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Gov’t Refuses Transplant, NYTimes Says it’s Insurance Problem?
Written By : Warner Todd Huston

It is interesting to see how people will twist and turn reality in order to support President Obama’s socialistic healthcare program, but this story has to take the cake. It is the story as detailed in The New York Times of Eric De La Cruz, a young man who was sadly diagnosed with a heart condition in his 20s.

Eric was diagnosed with severe dilated cardiomyopathy, a disease of the heart that enlarges and weakens the heart muscle. Unfortunately, Mr. De La Cruz and his loving sister, former CNN on-air talent Veronica, toiled for several precious but wasted years to find a way to get the heart transplant that Eric needed to prolong his life. Mr. De La Cruz was never able to get his transplant and died waiting for a transplant that never came.

The delays were several. To begin with, Mr. De La Cruz did not have any insurance to rely on to fund his care. For several years the De La Cruz’ went through enrollment for Social Security disability benefits — of which he was twice refused — and later successfully for Medicaid benefits that would come through his home state of Nevada. Unfortunately, Nevada’s state enforced rules excluded anyone past the age of 20 for heart transplants. The state of Nevada determined it could not change its 20 and under rule even though it was clear that Mr. De La Cruz would die without the operation.

From there the family tried raising the million dollars needed for a secondary insurance policy and for the operation that Mr. De La Cruz would need. But by the time all this transpired and the family finally got all their financial needs settled, it was too late. Mr. De La Cruz passed away from his condition at the too young age of 31.

Now, from this multiple failure of the system that so ill-served her brother, what did Miss De La Cruz and The New York Times conclude?

They decided that it was the fault of insurance companies.

She is still crusading, sharing the story with lawmakers in Washington and at rallies, including one in Times Square this past weekend. At the very least, she says, insurance companies should not be allowed to turn down patients with pre-existing conditions.

“If my brother had been able to buy health insurance, he would never have been in this situation,” she said. “No one should ever have to go through what we’ve been through. Eric should still be alive.”

But was it? This entire story started with a young man that had no insurance in the first place and then was diagnosed with an extremely expensive, life-threatening condition. Insurance would not take him after the diagnosis.

Then the family tried multiple state and federal agencies and they all denied him for whatever reasons.

Why is it that the insurance companies that are being found at fault and not the government that at every turn refused this man’s medical needs knowing he would die without the treatment?

The fix according to the Times and sister Veronica is for insurance companies to be banned by federal mandate from refusing new enrollees with pre-existing conditions.

The problem with this idea, though, is that this would not be insurance if that government regulation were to begin. It would be charity. The problem with telling insurance companies that they cannot exclude pre-existing conditions is that it would immediately bankrupt any insurance company were they to allow just anyone at any time to get coverage.

You see, insurance works by having a large pool of premium paying customers and a smaller pool of those needing to take money out of the system to cover medical costs. The larger the pool of people that need money taken out, the larger the pool of premium payers needs to be. If, however, people can still get new coverage even if they know they will need large payouts immediately, the pool of money will be so quickly depleted that no one else can get any payouts. The pool of available money will be paid out quickly without time to recoup expenses.

There is another problem, of course. If one can get a new insurance policy at low rates the instant one finds out that a major medical problem has been diagnosed, no one will take out coverage beforehand when it isn’t needed. People will only bother paying premiums when they suddenly find out they have a problem. This, of course, will completely eliminate the ability of the insurance company to gather that large bankroll to fund people’s medical needs.

After all, why pay years and years worth of premiums if one can get covered for just anything at any time. Why not just ignore the expense of paying insurance at all until it is needed if one can get away with that? What fool would pay if it isn’t necessary?

Insurance simply cannot work this way. It is fiscally impossible. So, we are left with government and/or charities to pick up those that cannot successfully comply with the insurance market reality. That is how it works and the only way it can work, really.

Now, let us take another look at the case of Mr. De La Cruz. He never did have insurance and then could not get it after the diagnosis. Then it was government that failed him at every turn.

And can we review who was blamed? Insurance, not government. Yet, it was government programs that refused this man. The safety net that government was supposed to be is what failed this man, not insurance.

So what happened here? Why did this mourning woman and The New York Times blame the wrong party for this situation? Well, because it fits the Obama nationalized healthcare agenda, that’s why. It fits Obama’s tactic of demonizing capitalism and insurance companies, that’s why.

The upshot of this is that The New York Times and Eric’s sister are playing politics with this poor man’s death. And that seems pretty despicable to me.

