Justice has been served, with a side of poop in a bag.

Yeah let's see... poop in a bag or die?

Bring me the baggie!

Seriously, congrats to the family for getting them to agree to this and best of luck to Nick.

Yea for Nick, I hope he gets better.

But it's s sad statement on our system that your ability to obtain care has a strong correlation to your media savvy. Reminds me of the Daily Show's Missing White Woman Syndrome formula:

T = I * ( C / R ) ^ 2 + L * S^3

where

T = Minutes of coverage
I = Family income
C = Abductee cuteness
L = Length of abduction
S = Media savvy of grieving parents

I work in the field of Radiation Oncology and this is normal. The cyberknife is a brand spanking new piece of technology that I'm sure very few insurance companies are willing to reimburse for because its considered "experimental". Even though it has been used thousands of times and has been approved by the FDA. There are other procedures that are almost 10 years old that insurance companies will not reimburse for because they too are considered experimental.

@Michael Belisle: oh and R = Skin color

disgusting that it takes media coverage of an evil deed by a company to get them to do what is right (hold up their end of the bargain).

Since when is Stanford directly consulting with private insurance companies on coverage decisions? That doesn't sound right.

I willing to raise a stink on a daily basis if it means someone gets the health care their policy was supposed to cover.

The ability to receive care has NOTHING to do with the profit margins of a corporation, of course.

Even backing down from this doesn't satisfy my sense of justice. PacifiCare should still be held accountable for denying someone a procedure his doctors recommend and dragging out this person's pain.

Profits be damned. High capitalism is grinding on everyone but the superrich, and they just don't know where to stop. When is the rage we feel going to morph from "sure would like to see that CEO be forced to work at McDonalds" to "wouldn't feel guilty about seeing that entire executive board lynched"?

"They're humans too," our better angels exclaim. Yeah - humans who decide every day that this cancer-stricken kid can curl up and die.

they should still protest

Glad to see that Nick will be receiving his coverage. Hopefully the procedure works and my prayers are with him and his family.

I really like how they were worried about the "potential side effects" of the procedure. Shouldn't that be the PATIENT'S problem to worry about? And compare the potential side effects of the procedure (poop in a bag) with the side effects of NOT performing the procedure (death). Yeah... I'd take the poop in a bag too.

They should protest and change their signs to say "This is what it takes for UnitedHealth to not kill this kid"

It isn't always about profit, it's about trade-offs. Let's think in smaller numbers.

I belong to a group of ten people who form an insurance group. Each of us pay, say..$25/month and at any time anyone of us can use the money that comes together(basically the definition of insurance).

Now, it's all fine and dandy because overall everyone is healthy. But a few years down the road #10 gets cancer. The normal treatment doesn't work, and the only option is a very expensive experimental treatment. Should the other nine carry that burden? Should their rates be increased because of one member?

Don't get me wrong - the insurance company makes more than enough profit. However, if they go about approving every experimental or high risk and cost procedure rates WILL need to go up.

Socialized health care won't fix this. Socialized health care will make it so that average Joe DOES have health care. But instead of paying insurance premiums, he pays taxes. In fact, we all end up paying taxes.

But there comes the issue. How much more are *YOU* willing to pay to see someone live? For a family member, I'm sure most people could give up 5-10%. But a stranger? A thousand strangers? In the end, someone has to handle that burden and unless people are willing to give up more to taxes, it won't be "unlimited and covering every procedure".

This country has limited resources. As I understand it, the review boards were asked to give an opinion on whether the procedure should be done, given the merits of the case. They were not asked whether Unitedhealth should pay or it. The review boards, an impartial third party, said the risk is too great. Is it any surprise that the family wants to pursue any avenue they can, no matter how risky? Of course not, they want to have hope. But we have to have some mechanism in place to not run every patient through every single experimental treatment. The review by an impartial third party is the best method we have right now. I know some of you are uncomortable with the notion that we can't save everyone, and I hope you realize what an emotional topic this is.

