The (Not So) Symbolic Middle Finger From The Insurance Industry

Here's a nice detail from an LA Times story about Hilda Sarkysian:

Surrounded by supporters, Hilda Sarkisyan marched into Cigna Corp.’s Philadelphia headquarters on a chilly fall day, 10 months after the company refused to pay for a liver transplant for her daughter.

"You guys killed my daughter," the diminutive San Fernando Valley real estate agent declared at the lobby security desk. "I want an apology."

What she got was something quite different.

Cigna employees, looking down into the atrium lobby from a balcony above, began heckling her, she said, with one of them giving her "the finger."

There's video of this confrontation. Check it around 3:40:



Sadly, this exchange is the only ledge on which the Sarkysians can hang a wrongful death lawsuit on CIGNA. A judge threw out the case on the basis of a 1987 ruling from the Supreme Court as well as ERISA (the Employee Retirement Income Security Act), which bars individuals from holding insurers of employer-paid health care plans responsible for their coverage decisions, but they can claim that the finger incident caused them "emotional distress." Even Hilda Sarkysian calls this absurd: "They kill a beautiful 17-year-old girl, and I get to go after them for a finger? That's sick."

But of course, the insurance industry sticks their proverbial middle finger up at the country every day, with plans that cost more every year for the same coverage, companies that rescind policies when patients want to use them, and byzantine rules that they use to get out of providing care. The only surprise about this gesture is that it's not one of the health insurer's corporate logos.

...Five more people were arrested at CIGNA HQ yesterday. I wonder how many of them were flipped the bird.

CIGNA Denies Cancer Patient Care, CEO Makes $120 Million

(I am a blogger fellow with Brave New Films on their Sick For Profit campaign. Visit us on Facebook.)



Today Brave New Films released their second installment in the Sick For Profit series, taking a look at the corrupt practices of CIGNA, denying care to their customers while their lead executives rake in millions and lead lavish lifestyles.

Meet Jo Joshua Godfrey. She had cancer without knowing for over a year.

"I would go to CIGNA and they would tell me I had bronchitis and give me medicine and send me home. No matter what medicine they gave me I wouldn't get better. Then the CIGNA Director called me up and she told me that there was nothing wrong with me at all. I called the doctor, and I came with my film and my CAT scan and he just put it in, it took exactly thirty seconds. He told me, 'You have cancer,' and he said the reason CIGNA did not want to give you your records is they've known right way back for years that you have cancer and they're not going to treat you."

CIGNA took in $19.1 billion dollars in revenue last year, with a $292 million dollar income. That doesn't include the salaries given to people like CEO Ed Hanway. He made a cool $12 million last year, and over the past five years he took in $120 million. Hanway has $28 million in unexcercised stock options. The company corporate jets, also not seen in profit statements, cost $68 million. This money is gained, as former communications director Wendell Potter says in this video, through denying claims and dumping the sick, enhancing the value of the company for Wall Street investors. The effect on people's lives, meanwhile, is tragic. Nataline Sarkysian, featured in the Americans United For Change advertisement, lost her life after CIGNA repeated denied her a liver transplant, despite the family having full coverage.

Meet Stephen Coddington, the wife of Marian, a stroke victim:

The case manager at the nursing home called me in and was really upset, and she said, "CIGNA is wanting to discontinue therapy with her. The doctors called and appeals were denied." It has been a day-in and day-out fight. Every talk that I've had with them, it's been, how can we wiggle off this hook.

This is the human cost for an insurance company's existence, for the record profits and supreme lifestyle of their executives. Welcome to the American health insurance industry. Instead of helping policyholders attain the health security they need for their families, big insurance companies get rich by denying coverage to patients. Now they're sending lobbyists to Washington, DC to twist the arms of lawmakers to oppose reform of the status quo. Why? Because the status quo pays.

CIGNA is not a special case in the insurance industry. It's perfectly normal and expected for a corporation to maximize profits. The difference with insurance is that the profit comes at the expense of your health care, and frankly, all the regulations in the world won't substantively change that. The best way to fight back is through exposure, a juxtaposition of the human luxury paid for by human misery.

So help us shine this spotlight. CIGNA's advertising tagline is 'A Business of Caring.' We think they ought to come up with something more appropriate for their actual practices. If you come up with one, post it on our Facebook page. Here are some examples. We'll send the best over to CIGNA. In addition, Jo Joshua Godfrey will join SEIU Healthcare 775NW outside the CIGNA corporate offices in Seattle, Washington today as they demand quality and affordable health care for every American as a fundamental right and not a privilege. If you're near 600 4th Ave in Seattle around 12:30 PT today, head down and show your support.

