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Human Exceptionalism

Life and dignity with Wesley J. Smith.

Lawsuit Against Health Net Reveals Danger of Single Payer



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This may seem counter intuitive, but a lawsuit filed in California against Health Net Insurance, for allegedly denying coverage for life-saving medical treatment, illustrates the danger of single payer health coverage.  First, the story from the L.A. County Medical Association Press Release, and then my reasoning:
It [the suit] alleges that the multi-billion-dollar insurance provider systemically refuses legitimate patient claims by employing its own definition and set of criteria for "medical necessity," violating well-established standards set forth by California law. According to the suit, Health Net is "the leader" in this calculated corporate practice to avoid paying claims. "Once again, we see a health insurance company putting profits ahead of patient health and lives," said Rocky Delgadillo, CEO of LACMA and the former Los Angeles City Attorney. "By deciding which medical treatments are necessary and which ones it will cover, Health Net is dictating medical care from the boardroom. Patient care should be decided by doctors, not business suits."
If Health Net did it, I hope they are ordered to pay through the nose! But imagine the same scenario under a single payer plan--as has happened in the UK, Canada, and Oregon Medicaid, which have all denied life-extending chemotherapies for people with terminal cancer.  The wronged patients were without a remedy--as I describe in this Weekly Standard article. You think I exaggerate?  Read the linked article and learn about the Arizona liver transplant patient--who had been approved for life-saving surgery on Medicaid--only to have the consent withdrawn when cost-cutting led the state to take away the benefit.  There. Was. Nothing. He. Could. Do.  But if it had been a private insurance company unilaterally pulling out the rug by suddenly changing the organ transplant benefits--the lawyers would have stampeded! In other words, in a private system, wrongs happen to be sure, but we have potentially robust legal and administrative remedies to both dissuade and punish.  In a publicly financed single payer system, often a wronged patient is limited to an in-agency administrative appeal--or less if the state decides the malady isn't to be covered.  As in Veteran's Administation appeals, good luck with that!


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