@bsalamon: Protest what?

I might be willing to side with the insurance company on this. There are all sorts of new treatments showing up to treat cancer. I have no problem with United Health consulting with Standford or any other research center to determine the validity of a treatment. Health insurance is about 1) making money and 2) distributing the risk of expensive health care across a large group of contributors. When excessive amounts of money are spent to treat one person, they are not available to aid other contributors. It is a cold way to view it but true. Its easy to pull at the heart strings and characterize the insurance companies as monsters, in the end, the United States spends more on health care per person than any other nation.

Oh yeah I forgot to add, cancer sucks, and cancer in children sucks even more.

@SomeoneGNU:

Some might argue that you are pooling together with many people so that, in the event you are the unlucky person needing the emergency experimental treatment, you can actually get the treatment.

Yes, some people cost more. And yes, some treatments are expensive and experimental. But if you don't do the experimental ones, you don't progress the medical field, and then where will we be?

@bohemian: This is very standard in the industry. Health insurers don't always have the expertise to decide what is appropriate in these kinds of esoteric conditions. Especially when all the 'normal' things have stopped working, you're basically into niche areas of knowledge.

From the sounds of it, the cancer got way too big and when it's around nerve endings thats a pretty bad sign. Most likely the procedure would have killed him.

@Islandkiwi: Experimental procedures exist within the system. Insurers won't cover them for liability issues. The issue is that it's impossible to cover every possible procedure. There aren't enough people to do this. Even in Canada there are cut offs for certain procedures because the costs are too great for the very few people who would be affected.

Just think of it from even a society aspect. I can either treat say 10 people with regular therapy that has a good percentage (60-70% of working). Or with that money I treat 1 person who usually at this point has a very low chance of survival 20-30%. Everyone is 'going to die without life saving treatment'. But sometimes you need to allocate resources in the way that maximized the benefit to all.

@bohemian: They were consulting with these guys, who I assume know their shit: Stanford CyberKnife.

@SomeoneGNU: The answer to your first question is yes. Of course. Because what if YOU were number 10? What is the point of opting in to such a scheme? There's a chance you might be number 10, and you want to be covered in case that happens.

Of course, insurance companies operate on a much bigger scale, but that is supposed to be how it works. Because they're 100% profit driven, they're always going to find a way to get out of holding up their end of the bargain, because their primary goal is to make as much profit as possible. If we're going to stick with this inefficient crappy system, we should at least insist that they hold up their end of the bargain. Mark my words, though, we will have some sort of government health care down the road. This can't keep going on indefinitely. More people are in favor of some sort of UHC, and that number will just keep going up as things get worse. People are getting fed up, and fewer will stubbornly cling to the notion that a for profit system is the best.

@satoru: I think few people would argue that resources need to be allocated. I've never heard anyone advocating for UHC who claims resources are limitless. For most of us, our argument is we would rather the decisions on how those resources are allocated not be made based on what fattens the shareholder's pockets the most. That is the crux of the whole argument, right there. When you rely entirely on a for profit model the way we in the US do, you end up with people completely left out in the cold. We have millions of people who aren't even covered at all. That's not acceptable. People can gripe and complain all they want to about all the horror stories they hear about people in Canada. But the fact is every single Canadian is covered. Every single Canadian has at least a shot at getting the health care they need, and if for whatever reason a procedure is denied, you can bet that decision wasn't made for a fatter profit margin. The vast majority of Canadians I've talked to wouldn't trade their system for ours for anything, and can't figure out why we put up with it.

And here we have in a nutshell why health insurance is unaffordable.

@bohemian:

How do you know his policy covered this?

There are plenty of procedures my health insurance doesn't cover.

Of course cancer sucks and no child should have to go through cancer treatments in an ideal world. But no child should be used by a Nurses Association to fill a political agenda either....