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  • http://wastingtimewithalex.com/ AlexinCT

    Why is anyone surprised that collectivsts and their propaganda arm in the MSM would misplace blame and refuse to acknowledge that government sucks at anything it does? The only time that the NYT and the leftists think government erred is when they actually do soemthing that makes sense. Upside down world.

  • http://conservativebootcamp.com martinhale

    I think it's innately human to hear a story like that of Mr. De La Cruz, and feel badly. But the reasonable person wants to go beyond just feeling badly for the man, they want to understand the details of the story in which there are realities which must be considered in one's final analysis of the narrative.

    Mr. De La Cruz apparently didn't concern himself with health insurance before the time when he was diagnosed, which was precisely the time he needed to have been concerned with it. He was young and presumably felt invulnerable, as most people that age do. But the decision he made to not struggle to obtain health insurance then, really set the tone for the slow unwinding of his life, and ultimately ending in his death. Then, the 'safety net' failed him utterly and completely – on grounds that are not substantially different than the grounds on which the evil insurance companies rejected him.

  • D-Vega

    There is a bit of a contradiction here.

    You are criticizing there NYT's blame of the insurance companies. The NYT is blaming them because they wouldn't accept a PEC.

    So then you say it was really the gov't's fault, since the safety net failed him.

    Yet, the right doesn't want this safety net to exist. The only option is mandating that insurance companies accept PEC.

    Either the public safety net kicks in when all else fails, to save someone's life, or the private insurance companies provide the net.

    You say IC can't work that way, but you don't want the public option either, but then you are blaming the public system for failing him.

    What is your alternative? Either you have regulated private insurance or public insurance.

  • http://PatriotPost.US bthewolf

    What is your alternative? Either you have regulated private insurance or public insurance.

    Posted by D-Vega

    2009-09-09 09:41:53

    Or how about being smart enough to get insurance before the condintion is PRE-Existing. Mr De La Cruz gambled on not needing insurance, nad sadly he lost.

    I've always had health insurance, got as soon my parents coverage dropped, always knew I was better safe than sorry. I have no sympathy for stupidity and lack of foresight.

  • D-Vega

    So then the people who fall through the cracks just end up six-feet under?

    No one thinks they are going to need a transplant in their 20's. Maybe you do need insurance, but you don't think you need that much at such an early age.

  • http://PatriotPost.US bthewolf

    Posted by D-Vega

    2009-09-09 09:56:28

    Then they ARE NOT THINKING, PERIOD!! When did it become my problem to pay for Mr De La Cruz's complete lack of foresight??

  • D-Vega

    I respect that you are taking the position of individual responsibility, wolf.

    Your position is that this guy made his bed and had to face the consequences of that.

    Putting that into the context of this post though, it means that the only person who was at fault here was him. Not the gov't, not the ICs.

    If the gov't had acted as the safety net, this man may still be alive. If the insurance companies were mandated to accept PECs, he may still be alive.

    The only way he would have definitely still died is none of the above, which is the right's position.

  • http://PatriotPost.US bthewolf

    Vega what about charities? I don't see any mention of them talking to charities, or doing charitable fund-raisers of their own.

    And many doctors will donate their services for the procedures if costs for the facility usage, materials, etc, are covered.

    And forcing INs cos to accept PEC is a non-starter: as has been pointed out it would bankrupt ins companies, as it is completely antithetical to how and why insurance exists.

  • D-Vega

    They tried to raise money, wolf, and came up short.

    So either people in this situation are just left to die, "rugged individualism" if you will. Or, there is a public safety net that kicks in at a certan point.

  • http://conservativebootcamp.com martinhale

    Vega:

    Ultimately, as I pointed out earlier, Mr. De La Cruz' decision to go without insurance when he was apparently healthy is what triggered the whole chain of events which culminated in his death. Is he solely responsible for his own death? Probably not. Is he partly responsible for his own death? Very likely.

    We can each give Mr. De La Cruz all the latitude in the world – "he was young and perhaps foolish", "who expects a transplant when you're that young", "he thought he could wait for health insurance" – but in the end, don't those look more like excuses than anything else? He most definitely made a decision which led him to his end – as surely as a drunk driver trying to beat a train at a crossing contributes to his/her own demise.<q>Yet, the right doesn't want this safety net to exist.</q>You'll have to forgive me if I've missed it in my reading of RWN, but I don't really recall any regular (and credible) poster here saying categorically that there should be no safety net like Medicaid or even Medicare. I have read many comments critical of how those programmes are administered, and how they have been administered over a long period. But I don't recall reading any comments saying that the "right" wants to get rid of the public safety net altogether. Personally, I'd like to see the safety net only be needed rarely, much as Mr. Obama thinks that abortion should be rare. But unlike Mr. Obama, I really mean what I say.

