If you've been following the health care debate over the last couple of years, you may have heard the grim tale of Nataline Sarkisyan. Just 17 years old, afflicted with leukemia, she needed a liver transplant, but the insurance company Cigna refused to cover the surgery. After being picketed by nurses and the family, the insurer relented, but too late: She died that same day. 
When he ran for president, John Edwards used the girl's experience as proof of the need for reform. Her parents went to Cigna headquarters to charge the company with killing their daughter to make money. Lately, a liberal group called Americans United for Change has used her in a TV spot to dramatize its claim that "if insurance companies win, we lose."
Her case is an excellent illustration of what is wrong with our approach to health care -- but not how Cigna's critics mean. The insurer declined to pay for the transplant because, it said, "the treatment would be unproven and ineffective -- and therefore experimental and not covered."
Nataline's surgeons disagreed, estimating she had a 65 percent chance of surviving six months with a new liver. But Dr. Goran Klintmalm, head of the Baylor Regional Transplant Institute in Dallas, told The Los Angeles Times the surgery was "very high-risk" and "on the margins." Even on the best prognosis, she stood a one-in-three chance of dying -- after undergoing a very expensive operation and taking a liver that might otherwise have gone to someone with a better chance of survival.
Maybe Cigna was mistaken. Maybe not. The problem is that the critics seem to imagine that once we crack down on insurance companies or go to a single-payer government health insurance plan, future patients like Nataline will get anything their doctors recommend.
They won't. No matter how we "reform" health insurance, there will still be close calls, where it's not clear that a costly procedure will actually do any good. There will have to be someone, either in government or in the private sector, to decide which operations and treatments should be covered and which should not. And there will be patients who will die after being refused.
Health care "reform" won't eliminate such incidents and may produce more of them. Despite all those greedy private health insurers -- or maybe because of them -- Americans get far more liver transplants per capita than the residents of Canada, France or Britain.
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