What is the cost of this procedure...I have yet to see it listed.

hmmmmm....well, maybe, just maybe, he SHOULD be a physician

@Pithlit: Even in Canada there are cut offs for certain procedures because the costs are too great for the very few people who would be affected.... Sometimes you need to allocate resources in the way that maximized the benefit to all.

@bnb614: How do you know his policy covered this...? No child should be used by a Nurses Association to fill a political agenda....

These are both good points that took me a few hours to realize. As some pointed out in the other thread, nobody ever said this treatment would save his life. This heart-wrenching situation has all the elements of a call to action-a young kid with a painful cancer, an evil company, and denied coverage-except one: a necessary treatment.

The call-to-action was suspiciously silent about why the care was denied. Only the people like Ben who called and talked to the company got the answer: their qualified consultants and the state said he's not a good candidate for the treatment. And his own doctors?

• Dr. Rosenthal: "Our goal here would obviously be preservation of function, palliative support, and opening up opportunities and options for treatment."

• Dr. Malogolowkin: "His best chance of prolonged disease control is with use of local radiation with Cyber Knife."

Neither of those are particularly positive and speak to the fact that treatment will at best simply make things more comfortable for him. The CNA intentionally left out and underemphasized these points to serve their agenda. I support their goals, but question if the effort here was time and money well spent: all we did was convince UnitedHealth to provide a painkiller for one patient at a cost of at least $20k. The price at which a quasi-public good like insurance should provide this service is not easy to agree on.

Quantity of Life: +1
Quality of Life: -5

@Pithlit: I do not advocate for any one system over another, but to simply assume that universal coverage will not require these same difficult, emotionally charged decisions based on costs - expensive procedures with questionable outcomes - is shortsighted.

Universal Health Care, in any form, will not automatically cover any and all procedures. The reality is that 'socialized medicine' or whatever you'd like to call it, will still involve private insurers in some capacity. Obama, Hillary, and McCain all proposed plans that operate much like Medicare - with a 3rd party actually handling the processing and administration of the government plan. The notable difference will be that instead of a corporation defining the plan coverages and particular policies, we place that responsibility in the hands of elected officials. Certainly, the government, in the face of bad press, much like the insurer in this case, would decide to cover the procedure, and in fact would probably change the law to then cover everyone.

Somewhere, somehow, there has to be a line in the sand, so to speak. Seeking the opinion of impartial, respected, outside sources is a judicious and responsible course of action to help make these challenging decisions.

CNNMoney/Fortune magazine had an interesting article on the presidential candidates' proposals here - [money.cnn.com]

They picked McCain's and explain their reasoning. It is clear that regardless of whose side you are on, these are exceedingly complicated and hard to solve issues.

@ben1711: Would be nice to have up front pricing on all treatments, probably would reduce overall cost of care by quite a bit.

I'm thinking that perhaps this guy just went out and got cancer to make this poor innocent HMO "look bad." Sure, cancer is fun - but why bother your insurer about it? They have other things to do!

I mean, jeez - people must do this ALL THE TIME.. pick up a fancy health insurance plan and then just get cancer or multiple sclerosis or AIDS for the fun and joy of harassing HMO bureaucrats. It's these idiots with the antisocial behavior of "getting sick" that are screwing it up for the rest of us who pay for health insurance with no expectation of receiving care. Why be so selfish as to expect that?!?

Let's push our Republicratic overlords to pass a simple law with some ridiculously inane acronym that essentially forces people to buy private health insurance but makes getting sick illegal. Problem solved. (you're welcome)

These "cancer coddlers" are making it harder and harder to make money off of weeding the sick people out of the "health" care system. "HEALTH" care - NOT "sick" care. This guy is sick - sorry, no coverage for you, buddy.

@SomeoneGNU: In other industrialized countries with universal or near-universal health insurance, it is paid for and paid out somewhat in the way the Social Security is paid for/out here. You contribute to money that is invested, and withdrawn according to the rules of the account.