And send this video to your friends. Everyone needs to know what's at stake in health care reform. This kind of denial of coverage can happen to anyone under the current system.

Americans United For Change Goes After CIGNA

One of the most despicable moments in the past few years came when CIGNA denied one of their customers, 17 year-old Nataline Sarkysian, a liver transplant. Bowing to public pressure after several days, CIGNA reversed itself and approved the transplant - but not before Sarkysian died. It was a perfect example of how insurance company CEOs get rich off of denying care. Americans United For Change remembered this sorry episode in a new political ad airing in Washington.

"This year Cigna CEO Ed Hanway will retire with a $73 million golden parachute. Seventy three million dollars. That's 292 liver transplants. Nataline only needed one. If insurance companies win, we lose."

Insurance companies are winning in some of the latest iterations of the health care bill in Washington, closing in on getting an individual mandate for everyone in the country to buy insurance, while maintaining a monopoly on the under-65 market by scuttling the public option, which would compete with private insurers and offer a not-for-profit alternative. They would get millions of new customers while potentially passing increased costs on to their customers. Nevertheless, they are still bellyaching about the meager changes to their bottom lines that would be more than offset by a forced market:

The insurers “would prefer to have absolutely no public plan on the table,” said Ana Gupte, an analyst with Sanford C. Bernstein & Company. Still, Ms. Gupte said, the insurers should benefit from the expansion in coverage — especially under Mr. Baucus’s proposed rules limiting the premiums that insurers would be able to charge from one person to the next. Under his proposal, premiums could vary by 7.5 times from the least expensive policy for the same benefits to the most expensive policy, based on age and other factors like use of tobacco.

Insurers also say they are worried about many of the new fees and taxes being proposed, including Mr. Baucus’s idea of charging the industry $6 billion a year in fees, in addition to taxing the most generous policies.

The industry also points to proposed cuts in payments to private insurers that now cover the elderly under Medicare — cuts that could amount to more than $100 billion over 10 years. “It’s a major issue,” said Ms. Ignagni, adding that health plans might not be able to continue to operate in some areas if the Medicare payments were cut too much.

There are still plenty of ways to ensure quality and affordable coverage for everyone under this plan. Insurance companies could be treated like regulated public utilities. They could have competition with a public insurance option that would force them to lower prices and improve quality. They could see an end to their corporate welfare in the form of Medicare Advantage payments, where they get free money from the government to run Medicare plans without any significant increase in quality. Any number of things could occur that would still allow insurers to skim off the top of a trillion-dollar industry and make very good livings.

But they want it all. And they traditionally have gotten there through denial of care, necessitated by a relentless drive for profit. The Sarkysian family knows this pretty well.

John Edwards Rocks Downtown LA

(more pics, courtesy of the Edwards campaign, at this photo set.)



John Edwards has generated a bit of notoriety today for smacking down Barack Obama's suggestion that Ronald Reagan can be credibly seen as a model of change.

“I would never use Ronald Reagan as an example of change...

"He was openly -- openly -- intolerant of unions and the right to organize. He openly fought against the union and the organized labor movement in this country. He openly did extraordinary damage to the middle class and working people, created a tax structure that favored the very wealthiest Americans and caused the middle class and working people to struggle every single day. The destruction of the environment, you know, eliminating regulation of companies that were polluting and doing extraordinary damage to the environment...

"I can promise you this: This president will never use Ronald Reagan as an example for change."

Edwards didn't mention any of this today at a rally in downtown Los Angeles at the SEIU Local 721 headquarters, but he did have some choice words for another actor-turned-politician.

The speakers prior to Edwards included members of the Los Angeles City Council, Herb Wesson and Richard Alarcon (Janice Hahn was also in attendance). All of them made a straight electability argument for Edwards' candidacy, which was a little jarring (especially because Edwards did not do so). Wesson even added "I don't care who's the first this or the first that, I want the best candidate to lead our country."

(Wesson also asked "When was the last time California mattered in the Presidential primary, and I yelled "1968 and 1972," but I don't think he heard me. Incidentally, given that three of the intervening races between now and then weren't competitive, that was only 5 primaries ago.)

Edwards, however, stuck to the facts, and his powerful argument for why he should be President. He offered the same policy shifts on Iraq (all combat troops out in 12 months), health care (universal coverage mandated for every American, mental health, preventive and long-term care included), global warming (80% reductions in emissions by 2050, no new nuclear or coal-fired power plants), defending the Constitution (ending Guantanamo, torture, rendition, and illegal spying), poverty (expanded social aid and an increase of the minimum wage to $9.50 indexed to inflation), and labor (fair trade and tax policy, the Employee Free Choice Act, no scab hiring, strong support for unions). But I want to cite two moments that deviated from the script.

