Family fights an HMO for 4-year-old's life

[caligirl]

Somewhere in a corporate office at Health Net Inc. is someone who needs to meet Jack Zembsch. Jack is 4, he loves SpongeBob SquarePants, and he is going to die.

One doctor in the country just might be able to save Jack, but the nation's largest HMO won't let Jack see him because the doctor is not within its network.

Jack, who lives in Moraga with his parents, Mark and Kim Zembsch, has an extremely rare form of dwarfism called metatropic dysplasia, or MD. It leaves his bones extremely soft, and before long, they'll simply stop growing even as his body continues to get bigger. Eventually, his lungs will be so constricted by his ribs that breathing will become a chore, and an infection could kill him.

That is, if his spine doesn't simply snap from something as simple as a fall. >>>>


http://sfgate.com/cgi-bin/article.cgi?file=/c/a/2005/11/05/MNG41FJMLM1.DTL

[BattyDem]

1. You gotta love the "culture of life" the Repugs have created!

No money ... your kid dies! :eyes:

I wonder how many "pro-life" people will be protesting outside of the HMO's office like they did outside of Terry Schiavo's hospice? :grr:

[SHRED]

2. And such is the state of our healthcare payment system

And the corporate controlled media will rant and rave that you are a "socialist" if you even whisper a Universal solution.
Insurance companies are ruining this country.

There are so many media sheep in this country I fear the worst is yet to come.

[bluestateguy]

3. Have they seen the movie "John Q"?

n/t

[Obamarama]

4. I hope Levinson sues the HMO out of existence.....

And I also hope if the poor kid dies as a result of the HMO's resistance to let the parents seek treatment, that there's someday an HMO CEO who, on his death bed one day in the future, is a) haunted by the kid to whom he issued a death sentence, and b) scared out of his wits as to what karma awaits him in the afterlife.

[Sarah Ibarruri]

5. I thought HMOs couldn't be sued? Didn't GOPers pass a law that

...makes it impossible to sue HMOs, or am I going crazy?

[ikojo]

15. With some HMOs you agree to accept

mediation which is not beholden to the laws of the land nor is it open to public scrutiny.

[Tandalayo_Scheisskopf]

6. Everything they said about The Clinton Health Care Plan...

Has come true.

The problem is that they killed The Clinton Health Care Plan and what we have now is supposed to be so much better.

Right. You betcha.

[Erika]

7. If you've got $, you're OK. Otherwise the GOP lets you die

This right to life of the GOP is BS. You think any of their wealthy elite is enrolled in a HMO?

W passed a law in Texas as Governor saying if you cant pay the bill, the hospital can allow you to die.

Let's hear again how Christian the GOP is. Is right to life only for the rich?

[gristy]

8. A few questions

What is Jack's life expectancy without treatment?
What is Jack's life expectancy with modest treatment"
What is Jack's life expectancy with aggressive, cost-is-no-object treatment?

And the same questions applied to quality of life, rather than life expectancy.

The article gives no clue.

These questions must be answered before the HMO's actions can be evaluated. Regardless of the fact that the HMO is a for-profit enterprise, pretty much every million dollars spent on Jack is a million dollars not available for other patients, more or less.

These stories tear one's heart out. But the bigger story is the cost of health care in this country and its accessibility to everyone. All else being equal, a policy of "treatment at any cost" increases the cost of health care and reduces its accessibility overall.

[sleipnir]

9. Good points. It really is a slanted article, to be completely honest.

I, too, would like the answers to the questions you posed before making a final judgment in this case.

[deacon2]

10. Sophie's Choice?

I'm certain it was unintentional, but there's a real "Sophie's Choice" air to your questions. Are you really suggesting corporate triage of American citizens? The current ruinous state of our nation is predicated on the specious notion of the free market as deus ex machina. A close friend left a good job with an HMO recently because he couldn't stand the case managers continually rejoicing at staff meetings over the deaths of "expensive" patients. Are these the folks you want deciding the fate of this child? How about your own?

[Erika]

11. With W, only the privileged will have first class health care

The rest of us will fight with HMO's, and the poor will just die. W 's Christianity in action.

[bogey18]

13. Thanks for those comments - not a popular position

I used to work as a transplant coordinator for an HMO - we had a 2 year old who within the space of a year had 3 liver transplants at a cost that could have provided pre natal care for my entire state for 6 months. A lot of the sad stories, like this one, have the ending that after a million dollars was spent and the patient underwent unbelievable pain and agony, they died anyway. That is not a story that people like to read or write. It just doesn't get that righteous anger juice flowing.

People believe what they want to believe - they think HMO's are at the root of all of their health care problems. Simple fact - you cannot have every technology known to man used on every problem and still have anything resembling affordable health care. Without some kind of negotiation intermediary, and some method of deciding what treatments are efficacious and which are not, most people couldn't afford to pay for the simplest of procedures, much less a bone marrow transplant or coronary bypass surgery.

If they want to rail against insurance, they need to throw in all of the other pieces of the greed puzzle, including unbelievably money hungry specialists, pharmaceutical companies and large hospital systems that charge an average of more than 20 times actual cost.

People have been brainwashed into thinking they don't want government provided health care, which makes us the only industrialized nation in the world that doesn't have it.

[gristy]

14. Yeah, I've been thinking today about folks like you who have these

incredibly difficult jobs. I suspect I have read (and even if I haven't, it is certainly true) that the people who have the job of deciding who gets what life-saving medical treatments suffer extreme rates of burnout.

All your points are excellent.

[sarcasmo]

12. Give us your tired, your sick , but only if they are

RICH.