    I do have a question for you, though. If insurors are mandated to accept pre-ex, how exactly do we deal with the large numbers of Americans who will chose to go without insurance until they get really sick, and then sign up for insurance after they're ill? So the insuror gets the "benefit" of taking on every big ticket expense without the "burden" of having to collect premiums for that person to help defray the cost of the big ticket expense. The whole idea of insurance, public or private, rests on a shared risk model – throwing mandated coverage of pre-ex throws a pretty big monkey wrench in that model, so much so that it would very likely break the model. Of course you could fine people for not having insurance – I think Sen Baucus' plan would levy fines up to $3800/yr – but isn't that just a faux tax hike of up to $3800/yr? Or you could have a National Health Service, with all the joys that entails. None of those are solutions which I think are acceptable, and a lot of people agree with me.

    But the bigger question is: if the government is mandating companies to run their businesses a particular way which is economically unsustainable, and mandating citizens to buy something they don't necessarily want, or forcing them to fund it through their taxes, where exactly is the freedom in that system, again? Oh, wait, I see now, there is none.

    I'm all for the government improving the public options we have. I'd like to see them start by fixing Medicare. If they can prove to us that they can actually fix Medicare so that it won't go bankrupt, then we have a reasonable basis on which to discuss covering the rest of us. But until then, we're being sold a pig in a poke, and I have no confidence whatsoever that they can accomplish what they say they will without seriously damaging the health care delivery system in this country and imposing huge tax increases on us all.

  • Mike_M

    The story begins and ends when De La Cruz chose not to be insured. Like most young people, he though he was invincible and didn't even bother to buy a catastrophic coverage policy which would have been available to him at an affordable price.

    See, the problem with denying pre-existing conditions is that everyone would be like De La Cruz. Why pay for insurance when you're healthy? Just wait until you have a serious illness or injury, then go out and buy it. Plop down a few hundred bucks a month and get a million dollar transplant. Well, if everybody did that the insurance industry would not work. Or the price of your premium would be equal to the cost of your medical bills.

    All you liberals that want free insurance and no restrictions keep forgetting that the money has to come from somewhere. We all feel bad for De La Cruz, but if everybody waited until they were being wheeled into the operating room to buy insurance the system wouldn't work for anybody.

    This story should be a lesson in personal responsibility and the realities of health care. If this guy had bought a high-deductible catastrophic coverage plan when he started work, he would be alive today.

  • http://wastingtimewithalex.com/ AlexinCT

    Liberalism is again seeking to protect people from their own stupidity, and this healthcare debate is more of the same. We have to fundamental problems here. The first is about freedom. We want the freedom to make choices it seems, but some people seem to get pissed and demand others pick up the slack when their choices prove not just wrong, but have bad, or real bad, consequences. I got not just health insurance as soon as I was on my own, but bought long term disability and other such medical coverage. I have had a very large term private insurance plan since the moment I got married 20 years ago that leaves my wife a boatload of money should something bad happen to me. My friends continuously told me I was stupid for spending my money on this crap when I was young. While most of them did fine with these choices, some of them are no longer laughing though. A couple of my friends had medical trouble when they had no insurance. One was lucky to get coverage after the fact, for a lot more money I should add, and now preaches about getting coverage all the time. The other was not so lucky, and is up to his ears in debt. Another died a year ago and because he felt he didn’t need to “waste” money on insurance beyond what he could get from his job, left his family much less well off than they should have been. And I have several friends that are now looking at long term care or personal insurance policies and such things and freaking out at the cost because they are jumping in so late.

    The fact is that insurance is a system that uses a group of people to mitigate risk. When some people decide they will not join and pay in early on or until they need it, they are going to either break the system or need to pay more to catch up. I prefer they have the freedom of the choice, but I do not feel much sympathy if they opt out and then don’t like the deal. Frankly, I would think the quickest and easiest solution to the problems that the left keeps dragging in to play on people’s feelings – be it the whole debate about not getting insurance for pre-existing conditions and the high cost of medical care if you can’t get insurance to the false claims that a government takeover would lower cost without drastically lowering access and quality – is to create the concept of a mandatory stepped catastrophic coverage policy.