First, Edwards has been discussing the sad case of Nataline Sarkysian, the 17 year-old from Glendale who was denied a liver transplant by her health insurer CIGNA, and died shortly after the company reversed the decision. This time, Sarkysian's parents were on stage with Sen. Edwards, and when he related that tragic story, I couldn't help but watch Nataline's mother choke up. It was affecting, it hit you right in the gut. And when Edwards said, in respect to the health insurers, "Are you telling me we should sit down at the table with these people? Never! I don't want to be their President," it was undeniably moving.

Second, Sen. Edwards obviously did his homework before the rally. He brought up the California budget crisis, and the austere across-the-board cuts proposed by Gov. Schwarzenegger. It's fair to say that he wasn't a fan. Here's his comments (a paraphrase):

I spent a day earlier this year with an SEIU health care worker... the people she cares for need her. The last thing this or any state needs are cuts to that kind of health care. The last thing you need are cuts to K-12 education. Does anybody believe that we are spending too much on K-12 education in this country?

It's fantastic to have Edwards still in the race. He's obviously an underdog at this point, and he willingly acknowledged that, saying that he's going up against "two hundred-million-dollar candidates." The compression of the primary calendar will make it very difficult for him to get his message out to the February 5 states. Yet he said to the assembled crowd of several hundred that "you have the ability to send a message and build a grassroots movement, a wave across this state and across this country." There's no question that Edwards has driven the policy agenda throughout this race, and his bold strain of populism and unabashed liberalism is sorely needed in Washington. However, sadly, even some of his most ardent supporters were making the case for Edwards to stay in the race to horde delegates and extract something from the eventual winner, rather than a case for him winning.

UPDATE: A neat postscript: Cate Edwards, the Senator's daughter, was on hand, and after the speech she was chatting with Mimi Kennedy of PDA, our local election reform activist here in LA. Minutes later, I saw Cate with something written on her bag: "Bradblog.com". Progress is slow, but it's happening.

Negotiating With Ourselves

So, What Digby Said (tm), but, you know that. And let me try and apply what she said to what everyone feels is the most important domestic issue of the election, health care.

The debate so far, as it's been set up by the leading Democratic candidates, is extremely narrow. It asks whether you want to mandate coverage through the government, or to bring costs down to the point that people will want to get coverage. And yet what often goes unsaid is what that coverage actually buys you. Why is this not the most fundamental point in the entire debate?

At 13, David Denney's body functions like that of a baby. Severe brain damage halted his motor development at 4 months.

Unable to walk, sit up, speak or even eat by mouth, David is cared for by a licensed vocational nurse who feeds him formula through a stomach tube, watching closely in case he retches.

Blue Cross of California, the family's health plan, paid for the nurse for most of David's life at a cost of about $1,200 a week.Then about two years ago, the company decided that David didn't need a nurse anymore -- contradicting the opinions of two of David's physicians -- and it stopped paying.

"He's fragile, very fragile," said the boy's mother, Amparo Denney of Torrance. "It's not humanly possible to do this without help."

As a matter of course, insurers scrutinize what physicians order -- watching for unnecessary drugs, questionable treatments, experimental and unproven therapies, unwarranted surgery.

The extent of treatment denials by insurers is unknown. But patients are contesting them more than ever [...]

Many people who are denied treatment never contest it because they are unaware that they can or are too caught up in their medical crises to bother. As a result, some denials go unnoticed; some draw headlines.

A much-publicized pair of decisions this month by insurer Cigna HealthCare to deny and then permit a liver transplant for a 17-year-old girl from Northridge drew much criticism after she died hours later.

In a sane world, the fault line would be: eliminating health care that values profit over treatment versus maintaining the same failed system, and the parties would line up on those two tracks. That's certainly the way the Republicans are playing it. They'd rather smear a seven year-old and his family than give them health care. This so-called "post-partisan" compromise for health care reform in California was passed in the state legislature without one Republican vote, it will continue to pass without one Republican vote, and may become law without one Republican vote. They're not interested in compromise. They're absolutists, and as Digby says, they're better in the opposition obstructing everything.

But the Democrats are so browbeaten by taunts of class warfare and extreme partisanship that they give in halfway before the negotiation even begins. And the Republicans obstruct, so they give in some more, and the Republicans obstruct again, and then the bipartisan zombie goons get all upset at the Democrats for not getting anything done.

