Friday, August 17, 2018

Commentary: Greedy insurance companies deny cancer treatment in the face of expert medical advice

By Walter Einenkel

The wealthiest in our country get the best care. This is not simply because they can afford the best health insurance. That helps, but is not the full story. The fundamental problem with health insurance is that it is a business that must make profits, and it is a huge business. In order to make profits, insurers of any industry make a bet with the patients they insure. Insurance companies bet you won’t get too sick, and you bet that maybe, possibly, you will. As someone paying for health insurance, it’s a bet we all hope to lose. But, as we get older, that bet is statistically less advantageous for insurance companies, thus the rising prices of premiums.* This, of course, is nothing new to people reading about health insurance at Daily Kos, but it bears repeating because it truly is as simple as that.
CNN has a very powerful report about a young woman who had to fight during her late 20s against a cervical cancer diagnosis. Kate Weissman was diagnosed with cervical cancer in 2015. As of today, she is two years cancer-free. But her treatment history was not smooth at all. After her initial treatment of chemotherapy and radiation, the cancer had spread by 2016. Weissman’s oncologist, and ultimately a team of “six highly esteemed oncologists,” agreed that the best course of treatment was to remove the cancerous lymph nodes and then use a “proton therapy” that would greatly lessen the damaging impact of a more standard treatment. But there was a problem. UnitedHealthCare (UHC)—Weissman’s health insurance provider—refused to cover it.
As one of Weissman’s doctors explains, in many cases “investigative” or “experimental” treatments consist of applying a type of treatment for a different form or location of a disease to a new form and situation. These “experimental treatments” are not done by throwing a dart at a board while blindfolded. The expert medical professionals in their field have tons of evidence and experience that they put together in order to make educated guesses as to the best chances of treating their patients’ maladies. Weissman’s doctors were afraid a standard radiation treatment regiment (that would likely be covered by insurance) would result in larger and life-threatening complications down the road. The treatment plan they came up with was one that has been used on pediatric cancer patients, for that very reason—trying to lessen the secondary damage done by more blunt radiation targeting. However, the “proton treatment” her doctors wanted had mostly been used on cancer in children’s brains, not in an adult woman’s cervical region. UHC told Weissman that "there is not enough medical evidence” to prove that this treatment would be “effective.”
Weissman was lucky, in that the $95,000 price tag that needed to be paid up front to begin the treatments was something her parents—and their retirement savings—could cover.
Weissman is not a unique case. Earlier this year, ABC News did a report on Debbie Robison, a 45-year-old Illinois woman who “had an advanced stage ovarian cancer” diagnosis. Her diagnosis gave her a 50 percent chance at survival. The best course of action, one that Robison’s doctors and she agreed upon, would consist of a very controversial and expensive stem cell transplant, coupled with a chemotherapy regimen. Her husband’s insurance, through his work, refused to pay for the treatment since there wasn’t enough evidence to prove the treatment “effective.”
In Robison's case, her condition was deteriorating so fast that her doctors believed she had to have the treatment within six months. They convinced Barnes-Jewish Hospital in St. Louis to pay half the cost, but the Robisons would still owe more than $60,000.
As far as running a business, this makes sense. You don’t get to ask people for a lot of money to do something that is completely unproven to work—that’s what transferring billions of dollars into bombing countries to “spread democracy” the way we have so “successfully” proven to work over the last 50 years is for. However, besides the fact that these are people’s lives at stake, there is a never-ending frontier of medicine that does not have time, the resources, or the likelihood of finding “x” amount of patients with the exact same set of issues, at the same time, to run a controlled set of tests on. The “evidence” that these companies claim to need, will not exist in the format they insist that it should. The Robisons sued and won, though the company told ABC News it would appeal that decision. Debbie Robison gives a very succinct explanation of exactly what the insurance company is doing.
"What they're telling me is that they're not going to waste their money putting it out on me, because in their view, I'm already dead anyway," she says.
Big businesses are sociopathic by nature. At a certain point people are put into positions that prove their efficacy to their company by making sure bottom lines are achieved, and various numerical cost goals are met or exceeded. However, while this may be a business model that has been used and abused for centuries, it is not simply the best way to do business. It’s completely immoral. Inhumane things can and will happen as “amoral” business decisions take precedence over people. An example of that would be how a Nevada physician—where assisted suicide is legal—found himself frustrated by insurance companies who were willing to cover assisted suicide expenses for patients, but not the more expensive life-saving treatments that might prolong and help their lives.
Brian Callister, associate professor of internal medicine at the University of Nevada, said he tried to transfer two patients to California and Oregon for procedures not performed at his hospital. Representatives from two different insurance companies denied those transfer requests by phone, he said.
“And in both cases, the insurance medical director said to me, ‘Brian, we’re not going to cover that procedure or the transfer, but would you consider assisted suicide?’” Dr. Callister told The Washington Times.
It is the “nature of doing business” that is most grotesque when it comes to these cases. As Kate Weissman and her husband discovered while fighting with the insurance companies, one of the “experts” making a decision on whether or not she would receive insurance for her proton treatments was Gwendolyn Yates.
A closer look at Yates revealed that she co-founded a tattoo removal office in 2014 called A Change of Art Laser Tattoo Removal, according to the Maryland State Board of Physicians.
[...]
Documents from early 2015 show that Yates was found to have violated the state's medical code for "unprofessional conduct in the practice of medicine" by allowing a non-doctor to use laser equipment without a physician present. She was reprimanded by the state board of physicians and ordered to pay $1,000. According to the documents, Yates did not have hospital privileges.
Yates wasn’t certified as a gynecologic oncologist and it sounds like she’s not much of a doctor in general. When CNN asked HealthCareUnited about all of this, they have been given what can only be described as a real runaround, replete with assertions of due diligence with Weissman’s doctors—assertions that the doctors say are complete fairytale fabrications of events that never took place. Weissman and her husband were able to get top politicians like Sens. Elizabeth Warren and Ed Markey, as well as Rep. Mike Capuano, to put pressure on UnitedHealthCare.
UHC continues to say they didn’t do anything wrong, but Weissman’s parents say they received a check from UHC for $40,000 a few months after they had paid out their retirement savings of $95,000. What UHC and other insurance providers are doing in these cases amounts to fraud—fraud against the consumers who believed that their medical expenses, when essential, would be covered.
A single-payer system, a Medicare-for-All system, is the only viable future for this country. For-profit health providers know that this wave is here and have been pushing hard against progress because, in the for-profit world, this is their Waterloo. There are economic reasons and social reasons, and most importantly humanistic reasons, for us moving to a truly nationalized system of healthcare. But in the end, we need to try a system that does not replicate the system we have had in place for the last few decades—because that system has proven to the world that it does not work.
It has been many years since the Affordable Care Act was signed into law. The flaws of the Affordable Care Act were that it did not go far enough. President Obama and others were right that people would like their health care, and that the ACA was the foothold needed to move from the private insurance system toward a more European-style, socialized healthcare system. But they underestimated the strength with which the private insurance giants, along with their Republican lackeys, would twist and turn reality to make citizens say they don’t want what they actually want.
This is a big part of the excitement being seen on the left. Americans want a meaningful big idea that promises to help everyone, no matter who you are. The days of paying even a little attention to Republicans whining about deficits are over. They’ve played all of their cards, and their cards show that they have a losing hand. That’s the reason they are trying to dismantle the democratic functions of our country: Republicans have no place in a democracy.
*The same goes for smokers, drinkers, high health-risk lifestyles.

Editor's note: This article was originally published at the Daily Kos, which specifies that its "content may be used for any purpose without explicit permission unless otherwise specified."

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