    The basic and cheap plan would come from government – which can collect cash for it through some tax – and provide the crappy quality you expect there. It would likely cost a fraction of what a complete takeover would cost making it palatable. Better options that give expanded and more extensive coverage would be available for those that choose to pay for those plans. These plans would cover any incidents or annual expenses that go over a certain limit, let us say $10K a year (but this could vary up or down depending on how much the costs for the plan is), for individuals. People would have the choice and be left to figure out how to cover themselves for the other stuff and the basics. Of course to make this work we will also need to drastically curtail the ambulance chasing make-work programs for lawyers that exist today, amongst other things.

    I doubt we will ever see anything like this however, because the collectivists don’t really care much about insurance or helping people, they want the power that they would get from funneling the healthcare money and decision making through them (government), and the insurance companies are not want to change something they have now that is working for them because of the risks involved. But barring a change like the one I detailed above to the healthcare system, I prefer to keep what I have now, period. Practically every problem with health insurance right now can be traced back to some decision or action by someone in government, and I will be damned if I reward them and shoot myself in the foot by handing this over to them.

  • D-Vega

    If there was a public option, he would be alive today as well.

  • Mike_M

    "If there was a public option, he would be alive today as well."

    No vega, if the health care bill had been in effect De La Cruz would have been fined for going without insurance. Why do you think that fine exists in the plan? It's to keep people from doing exactly what he did: foregoing insurance until they get sick, whereupon he would roll on into a government office and pick up his public option insurance.

    Even the government is smart enough to know that's unsustainable. So why do they mandate coverage but want to deny exclusions for pre-existing conditions? Because the government has unlimited money and insurance companies do not. This is direct evidence that the government intends to strangle private insurance and eventually force everybody onto the public option.

    Obama and the Dems know their own plan won't work as advertised, but they don't care because the goal isn't providing people health care. It's shackling them forever to the government.

  • D-Vega

    You are talking about the "bill", Mike.

    I am referring to the public option. That is, a health insurance safety net for people who don't or can't afford private insurance and have life-threatening diseases.

    It's not about "shackling" anyone to anything. Your rhetoric doesn't match the facts. If you want private insurance, then go ahead.

  • http://conservativebootcamp.com martinhale

    "If there was a public option, he would might be alive today as well.

    Your statement needed one small correction. Having a public option is no guarantee that a)a suitable donor organ would have been available for him in time, b)that the public option plan would have absolutely no restrictions on procedures covered or lifetime caps on payments for things like anti-rejection drugs, and c)that he even would have survived an operation with a high mortality rate.

    None of those are a certainty, so casually saying that he would have survived is perhaps not accurate.

  • tblrk2006

    If you want private insurance, then go ahead.

    Posted by D-Vega

    2009-09-09 14:31:39

    Not if I plan on making any changes or adding anybody to it. Illegal. The end game, vega, is to have everybody on the govt list at some point. Thats why its full of punishments.

  • tblrk2006

    None of those are a certainty, so casually saying that he would have survived is perhaps not accurate.

    Posted by martinhale

    2009-09-09 14:36:21

    And given the current demonstrations we have in Canada and the UK its not probable.

  • Mike_M

    "It's not about "shackling" anyone to anything. Your rhetoric doesn't match the facts. If you want private insurance, then go ahead."

    Unfortunately vega, there's another 999 pages of the Obamacare bill in addition to the public option you want. Those 999 pages appoint a Health Care Dictator (Commissioner), cripple the private insurance industry, establish a vast new network of mandates and regulations over every aspect of the industry, and ultimately give the government power over life and death.

    I'm actually for some form of a health-care safety net for the truly disabled, and in favor of reasonable means to assist the poor. But you liberals aren't content with just getting people health insurance. You need sweeping power over every man, woman, and child that goes to see a doctor. And power over the doctor too for good measure.

    Tell Obama to get his boot off of our faces and maybe we can find common ground. As long as he keeps pushing his facist health care bill, screw him.

  • http://wastingtimewithalex.com/ AlexinCT

    If there was a public option and someone in the government did not like Mr. De La Cruz for whatever reason, he likely would have been stalled until he died.

    That's what government gets you.

  • http://wastingtimewithalex.com/ AlexinCT

    I am referring to the public option. That is, a health insurance safety net for people who don't or can't afford private insurance and have life-threatening diseases.

    Funny how the vast majority seem to be unable to "afford" the insurance until they need care though, huh Vega?

  • http://conservativebootcamp.com martinhale

    "The courts are beginning to be inudated with such cases nation wide."

    Inundated? Really? Boy, I'd like to see some hard data to corroborate your statement. Inundated? Is that like a couple of hundred cases per state? Inundated.

    Are you sure you weren't just engaging in some good old-fashioned hyperbole? It's OK if you were, we understand. You can tell us.

  • D-Vega

    Funny how the vast majority seem to be unable to "afford" the insurance until they need care though, huh Vega?

