Well, the insurance company is not dictating how a patient is treated; rather, whether the insurance company will pay for that treatment. Now, yes, I realize in practice that is a distinction without a difference. But, perhaps it points more to the issue of how health care is billed more than anything else.

One of our problems is that insurance isn’t “insurance” anymore. It’s a healthcare payment system. It’s like if your car insurance covered your oil changes. If insurance covered just “big stuff” and you paid for routine stuff out of your own pocket, yes, you’d be better off.

When healthcare became expensive and the insurance companies had to figure out how to keep making money.

We got here because expansion of insurance, beyond what insurance usually means, allows doctors and hospitals to make more money and a whole sector of insurance companies to make more money, while not really providing any better care.

The other big difference is that auto insurance is bounded by scrap cost of autos. I think this is one of our big questions- what is the scrap cost of a human?

I’m a doctor. l HATE dealing with insurance companies.

That said, “death panels” are a necessity if we want to keep costs down. Doctors will not be responsible stewards of health care resources. Neither will patients. They will do everything and anything more often than not. So whether it’s a private company or the government, someone will throttle the money being spent.

I’ll add, importantly, these aren’t decisions about healthCARE. This is a decisison about healthcare PAYMENT. Aetna cannot stop the treatment, only deny coverage of it. Due to cost, that’s often the same thing. In this specific case all the insurance company was asking was for the patient to update blood work he hadn’t had in 3 years before approving a $20k treatment. That seems reasonable. The patient didn’t comply initially. Once he did he got his treatment paid for. Again, reasonable.

Lastly, the answer in an ideal world, is either a centralized payer who covers basic stuff and a secondary insurance market for stuff not covered that way or a total free market where insurance companies and doctors compete for business by offering the best coverage and providing the best service at the lowest cost. Currently we have neither of those.