[lit-ideas] Health insurance -- Judy, Erin?

 

Here's health care in America.  Would it be different, would the actions  and 
outcomes have been different in Canada?  Or Europe?  (Maybe  someone needs to 
redefine "necessity"). 
Julie Krueger 
_Man  Dies After Insurance Co. Refuses To Cover Treatment - Yahoo! News_ 
(http://news.yahoo.com/s/kmbc/20060211/lo_kmbc/3257367;_ylt=AgGWfeZ_n0oGdpks3kbuHhc
DW7oF;_ylu=X3oDMTBiMW04NW9mBHNlYwMlJVRPUCUl)   
<<Tracy Pierce, 37, lived a full life. He grew up with family and  faith. He 
went to a Catholic school, got married, had a son, and he even had the  car of 
his dreams. It was the perfect life.  
"He's been strong. He has," his wife, Julie Pierce, said.
Two years ago, Tracy Pierce's life changed dramatically when he was diagnosed 
 with kidney cancer. 
"I have no treatment. Three months has gone by and I haven't had any  
treatment," Tracy Pierce told KMBC's Jim Flink in May 2005. 
When Flink talked to Tracy Pierce, his cancer was attacking his body. Despite 
 being fully insured, every treatment his doctors sought for him was denied 
by  his insurance provider. First-Health Coventry deemed the treatments were 
either  not a medical necessity or experimental. 
"I don't know what else to do but just wait," Tracy Pierce said last May. 
As he waited, his doctors appealed again and again, including a 27-page  
appeal spelling out that Tracy Pierce would die without care. Coventry 
dismissed  
each request. 
"It's purely economical. You never see an insurance company try to block an  
inexpensive test," said William Soper. 
Soper leads a group of doctors who filed a lawsuit last year against  
insurance providers. This week, Soper went to Jefferson City to lobby  
legislators 
for change. 
"And you know, it's not going to get better anytime soon. It's going to get  
worse," said Myra Christopher, who is the president and chief executive 
officer  of the Center for Practical Bioethics. 
Christopher told Flink that change won't happen until there's a change in the 
 entire medical model. 
"I just believe strongly that we need to start being honest about what's  
going on here," Christopher said. 
What is going on is that some insurance companies deny even routine  
treatments because insurance companies treat their patients as costs, not as  
clients, 
Christopher said. 
"Some of these companies are just unethical the way they treat both  
subscribers and providers, doctors and hospitals," Soper said. 
Two weeks ago, Tracy Pierce talked with Flink again. 
"Just holding a lot of anger in," Pierce said. 
Cancer ravaged his body, moving from his kidney to his lungs and to his  
brain. 
"Now, we're just to the point where we're trying to make him comfortable,"  
Julie Pierce said.  
Even as he was dying, for more than a week, his insurance company denied him  
oral morphine, which had been prescribed to reduce his pain.  
"That's unacceptable because in this day and age, no one should be in pain,"  
Pierce said.  
"I just hope we can get something done about it, that's all. We just have to  
get something done," Tracy Pierce said.  
An hour and a half after Tracy Pierce talked to Flink, he took a nap and  
never woke up. His family calls his case death by denial.  
"They just wrote a prescription for him to die," Julie Pierce said.  
The family is begging for change.  
"The reality is the blame-and-shame game isn't going to get us anywhere. We  
are all at fault," Christopher said.  
Insurance companies, hospitals, doctors, patients and politicians all need to 
 work together, she said.  
"We have to have the moral will. We have to have the intelligence. We have to 
 have the political leadership to change this," Christopher said.  
For Julie Pierce, it was 15 months of watching her husband die slowly,  
painfully and helplessly with no chance at lifesaving treatment, Flink 
reported.   
"My mother always told me to get a good job with insurance. For what? It  
hasn't done anything," Julie Pierce said.  
Julie Pierce said that she understands that we will all die. What is  
expected, she said, is that if you have health insurance, you'll be given every 
 
fighting chance. She said that is not happening.  
Leukemia Story
Last fall, 12-year-old Nathan Crabtree was an outgoing child getting ready  
for a new school year. But his father says Nathan often played sick to extend  
summer vacation by a day or two.  
To prove a point, his dad took Nathan to a doctor for test, which showed that 
 Nathan had an aggressive form of leukemia -- one that needed immediate  
treatment.  
Flink reported that a hospital room has become Nathan's classroom. He spent  
just two days of his sixth-grade year with classmates; mostly, he's been at  
Children's Mercy Hospital.  
"It's not going away, so they were going to send me to Minnesota," Nathan  
said.  
Doctors wrote to Nathan's insurance company, urging it to send him to the  
nation's foremost research hospital. Nathan's bags were packed, when his  
father's insurance company, Coventry, refused to pay for that care, calling it  
"experimental."  
"You don't have anyone to fight for you," said Lee Crabtree, Nathan's father. 
  
Lee Crabtree said he's desperate.  
"I have to go out and find private grants, because for all intents and  
purposes, I have to assume I have no medical coverage," Lee Crabtree said.  
"I think they expect or depend on people giving up after the first phone  
call," said Dr. William Soper, the executive director of Mid-America Medical  
Affiliates.  
Soper said his group is so upset with insurance companies that it has filed a 
 lawsuit alleging insurers block patient care.  
"We have patients who say, 'I want a complete physical,' and we'll look at  
their insurance coverage and we have to say, 'Sorry, but your plan doesn't 
cover  a complete physical,'" Soper said.  
Flink reported that many people don't realize what isn't covered by health  
insurance until it is too late.  
Lee Crabtree said he has a helpless feeling when he looks at his son and  
tries to explain why he can't help him live.  
"The feeling of this is beyond words. It makes you feel hollow," Lee Crabtree 
 said.  
Late Friday, KMBC learned that Nathan's mother found out she could apply for  
coverage with Blue Cross Blue Shield at her workplace, and so she had 
applied.  What Coventry spent months denying and calling experimental, Blue 
Cross 
Blue  Shield approved on the first request.  
Nathan Crabtree leaves for Minnesota on Sunday morning.  >>

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