A Tragedy in Four Colors

I called CIGNA while writing this and explained to them what this story was shaping up to become, and that I’m not a fan of attack journalism. Would CIGNA like to be part of the story? There are two sides to everything, and National Underwriter has a good relationship with the company. I could easily get Bill’s family to sign a HIPAA waiver on his case so CIGNA could talk about it, but the company was not interested. That is unfortunate, because in cases like Bill’s, the natural tendency is to assume that the health insurer had the worst motivations in mind when it essentially cut off coverage. But I really don’t think anybody at CIGNA or any other health insurer ever wakes up thinking, “Today’s the day I’m going to make somebody unhappy.” Maybe I’m naive, but I really don’t think very many people intentionally set out to cause villainy. I think what happened in the Mantlo case was our healthcare system – and more importantly – the risk financing mechanism that makes it all possible – acted exactly in the manner it was supposed to. When you think of health insurance acting as a machine, the machine in this case did not malfunction. But if you get your hands stuck in the gears, it can cripple you. And I think that is what happened here, to some degree.

I have written a separate editorial for the print book explaining that this story takes a hard look at all health insurers, not just CIGNA in this one case, and indeed, in the case of Bill Mantlo, CIGNA didn’t act in any way other than it should have. The question is, when it comes down to the mission of delivering healthcare to people, is this really the best way it can be done? I’m not saying that by default, the answer is PPACA, because it is not. (In fact, a point of “Tragic Tale” is just how poorly PPACA achieves its stated aims.) And I’m not saying that medicine cannot be a for-profit business either. I don’t know what the answer is. I just get the nagging feeling, having learned about Bill Mantlo’s case, that someway, somehow, there must surely be a better way than this.

I don’t want the healthcare industry to dismantle. Nor do I want to replace it with a government equivalent. I have less faith in the government to fix things than in private enterprise. But maybe the biggest problem with health insurance is that as a business, it is in the practice of managing risk. And the thing about risk management is it often reduces one’s risk tolerance to an extreme degree. That sort of thing can create problems, and in the case of private health insurance, an extreme risk avoidance reflex is a natural barrier to innovation. Innovation is the key to improving healthcare delivery, service and profit. We did not see enough of it quickly enough from the industry before a wellspring of public backlash empowered politicians to pass some pretty intense reforms. Can the industry still be the master of its own destiny? Can it innovate a solution that makes future lawmaking unnecessary? Absolutely. And I truly hope that it does. But so far, I am not sure we are seeing it. And as the Bill Mantlos of the country grow old in out-of-the-way nursing homes, it raises difficult questions with even more difficult answers.

Image courtesy of Marvel Comics