Today's Wall Street Journal has a page A1 article (and accompanying blog post) about John Edward's decision to invoke the Nataline Sarkisyan case in his campaign-trail discussions of health care. Sarkisyan, you may remember, was the 17-year-old California girl who died a few weeks ago, shortly after her family's insurance company turned down her doctors' request that they cover a liver transplant for her. The tone of the article is somewhat negative toward Edwards' decision, and not all of their criticism is entirely unfair.
Edwards, they claim, "has been bashing big health insurers in recent days with the [Sarkisyan] story ... but ... may be oversimplifying the tale." In truth, the Journal is almost certainly right. Sarkisyan's case was very complex. The transplant was very risky. According to her doctors, the transplant would give her a 65% chance of surviving for another six months, and even if the transplant was a complete success, there would still be the problem of the underlying leukemia to deal with. It's entirely possible (if not probable) that the chief medical officer for the insurer is correct when he says that, "It is highly unlikely that any health-care insurance system, nationally or internationally, would have covered this procedure."
Despite all that, Edwards is absolutely right to put this case front and center in the debate over health care policy in this coverage. There may be a great deal of room for debate over the details, but the undisputed facts of the case illustrate both some of the key problems with our health care system and the complete and utter fallacy of one of the primary sound bites used by the politicians who oppose any significant health care reform.
The undisputed facts of the case are simple:
- The child was undoubtedly going to die (and ultimately did) in a very short time without a new liver.
- Despite the risks and uncertain outcome, the child's doctors recommended that she receive the transplant.
- Despite the risks and uncertain outcome, her family decided to proceed with the transplant.
- The decision not to proceed with the transplant was made by the family's insurance company.
It's also an indisputable fact that when the possibility of a national health care plan of some sort is raised, we hear something along the lines of "doctors should make the decisions, not government bureaucrats" coming from the right. I recognize, of course, that although this is an indisputable fact, there are likely to be some who will try to dispute it anyway, so let me provide a few concrete examples.
Former Senator Rick Santorum (R-PA), during his unsuccessful 2006 re-election campaign:
We should be enacting policies that increase competition and choice in health care, not eliminate it. Patients and physicians should make health care decisions, not government bureaucrats.
President George W. Bush, during the 2004 campaign:
And one thing I want to assure you, in all the discussion about health care, we're going to make sure that the doctor and patient are the decision-makers, not bureaucrats in Washington, D.C.
Laura Bush, from her standard stump speech during her husband's 2004 campaign:
My husband would also make sure that patients and doctors are in charge of health care, not bureaucrats in Washington, D.C.
Lest you think that this is simply a blast from the past, here are a few lines from a current Republican Presidential candidate:
Democrats believe that the solution to these problems is a one-size-fits-all, government-run, socialized health care system -- a course that threatens medical progress and restricts free markets. They think that government can do a better job of choosing a doctor and making better health care decisions than individual Americans can.
If the Sarkisyan case shows us anything, it is that bureaucrats are already making the health care decisions for most Americans. Unless you have the resources to pay for your medical care out of pocket - and for almost anything more complex than a sprained ankle that requires at least a six-figure income - there are an enormous number of health care decisions that you don't get to make.
Health care decisions are made by the people who pay the bills. The vast majority of Americans cannot afford to pay the bills from their own pocket, so they are all too often left out of the process. Decisions are made on their behalf by whoever is going to be paying the bill for them. Most often, this is a for-profit insurance company that has a responsibility to do what's best for its shareholders, and is ultimately accountable to them. Our government, on the other hand, is ultimately accountable to us - provided, of course, that we choose to exercise our right to hold it accountable.