In hope we never become immune to the stories of real people suffering from Big Insurance criminal abuse and from having no health coverage. Sometimes, though the stories are so far removed from human decency that indignation is the only appropriate reaction.
PAUL AND MARIA VanNocker are filing a federal lawsuit today on behalf of their 5-year-old son, Kyler, whose insurance company, HealthAmerica, refuses to pay for the latest treatment needed to prolong his life.
The complaint raises lots of questions that I assume will be answered at trial, should it come to that. The question it won't answer is one that's been gnawing at me since I first wrote of Kyler's plight in December:
How do HealthAmerica's overlords sleep at night?
I know my own dreams would be haunted if I acted as arbitrarily, capriciously and abusively - to borrow some pointed adjectives from the complaint - as the VanNockers allege HealthAmerica has regarding their little boy.
The Harrisburg-based company's denial of benefits to Kyler, the lawsuit claims, is the result of "a biased, self-serving misreading and misinterpretation" of everything from Kyler's medical records to the company's own internal documents.
HealthAmerica's Kendall Marcocci told me yesterday that the company won't comment on pending litigation. Center City attorney David Senoff, though, was happy to explain why he is representing the Van Nockers for free in the lawsuit.
"These companies have to be brought to the courthouse to get them to do the right thing," said Senoff, a specialist in insurance disputes. "This child needs this treatment, or else."
He didn't need to explain what "or else" meant.
Readers may recall that Kyler has neuroblastoma, a rare, deadly childhood cancer that attacks the nervous system, creating tumors throughout his body.
He was diagnosed in 2007 and endured a year of medical treatment, with complications he barely survived. Thankfully, it knocked his cancer into remission for 12 lovely months, and he got to revel once again in the glories of childhood.
Last September, the disease came roaring back. This time, only one form of treatment, something called MIBG therapy, could help save his life.
But HealthAmerica refused to pay for the MIBG, which it considers "investigational/experimental" because there is "inadequate evidence in the peer-reviewed published clinical literature regarding its effectiveness." Nor is MIBG approved by the Food and Drug Administration, another criterion that HealthAmerica requires.
How come, then, asks the lawsuit, HealthAmerica covered not one but two prior therapies for Kyler that did not possess these supposed requirements?
In April 2008, the company approved Kyler's use of a drug to treat a life-threatening blood-flow complication, even though the drug wasn't FDA-approved, wasn't manufactured in the United States and wasn't "peer-reviewed."
However, it was the only known drug to treat Kyler's condition, and he responded well to it. Four months later, HealthAmerica paid for another medication that wasn't FDA-approved for neuroblastoma treatment.
Again, Kyler responded well.
So why, pray tell, is HealthAmerica playing the "experimental therapy" card in the case of the MIBG treatment Kyler now needs? Gee, money couldn't have anything to do with the decision, could it?
In my December column, HealthAmerica's Marcocci was emphatic that her company declined Kyler's MIBG therapy not because of its cost but because of its experimental nature.
But that doesn't mean MIBG is ineffective.
"It's considered the standard of care in Europe and the United States for recurrent neuroblastoma," Kyler's oncologist, Stephan Grupp, told me then. "It's not an unproven treatment with no basis in medical science. Actually, the results are often very good."
Regardless of how you describe MIBG, one thing became clear last week when Paul and Maria got the results of Kyler's latest tests to track his neuroblastoma.
The MIBG is working.
Children's Hospital, where Kyler receives much of his care, proceeded with two rounds of MIBG therapy for Kyler - at a cost of $110,000 - despite the VanNockers' inability to pay for it…
Inserted from <Philadelphia Daily News>
Here’s Keith Olbermann’s take on this. His closing is particularly effective.
I have nothing but praise for the hospital that saved Kyler’s life with no guarantee of payment. I have nothing but scorn for the insurance company death panel that denied his treatment and for the Republicans and DINOs that are blocking reform.
Meanwhile, the uninsured are still dying at a rate of several 9/11s per year.
Since the unlikely election of Scott Brown in Massachusetts, hardly a day goes by in Washington without a torrent of speculation on what loss of a filibuster-proof majority will mean for the healthcare reform legislation that both houses have already passed. But as the president recently noted, the intense focus on the process of moving the bill over the finish line has done much to obscure the actual human stakes of the policy being debated.
Particularly striking is the near-total absence of the voices of those most acutely affected by the capriciousness of our current healthcare system, the millions who have no insurance. Despite the fact that 30 million of these folks have arguably the largest stake in the legislative outcome, they're almost totally absent from the national conversation over its fate.
Here at The Nation, we have been working to right this in our own small way. We've spent the last two weeks searching for stories from the uninsured. Despite our chosen tools (Twitter and e-mail), or perhaps because of them, we received 185 responses from a diverse group of people. From recent college graduates, to struggling single parents, to recent retirees, the storytellers ranged vastly in age, background and occupation. However, a common thread held them all together: the anxiety and uncertainty that comes with being uninsured.
Many stories expressed great, unshakeable fear that one medical emergency would ruin them. "I would say my wife and I are one medical emergency away from losing everything, but actually I've pretty much resigned myself in my head to the reality that if I have a medical emergency I am going to die," says a used-book seller in California.
The responses included wide array of opinions and varied hopes for the future of healthcare reform, but what an overwhelming majority agreed upon was that the United States government, particularly Congress, had failed to represent them within the debate…
Inserted from <The Nation>
This article goes on to detail many of the stories mentioned. I hope you will click through. They are worth the read.