Maleficent’s First Job Was Sitting On A Death Panel!
I sat on a REAL death panel, even though it was never called that. The death panel had a sanitized name. Managed care ‘death panels’ were and are still called ‘utilization management review’; but, Virginia, don’t be fooled! Utilization management departments are the REAL death panels. They are panels made up of bureaucrats, insurance company physicians, nurses and even some employees who have had no clinical training at all. They are where a request for care many times goes to be denied. Whenever your physician wants you to have a procedure considered out of the ordinary, an expensive medication, an inpatient hospital stay, a surgery, chemotherapy, radiation, an MRI, a CT scan, etc., the managed care ‘death panel’ reviews the proposed care, and then decides if it is ‘appropriate’ and will or will not be paid for by the insurance company.
Cost vs. outcome is the key phrase to remember. That, and the phrase, “Too bad, so sad!” That is the phrase used when care is denied, many times because it does not meet acceptable profit margins. There are medical guidelines that also come into play, but cost vs. outcome is usually the primary dictator of the denial of care.
There are numerous cases of death panel decisions that have made the news. Those negative decisions that hit the media are quickly reviewed and in most cases approved. No bad publicity goes unnoticed or ignored. Then, the decision to deny care usually turns into a prompt approval of care. The insurance company is given a pass by the media and consumers and is again able to fly under the radar, until the next highly publicized case comes along.
One of the most publicized denials of care came when Cigna’s utilization management review (death panel) approved a liver transplant, then denied the liver transplant, and then approved it again, right before the patient died. The outrage was nation-wide, but nothing has changed, especially with for-profit medical insurance companies. Not-for profits are just as guilty.
The most widely publicized case: 17 year old Nataline Sarkisyan was a leukemia patient. According to her doctors at UCLA Medical Center, she required a liver transplant to survive. Nataline would definitely die without a new liver and Cigna originally authorized the surgery. When Nataline developed a lung infection, her liver transplant was denied with Cigna stating that the procedure was experimental. Her doctors and family appealed the denial and contacted the media. Nataline was in ICU for 10 days waiting, with her medical condition deteriorating while her insurance company pondered the evidence for the appeal. Finally, when a protest took place at the Cigna offices in Glendale, California, under the glare of television cameras, Cigna changed their mind again and approved the surgery. Reports state that Nataline’s 10 day stay in ICU was too long. The delay caused her condition to deteriorate so badly that she died prior to getting the transplant.
Don’t think that the Sarkisyan case is unique. In my experience, it is quite common.
Yet again, and still, Republicans are trying to turn nothing into something! Rep. Fred Upton (R), Michigan, wrote an editorial that was run by Politico on July 13, 2011. In the editorial, Mr. Upton spins a great tale about the rationing of care that will cause harm to patients unless the IPAB and the Affordable Care Act are repealed. The full article is printed at: http://www.politico.com/news/stories/0711/58851.html
The IPAB is short for the Independent Payment Advisory Board and it is NOT designed to ration care. According to the New England Journal of Medicine: “The effects of the IPAB’s proposals, however, may not be to “ration health care,” raise costs to beneficiaries, restrict benefits, or modify eligibility criteria. Proposals may not, before 2020, target the rates of particular providers –primarily hospitals and hospices — that are already singledout by the ACA for extraordinary cuts. The board is not prohibited from cutting payments for physicians, but its powers may be limited if a permanent fix for the sustainable growth rate –the formula that determines increases or decreases in Medicare’s physician payments — is passed.”
So, if you are interested in death panels, examine and investigate the REAL ones. They have a home at every single private insurance company, as well as at Medicare Advantage plans that are administered by private insurers such as Secure Horizons, Kaiser, etc. Private insurer? Death panel in existence!
Mr. Upton, in the words of your esteemed colleague, Rep. Joe Wilson, “You Lie!”
Mr. Upton and his GOP colleagues are again lying to the American people. Yes, Virginia, the Affordable Care Act does cut the payment of BONUSES paid to private insurance companies. The $500 BILLION is a BONUS paid in exchange for providing care to Medicare patients under Medicare Advantage, or Medicare Part C.
You see, Virginia, the government originally thought that they should make it more lucrative for private insurers to provide Advantage programs, so they offered the private insurance companies an incentive. Provide care and we will not only pay you for the care that you provide, we will pay you an extra $1100 or $1200 extra per patient, per year. It is only the BONUS that is stripped! That BONUS adds up to over $500 BILLION dollars.
By Jillian Barclay
Author’s Bio: I am an ‘older’ progressive; a holdover from the hippie generation. I have raised 3 children, am a proud grandmother, and an outspoken political junkie. I have worked in the healthcare field for 30 years, both for insurance companies and for the other side, so I know my way around the health care industry. I have forgotten more than anyone should ever know about our health care system. Bad enough that my memory loss is insufficient to erase all of the dishonest policies of the insurance industry, I even have memories of fraud on the provider side as well. I was a whistleblower in the mid-90’s, reporting illegal denial of necessary medical care to patients. To the best of my recollection, I do not believe that I have ever voted for a Republican. I have ethics and a sense of fair play, therefore the Republican party does not qualify as a choice for me.