WE WOULD DO IT AGAIN

A few days ago, The New York Times published the following:

OKLAHOMA CITY — A jury has ordered Aetna to pay more than $25 million to the family of an Oklahoma City woman who died a year after the insurance company refused to cover a type of radiation therapy.

Jurors found that Aetna doctors didn’t spend enough time reviewing Orrana Cunningham’s case before denying her coverage for proton beam therapy in 2014, The Oklahoman reported . The jury ruled that Aetna recklessly disregarded its duty to deal fairly and in good faith with Cunningham, who had nasopharyngeal cancer.

Aetna is considering whether to appeal the ruling, which was issued this week. Company attorney John Shely said the insurer tries to do the right thing.

“If it’s in our control to change, that’s what we’re going to do,” Shely said. “Aetna has learned something here.”

The background is scary. Mrs. Cunningham’s cancer was located so close to the brain that regular radiation would likely have disabled her — with blindness, and worse.  Now, with this sort of situation, Medicare routinely pays for Proton Beam Therapy, and it is covered by insurance companies for people younger than their early twenties. But for everyone else, Aetna has denied it, claiming it  is”investigational and experimental.”  Aetna’s spokeman told the Jury, “we’d do it again.” 

Mrs. Cunningham’s doctor had strongly recommended proton beam therapy; her husband had pleaded for it, but Aetna would not budge. The Cunninghams had to mortgage their house and resort to a “fundme” website, but by the time the money was raised it was too late, and she died.

THIS IS WHAT TOO OFTEN HAPPENS WHEN PROFITS ARE PLACED ABOVE PEOPLE. 

In my opinion, our system of delivering health care is as sick as the patients it treats. The purpose of this website is to detail what is wrong with our system, and to suggest why the only real improvement is to largely remove the profit motive from medicine.

In the meantime, I’d love to hear the opinions of anyone reading this. And if you know of a patient whose story is disturbing — or inspiring — please let us know that, too. Obamacare has saved lives which would have been lost without it. Those stories also need to be told. 

The best thing would be to share your thoughts on this blog, but if for any reason you wish to communicate to me privately, use the email link provided in my profile. Thanks!

Dio. 

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