Recent events illustrate how hope and death hang over our discussions of health care like shadows whose influence is ever present though seldom seen. Two competing specters: one so intensely focused on the present moment that it occasionally reeks of desperation; the other smugly confident that no matter how many battles it may lose in the short term eventually it will win the war.
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 CIGNA determined that the procedure was too experimental and there was not sufficient evidence that it would work in Natalie’s case. Following a week of protests by supporters of the family, CIGNA reversed its decision, alas, too late to benefit Natalie.

Mark Geragos, attorney for the family, is seeking to have the insurance company charged with murder, a dubious threat not likely to do much more than garner a few headlines and stoke the embers of grief smoldering in the Sarkisyan household. CIGNA, of course, was not responsible for Natalie’s death; blood cancer killed her. CIGNA merely refused to pay for a procedure the family hoped would give their dying daughter a few more months of life. Having lost family members to illness, I know all too well that the pain seems unbearable, the grief overwhelming. As a parent, I also know that, like the Sarkisyans, were one of my children dying, I would reach with both hands for whatever hope I could find – no matter how small -- and hold on tight.

My heart and prayers go out to the family.

The reality, however, is that hope costs, and while hope may spring eternal, resources do not. The fact is that whether it is a private insurance company or the federal (or state) government, there is not enough money to pursue each and every medical procedure for everybody that wants one, no matter how low the chances of success -- to pursue hope to the inevitable end. It is telling that in spite of Natalie’s doctors’ opinions and the pressure of media coverage, UCLA Medical Center did not simply go ahead and perform the procedure and worry about payment later. It would appear that cost benefit analysis is not reserved for insurance companies.

It is certainly reasonable to ask the insurance company exactly what circumstances determine whether or not they approve payment and if the decisions the insurance company makes are based on objective criteria or are they, in fact, squishy guidelines subject to the influence or pressure of individual citizens. In other words, after a few days of public pressure, CIGNA reassessed their position and approved the payment for Natalie’s liver transplant. If these decisions are based on objective criteria, how does the protest of a few dozen concerned citizens change that objective equation? And what of the next family? Does their inability to bring public relations to bear on the insurance company mean that their child will receive no consideration?

When it comes to our health, we not only want care, we also demand hope. Sadly, politicians and other proponents of universal health care are all too willing to invoke Natalie’s name followed by promises to provide both hope and care in abundance. The problem, they claim, is greedy insurance companies choosing profit over life. Only they possess the compassion and righteousness to hold the bogey man at bay. In truth they will control finite resources through rationing of care and like insurance companies will look at the numbers. Today, it is an insurance adjuster at CIGNA. Tomorrow, it will be a mid-level government bureaucrat weighing the relative prospects of a particular procedure’s success versus the cost and the potentially better application of those same resources towards other patients that are also in need. The specter of death bides his time knowing that at some point someone will and must say, “enough” – must for all intents and purposes make the decision as to who will live and who will die.

Ideally, these decisions are best left to doctors, their patients and their families. To pretend that adding a disinterested third party into the mix empowers families is an offer of hope, but it is hope of a specious kind.

 Joseph C. Phillips is the author of “He Talk Like A White Boy” available wherever fine books are sold.