    Just because they need care, and get insurance, doesn't mean they can afford it.

  • D-Vega

    I'm actually for some form of a health-care safety net for the truly disabled, and in favor of reasonable means to assist the poor.

    Then why aren't conservatives, or at least Republicans, offering an alternative for a public option?

  • Mike_M

    "Then why aren't conservatives, or at least Republicans, offering an alternative for a public option?"

    They are vega. You're just too blinded by Obama's aura to pay attention.

    For example, Sarah Palin.
    http://online.wsj.com/article/SB10001424052970203

  • http://wastingtimewithalex.com/ AlexinCT

    Just because they need care, and get insurance, doesn't mean they can afford it.

    I bet that if they had gotten the insurance before they needed it, they would be paying a lot less, and very likely to afford it. Unless it is my fault they are hurt, I want a choice in the decision to use my money to help them. Especially when that money would have allowed me to help my family instead on other things.

    There is a reason that collectivist utopias are all sh*tholes. When you try to give everyone everything, nobody gets much of anything, and more importantly, most people feel obligated to a lot more than they deserve considering what they contribute (which will practically always be just the minimum to avoid trouble). If you feel an obligation to help all the people in need do so. But do not use the power of government to force me to do so too when I do not want to. You are not being a good samaritan when other people bear the burden, you are more likely a crook.

  • D-Vega

    Man, you have some deep questions, martin.

  • D-Vega

    For example, Sarah Palin.

    Talk about auras, Mike. We used to call that hanging on her bra-strap.

    Palin has no new ideas, she is just parroting what some other conservative thinktanks said.

    I asked specifically for a public health insurance alternative. Not a review of what conservatives have been aiming at for the last 20 years.

  • aharris

    You mean something like this: http://thomas.loc.gov/cgi-bin/query/z?c111:S.1099

    De la Cruz should have bought insurance when he felt he did not need it, and if he couldn't afford it, then he should have explored his options prior to getting sick.

    It's like this, no one ever thinks they're going to have that catastrophic crash in their car either, but we all have insurance against just such an occurence. I haven't even had a traffic ticket in my life, but that doesn't mean I'll never need car insurance. Case in point, there was a head-on collision on our street. One of the cars went completely out of control and rammed the neighbor's van, shoving it into the side of their house, before continuing on down the hill to total my car where it sat in my driveway. Thankfully, I had insurance to help pick things up until the other driver's insurance could recompense, but it would have been ugly had one of us not had insurance. What company in their right mind would pick someone up as they were making a claim that required more payout than they had paid in?

    And, the reason we don't want to see more of a government "safety" net for health care than already exists is that the two entitlements we have are broke and they deliberately undercut the real costs of care when they pay out. Doctors are shorted on pay and paying more in administrative costs thanks to the government entitlements. There is no way adding a third massive entitlement will increase the pay doctors get for their services or reduce administrative overhead costs. The CBO says as much.

    At some point, people are going to have to face up to the consequences of their poor choices, including the choice not to have insurance. It isn't anyone else'e fault that people think it a wasted expense right up until they need it, and no one should be forced to pay for the stupidity of those people.

    Besides, even if there was a public option that would have extended to cover de la Cruz, there is no guarantee it would have deemed a transplant worth covering in his case. If the operation is riskey enough, the government might have felt that the painkiller was the best option.

  • http://PatriotPost.US bthewolf

    If there was a public option, he would be alive today as well.

    Posted by D-Vega

    2009-09-09 14:01:30

    Right because there is no chance in hell that some panel won't decide it's too expensive to pay for the surgery!!!! Just like there's no chance that some panel would tell a mother her premature baby was too expensive to raise, and there for let it die despite signs of strong life!!!!

    Spare us all the BS, Vega, you're not clever enough to sell it. Leave that to your Messiah.

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  • jimb123

    I feel truely sorry for Mr. De La Cruz and his family.

    This reminds me of the last time I was hit by a driver who didn't have insurance. The guy's reponse to the cop was "um, I'm on my way to Rodney D young right now" (Rodney D Young is an insurance broker here in St Louis who sells coverage to meet min state requirements for those who don't have the insurance). The officers comments were "How were you planning to get there – you are going the wrong direction?".

    Sad to say my rates still went up.

    To the libs out there – as we have mandatory auto insurance in most states if one chooses to drive (I know that some choose to drive uninsured) do you support mandatory health insurance or face a fine (which would amount to a de-facto tax increase on those people)? How would this be enforced? What about those in the underground economy who might not be as honest in regards to their income?

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