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.
But liberals are not the only people who fantasize that our health care resources are unlimited. Republicans have accused the Obama administration of plotting to set up "death panels" to ration care for seniors. Former Lt. Gov. Betsy McCaughey of New York called the House Democratic health care bill "a vicious assault on elderly people" that will "cut your life short."
Republican National Committee Chairman Michael Steele has taken the same tack. After the administration proposed modest reductions in the growth of spending on Medicare, he did an impersonation of John Edwards.
"We want to make sure that we are not cutting the Medicare program," Steele said. "Anytime you get a body of individuals that go beyond me and my doctor who are going to make decisions about what kind of health care I get, that's rationing of health care." But as long as someone else has to pay for those decisions, someone other than doctors and patients is going to make decisions about what treatments are worth the cost.
As it happens, Washington is not about to get stingy with seniors. The cost constraints in the health care bills moving through Congress would trim total projected Medicare outlays by only 3 to 5 percent over the next decade. A cut of 5 percent in 2019 spending, however, would leave it 80 percent higher than this year.
Ten years from now, even with such "cuts," seniors will have more and better medical options than today. Yet Republicans act as though everyone over 65 will be herded onto an iceberg and pushed out to sea.
What left and right have in common is the delusion that when it comes to medicine, nothing succeeds like excess. But no health care measure can alter the fact that our resources are not unlimited. We may not want to hear it, but no matter what kind of insurance system you have, sometimes someone has to say "no."