Bob, I went to the link you provided and when I saw Kyler's face...I am fighting back the tears. I have a son who is only two years older.
It's unconscionable what insurance companies continue to get away with.

This from the Philadelphia newspaper that published his story:

"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. (CHOP hopes that HealthAmerica will reconsider or that Medicaid will cover the MIBG cost; the VanNockers are Medicaid-eligible because they are bankrupt by medical costs)."-by Ronnie Polancezky

Bankrupt by medical costs.

Fucking crooks! This is the reason we need an alternative.. we need a public option, one that doesn't act as the dumpster for the customers that the industry wants to toss out.

The head of HealthAmerican should be forced to go sit in the hospital room with the boy and later on down the road attend the boys funeral.

He should be forced to watch his parents cry, and be forced to show his face among a vengeful public.

What a disgrace

I can't tell you how awful this makes me feel. My heart goes out to that family. Still, this story needs to be forced onto front pages everywhere to remind the American people who the bad guys are, and were when we started down this road. Won't happen, I know, as our media are totally bought into the story about how insurance companies need love, too.

I share your distaste for the health care industry's practices. And the child's parents choice to sue is wholly understandable. But regarding, your suggestion that reform would have pre-emptively solved this sort of crisis: my understanding was part of what many people want health care reform to do is handle cost controls by instituting evidentiary requirements for procedures, yes? I'm not convinced health care reform would result in covering the experimental procedure in question. The child's parents have a right to sue the company based on the complaint that decision making practices are inconsistent, but I could easily see a government policy that went something like:
* procedures costing > $X must comply with such-and-such scientific standards.
If such a policy existed, then situations like that child's could easily occur, with no particular recourse. I'm not saying it's right, or even that it's wrong. I'm pointing out the problem may not be solveable even with health care reform.

Bob - I read a case similar to this in my Health Care Law course just this past week (though thankfully, with a happier outcome) that illustrates several problems with our system. The case name is Bechtold v. PHP of Northern Indiana.

After being diagnosed with breast cancer, Mrs. Bechtold tried to obtain approval for a complicated treatment procedure that had been proven extremely effective in treating the types of tumors she had. Her insurance company (PHP) denied her claim for this "experimental" procedure. Under the plan, PHP had the right (but not the obligation) to change what it considers "experimental" - but assuming they choose not to do so, the default definition of an experimental treatment is "anything considered experimental by the Medicare Coverage Issues Manual." (Here, we see our first breakdown in the system - what is considered appropriate medical care for a 40 year old woman has been linked to what is considered appropriate for a 65+ year-old MEDICARE patient, when in reality the treatment that is considered medically appropriate for a 40 year old and a 65+ year old could be drastically different...especially for something like breast cancer). Of course, the procedure had been pretty much universally accepted in the medical community as the best treatment for her type of cancer in women her age...but the Medicare Coverage Issues Manual had not yet been updated, leaving PHP free to not cover the procedure on grounds that it's "experimental," even though they knew that wasn't actually true. Here, we see our second breakdown in the system - medical knowledge disseminates much faster than our tortoise-esque federal government can update a manual that is thousands of pages long.

Under the terms of her plan, she had the right to appeal the ruling, which she did (meanwhile, luckily, her husband had some kind of supplemental insurance, she had the procedure done anyways, and made a full recovery).

The appeals committee basically said, "PHP should change its policy regarding this treatment...but since it hasn't, we're not contractually obligated to pay for this treatment." And of course PHP rejected the recommendation of its own appeals committee. So here we come to our THIRD breakdown in the system - PHP basically said "Yes, that is the proper treatment procedure for your breast cancer...and no, we're not going to cover it."

Under existing health care law, the court found all of this to be perfectly acceptable. SHAMEFUL.

Bob, are you sure the senate beill would prevent this kind of abuse?

Or even the House bill, for that matter. Both are pretty thin gruel.

Even if there's language written to prevent these outrages, what's the enforcement mechanism? Some piddly fine, that even in and of itself is probably unenforceable?

Adding: lots of people who have insurance now are routinely denied actual coverage if the insurance company deems theh procedure "experimental" or comes up with some other bogus reason to deny.

What we've been fighting for, presumably, is not simply the right to buy insurance. It's been for actual solutions to skyrocketing health care costs. Providing 30 million new customers to an untrustworthy middleman entity that's only essential service is that of skimmer, doesn't seem to be a solution.

It does people no good if all they're purchasing is junk insurance, i.e., a policy that affords few if any actual benefits due to sky high premiums, plus unaffordable deductibles and co-pays. That's not a solution.

I just purchased eyedrops for glaucoma and my copay was $50. I can afford that, at least for the moment...don't want to tempt fate. What if I couldn't? Do I choose between blindness and food for my family?

Oy, I've got to start previewing.

"essential service" was not what I meant. The only role of the insurance companies is that of skimmer...that's what I meant.