So we have these Rube Goldberg plans that try to split the difference between universal health care and placating insurance companies. And we hear all this happy talk about giving a place at the table to all competing interests and forging a workable solution.

I'm sorry, the company that favors the balance sheet over human life isn't really interested in that. The trade-off is supposed to be a forced market through mandates in exchange for having to sign up everybody. What about quality of care? I can tell you that in our California plan, which many have said is supposed to be better than the major Dem candidates' plans, there is no defined minimum baseline coverage. The companies have to spend 85% of premiums on health care (Medicare spends 96%), that's it. Good thing we don't live in a country where there have been phony accounting scandals recently!

The Nataline Sarkysians of the world, the David Denneys of the world are still at risk in that scenario. My man Edwards at least understands that negotiation isn't an option, but his plan doesn't say "Look, the hell with it, they're not going to compromise, sign everybody up for Medicare." It tries to sneak that under the door, but the conservative movement really isn't being sneaky, and they're not likely to get duped. They'll lie and call something that doesn't approach socialized medicine "more from the Commies who wanna control every part of your life."

So why are we so interested in being cordial?

Insurance Companies: Profit Through Creating Tragedy

Health care reform in California is in stall mode right now, and with each passing day the price tag for gathering signatures rises. But between the twin fundraising efforts of the Speaker and the Governor, as long as they cancel travel for a month they should be fine.

What's working against the proponents of health care reform, in my view, is the continuing tragedy of Nataline Sarkysian. By November 2008 this will be out of the headlines, but within weeks the State Senate will be debating the merits of a reform measure that keeps the insurance companies in business to do this:

A Friday funeral was set for the Northridge teenager who died last week after her insurer refused to pay for a liver transplant and then reconsidered. Meanwhile, the girl's health plan stood by its initial decision Monday.

Philadelphia-based Cigna HealthCare has a record of approving coverage for more than 90% of all transplants requested by its members, as well as more than 90% of the liver transplants, company President David Cordani said in a memo addressed to employees and distributed to members of the media.

This is definitely a time to be citing statistics.

CIGNA clearly makes decisions based on corporate profit and lawsuit threats. They decide what treatments are "experimental" based on flowcharts and spreadsheets, not by looking into their customer's eyes. And their complete lack of empathy proves that they're willing to let this continue.

Just the other day, a state appeals court ruled that insurers cannot play the game of canceling coverage because of faulty applications only when the patient actually needs to use their health care.

California health insurers have a duty to check the accuracy of applications for coverage before issuing policies -- and should not wait until patients run up big medical bills, a state appeals court ruled Monday.

The court also said insurers could not cancel a medical policy unless they showed that the policyholder willfully misrepresented his health or that the company had investigated the application before it issued coverage [...]

The decision came in a closely watched case involving Steve Hailey, an Orange County small-business owner whose coverage was canceled by Blue Shield of California after he had a disabling car accident. The ruling in favor of Hailey sends the case back to the lower court for trial and requires Blue Shield to pay Hailey's appellate costs.

The types of tricks of the trade employed by CIGNA and Blue Shield are a nationwide trend. Legislation and lawsuits have yet to stop them. They'll claim that they can't do business without this kind of chicanery. At some point, government must grant their request.

Murder By Spreadsheet

This is a disgusting story. On December 10, 17-year-old Nataline Sarkysian was at the top of the list for a liver transplant. CIGNA, her insurer, denied the operation, suggesting that the treatment was experimental. For 10 days her family struggled, begging to get CIGNA to change their position on denial of care. UCLA had a liver ready and waiting for her for over a week. A fierce campaign begun by the CNA and the netroots came to a head yesterday, and CIGNA finally changed their mind and allowed the operation to go forward. It showed the power of individuals to create change.

But it was too late. Nataline died yesterday.

But don't worry, we're all going to get everyone covered by these same companies!

The sad truth is that insurance companies value profit over treatment. And they always will. And no amount of regulation will ever change that. As SiCKO revealed, the problem isn't just who doesn't have coverage, the problem is who DOES.

This is revolting. I'm beyond sickened, and CIGNA should have its license to do business in California revoked. The Insurance Commissioner should hear from all of us.

Nyceve has more.

UPDATE: Ouch, the family got Mark Geragos to represent them. And he's asking to pursue criminal MURDER charges against CIGNA.

I hate to be crassly political, but this is the end of health care reform in California. And it's entirely the fault of these criminally negligent insurers who put profit over people. They deserve to be legislated out of existence.