The problem with U.S. health policy is that it costs us more, in total $ and in $ per person than other nations, and we have a large percentage of our population (estimated at 15% and growing) that have no meaningful access to medical care. These other countries, with their "taxes," pay less and get more. If 'mericans paid a "tax" for health care, then they wouldn't have to buy health insurance anymore.

Another benefit with such a system is that there would no longer be a bunch of insurance companies to feed. A centralized system would be much cheaper. Insurance companies take up about 15% of all U.S. health care spending--this is money that never goes to provide medical care.

The way insurance is done in this country is quite a bit more messy than what you describe. What we really have is a bunch of clusters of people, who are to varying degrees cherry-picked by insurers for their potential profitability, being pitted against each other by age, sex, health history and other criteria, and against medical providers and the insurance companies themselves. Risk is not spread in a manner one could call "even." The result is that we have a near-lottery system, where some people get huge payoffs of healthcare benefits, and others get nothing at all. Those paying premiums often have to pay a bit extra to cover the inevitable expenses of caring for the uninsured, which doesn't seem fair either.

In other countries, it is true that certain treatments are rationed, postponed or unavailable. But this is true in the U.S. for many people also; only the criteria for the rationing are different. Whereas in a European country the rationing is based on epidemiological data, cost-benefit ratios and available funding, here such decisions are based on what lottery ticket/health insurance card you have, if you have one at all. The result is that these other countries have lower rates of infant death, and healthier and longer-lived populations.

Another benefit to the U.S. were it to have a more centralized health care system, is that other countries' lower health care costs (paid in payroll and consumption taxes usually, rather than as insurance premiums here) make their businesses more internationally competitive--the individual business isn't stuck with the entire cost of insuring its employees. I'm surprised we don't hear more screaming from GM and Ford about their health care costs, which must be enormous, both for their current workers and their retirees. Maybe the auto manufacturers should take the lead in demanding health care reform.

@ChuckECheese: Interesting thought about the auto manufacturers - - exactly why GM was happy to fund a trust for future long term retiree health care costs, and the UAW was hesitant to agree, the prospect of unbridled growth in costs is scary.

This all just recently came to an agreement, likely to serve as a blueprint for Ford and other UAW employers. It still needs final court approval...UAW members were supposed to hear the details of the proposal by the end of March, so maybe you're onto something!

Here's the email address for that abomination of a human being:

tyler.mason@phs.com

@OSURoss:

And what makes him an abomination? There's no evidence that UHC is contractually obliged to pay this procedure, and they have what appears to be strong medical backing for NOT paying for this procedure.

You have not, to the best of my knowledge, offered to pay for this treatment. It appears, then, that you, by not offering to pay for this kid's treatment, are also an abomination. Please post your addres so that people can send you nasty emails.

@bohemian: "Stanford" in this case refers to Stanford University Medical Center which is where Dr. John Adler works.

Dr. Adler is the guy who invented Cyberknife.

Another big issue with healthcare in general, with respect to insurance, is the way we expect it to cover _everything_. Not just the catastrophic stuff, but every little thing. How many people expect their insurance to cover: routine check-ups, routine dental visits, annual eye exams, etc.? Of those who expect that coverage, how many are willing to pay higher premiums? The money to cover all those little things has to come from somewhere, and since there are more people clamoring for these little coverages, when a case like this one comes along, it does cause more cost/benefit analysis work for the insurer.

It's easy to say "ooh evil insurance company won't pay for it.", or to post inane drivel like Dweebster's post, but really, how much of it stems from us expecting more from the system than we should?

you told me everyone had a poopsack!!!!

The mitigating information, like "the world's top experts suggested the procedure would be a failure", was somehow left out of the original stories, wasn't it?

In a capitalist society, the only entity to blame here is the marketers of CyberKnife instruments, who clearly haven't been wining and dining doctors enough.