- how should the CEO handle this?
Insurance would pay for standard care of an aggressive cancer, not for something that was much worse at prognosis.
It's really weird to go to bat for the health insurance industry.
It baffles me why people are OK with insurers dictating care to doctors rather than the other way around.
Doctors are free to give any care they want.
Sorry guys but you are really living in a shithole country.
Remember the big flap about bone marrow transplants for advanced breast cancer? End result: a successful transplant meant you lived longer, but the risks of the transplant offset that, there was no survival advantage.
This is not to say that there are no improper denials. It's pretty obvious some companies use red tape, and I suspect some reviewers are either being held to unreasonable standards or being overworked, resulting in deliberately lost paperwork. (Remember the scandal with the VA dropping patient visits to make the numbers look better?)
And reading the article a few things stand out to me:
1) I can't find the name of the drug being denied.
2) She gives the stat that 49 million claims are denied but 0.2% were appealed--is that truly evidence of wrongdoing, or is it evidence of the insurance companies providing the no that doctors are afraid to give patients? And how many are entirely legitimate (my wife had a denial--right drug, right digits, wrong form, wrong dose. Clearly a human selected the wrong thing from a list)?
3) She talks about lives that would supposedly be saved by Medicare for All--never mind that that would collapse our system as there is considerable cost shifting from Medicare to those with commercial insurance.
Milder chemo came and went. My body felt like it was filled with cement after infusions; my eyes could not stay open; but the hairs on my head grew longer, and there were no more boils in my throat making it impossible to swallow or speak.
I went into remission that fall, and set myself to moving beyond cancer while also beginning to process the changes it had wrought on my body, and the nearness of my brush with death.
> polling showed that a third of Americans who had faced claim denials said they viewed Mangione positively. Some saw this reaction as sociopathic, but its extremity was the very point. How far must someone go in order to be taken seriously by those who adjudicate access to life itself?
> there is no justification, ever, for denying a sick person care
Everyone above is justified in their outrage, but they have picked the wrong target.
For-profit companies exist for the purpose of making profits. They will never offer services that produce sustained losses. It's weird to blame the CEO for this - he's just doing what the shareholders hired him to do. Blaming the CEO for denying you healthcare is a bit like blaming a real estate agent for not giving away an empty house to a homeless man.
You're better off blaming the shareholders for being selfish... but that too is a bit like blaming every single person you meet who chooses to buy an iPhone instead of putting that money into a GoFundMe for a sick patient.
The real blame lies with the government. It is the government's job to give everyone a baseline level of healthcare. Taxes exist for the express reason of overcoming collective-action problems like the above. And yet, our government refuses to provide better healthcare, because a large fraction of voters prefer lower taxes over better healthcare access. if you're looking for someone to blame, blame them
They can, however, be regulated. At it's core an insurance company should just be a risk pool that gives premiums for that risk, and covers its cost + profit on getting to hold your premium for the period.
IMO what's really missing in America is a collectively incentivized set of activities to deeply reduce risk, for example one of two should be true -- smokers pay way way higher premiums, or perhaps baking in incentives by taxing cigarettes heavily like they do in Canada, for example. I see so many opportunities for healthcare to be much much cheaper just unused -- Smoking, Alcohol, THC products, risky driving, lack of exercise, high body fat, Standard American Diet (SAD) all could save a lot. Just a WAG but probably on the order of many billions in the USA.
I think one thing that makes it a mess is that healthcare comes from your employer, and your employer isnt going to diagnose each employee's lifestyle factors and pass on the risk pool savings of good choices. If the individual paid and could somehow capture that incentive profit then they'd at least have the financial incentive to be healthy.
Edit: An example I see frequently of shirking the risk/incentives structure is how Auto insurance seems to have shifted from investigating to just 50/50 outcomes unless you have a dash cam to prove your innocence. Those with risky patterns are not paying their share of insurance premiums. So until everyone dashcams it's now under penalized to do risky behavior.
Not to mention the uninsured motorist issue.