never manipulate the system.Healthcare prices are so exorbitant! This really can happen to anyone.
You cannot look at this child and say we should have let him die because it costs too much.
We've had a thoughtful discussion about hard choices in health care. I'm grateful to Maggie and to many commentators who got it just right. And I'm grateful to Matthew's mom who reminds us that behind the abstract policy decisions are little boys like Matthew.
This is an example of how the free market doesn't work well in some cases. Medical services are necessary at times, and we don't have a realistic choice. The technology is there, but only the rich can afford it, and even then if the problem is bad enough they won't be rich for long. The responsibility lies mostly with the doctors, IMHO. They make the choice to deny care because the patient can't pay. Surgeons, and many doctors, make a LOT of money. It seems they need to give the needy free services, especially in life threatening situations. Many do, but it is still not enough. Should doctors and hospitals be required to perform services for families when insurance runs out, and insurance companies have higher caps without raising premiums? What effect would that have on the quality of care for everyone? These are all tough questions. I still think Universal Healthcare may provide some solutions to this, but there will be more problems as a result. In the end, someone has to pay for the care, and the continued advancement in medical technology. Artificially controlling it has consequences.
Jim Anderson
The Truth About Credit
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June 19, 2007 8:50 PM | Reply | Permalink
It is not the surgeons and doctors making "a LOT of money" who are telling Matthew's parents he's too expensive to keep alive. It's the insurance company.
You ask, "should doctors and hospials be required to perform services for families when insurance runs out, and insurance companies have higher caps without raising premiums?"
Let me ask you this: should we let little kids die because a private, for-profit insurance company needs to maintain that loss ratio for its stockholders?
Don't hide behind the "these are all tough questions" screen. These are life and death questions.
The point of universal healthcare is to take the dollars already in the system and redirect them into patient care and away from insurance company profits. We already have rationing (see Matthew) and we already have long waits for surgery (while we fight with the insurance company for "pre-approval" that is actually no guarantee of payment). We also have people who choose between paying the co-payments and the high deductibles and paying for utilities and food.
Now THOSE are some tough choices.
June 20, 2007 5:58 AM | Reply | Permalink
Apart from solving this single family's problems right now and those of others in similar situations (i.e., re-insurance by a state government, etc.,)
I think that Matthew's story would best be be used, the debate best be "narrowed," as an example of how health care is ALREADY rationed under our current system, against those who bring up the fear of rationing in a national system. What is called "rationing" will always occur if we have technological advance in medical treatment, with or without a national system, deal with that reality. That it is a factor that is always going to have to be dealt with, whatever the system of insurance. The real question is: who do you want making the decision on who gets the million dollar treatments?
It helps the argument for universal national coverage to point out that the greater the pool, and the smaller the overhead, the more exceptional expensive treatments can be afforded. That still not everyone will get them, but more people will.
(Also, to bring up the fact, as many do on all sides of the issue, that "the rich" can afford any kind of treatment, is just a distracting argument, because they can afford any kind of treatment in any system, they just go to another country if their own disallows a treatment. The proper response when someone brings that up: so what, what are we going to do about everyone else?)
June 20, 2007 6:50 AM | Reply | Permalink
I don't think this round of posts narrows the debate because various persons keep interpolating pre-existing views about insurance companies into the specific facts. If you read closely, the family does not charge the insurance company with having rationed care or profited from its coverage for the child. The insurer has paid the full limit of its coverage. At $2 million for one child, it is unlikely it made a profit. The insurer did not deny them care at the more expensive Stanford to protect its shareholders. What is the principled basis for a stranger to this situation to command the insurer to do more than it bargained for, or to demonize it for not doing so?
Of course, if a society is to have the benefit of private insurance - here $2 million of benefits - then the insurers are going to have to stay in business and to do so will have to limit coverage, either plainly by contract or less plainly but no less limiting, by the amount of the capital they have. That is not immoral, it is just economic reality. If charity or the state do not step in at the extreme, then there will be uncovered persons who do not get care.
Since charity cannot be mandated effectively, the real policy issue is whether the state should cover cases that exceed coverage limits (or where one is uninsured to begin with), either a) as insurer of last resort, or b) as part of a broader health insurance program that displaces private insurance, in part or in whole. But there is no such thing as unlimited coverage, even from the state. Any state program requires either tax collections, insurance premiums being charged to someone by the state, displacing other state expenditures or borrowing from private creditors. The tradeoffs involved, which are partly economic but also political, should be the focus of constructive healthcare policy debate.
June 20, 2007 8:33 AM | Reply | Permalink
I'm not sure that this is an example of the free market not working well. It's an example of a really terrible situation where a family needs an enormous amount of money to pay for something they need, and they might not be able to come up with the enormous amount of money.
I think many of the above comments are missing the distinction between uninsurance and underinsurance. My favorite example of this involves picturing a homeless man in the street: is he going to be helped more by a super-deluxe PPO plan that covers everything with no deductibles or copays, or by a roof over his head, a hot meal, and limited basic coverage? To read the health-policy discussions on this site, you would assume that his lack of a PPO is a far greater affront to humanity than the fact that he sleeps in a park. This is an area where I think the undiscriminating, reactionary hatred that many on this site have for private enterprise becomes a real problem. I don't know about you, but the Part D doughnut hole and means-testing in Medicaid bother me a lot more than the thought that my health plan might not cover some experimental scanning procedure for me someday. But ideas like that detract from the "evil insurance company" meme that folks here are so fond of. (On a related note, anyone who thinks that inefficiency will magically disappear from the U.S. system once we're in a single-public-payer environment needs to take a moment to contemplate Part D. I would think that TPM readers would have an idea of how amoral and spectacularly wasteful the Federal budgeting process is.)
June 22, 2007 2:54 PM | Reply | Permalink