The death of 17 year old Nataline Sarkisyan while waiting for Cigna Insurance to change it’s position and approve a liver transplant is a tragedy.  The death of any 17 year old is a tragedy.  But tragic outcomes do not murderers make.

The Sarkisyan family is represented by a lawyer named Mark Geragos.  Mark is a well know lawyer, though belied by the ugly detail that his clients seem to consistently do very poorly.  He’s  making headlines claiming that Cigna should be prosecuted for murder.  He’s good at making headlines.  He’s good at being on Larry King, though he had gone largely underground following his Scott Peterson fiasco and the inexplicably horrific representation of Winona Ryder, a case that any rookie PD could have handled better.

This situation presents another example of why important issues that become entwined with terrible tragedies end up producing confusing and, usually, unhelpful discussions.

There are two significant, and conflicting, interests at stake here.  The first is the more obvious.  Insurance companies, despite their cries of poverty, are raking in extraordinary amounts of money, paying their CEOs astounding bonuses, and cutting back fees or stiffing health care providers regularly.  It’s extremely difficult to ignore this when assessing the virtues of health insurer decision-making.

The second consideration, however, is sometimes overlooked.  In spreading out resourced, insurers are supposed to make the best use of resources for the broadest range of people possible.  In other words, if it approves a million dollar procedure, that’s a million dollars that becomes unavailable for prenatal health care for poor women.  It’s the allocation of scare resources, and due to the ever-growing universe of high-risk, low-success and mind-blowingly expensive procedures, providing the “chance of life” to one person means denying the routine care needed by many.

Given the cost of health insurance, there are many people who view it as a huge well from which they are entitled to dip at any time for any reason.  Some people want MRIs at the drop of a hat, and somebody has to pay for those MRIs.  You know that the CEO of Cigna can afford it.  Can we afford to pay for every whim, no matter how unlikely or inappropriate a last-ditch procedure may be?  We hate to see anyone denied any chance at survival, as it offends our humanity.  But would we give up our own health for it?

As I said, the second consideration would hold far more weight if it wasn’t burdened with the fact that insurance companies are siphoning off so much of our health care dollars into their own pockets.  They are, in my view, piggish.  Whether they require regulation is a political matter, as is the whole issue of whether it should be taken out of the sphere of profit-making altogether. 

But back to Mark Geragos, trying to milk his return to the limelight for all it’s worth.  I’m not qualified to say that a liver transplant was not the absolutely proper treatment, and that Cigna initial denial was not improper at all.  And I am certainly not one to defend insurance carriers’ callous treatment of its insureds, or health care providers for that matter.  But while calls for a murder prosecution may make for a great headline for a lawyer inclined to grab whatever he can get his hands on, I fail to see how the concept of criminal liability squares with the concept of risk assessment.

Perhaps the tragedy of Nataline Sarkisyan’s death will spur action to provide a more rational distribution of health care, guided by acceptable cost-benefit analysis rather than arbitrary knee-jerk refusal to pay a dime more than an insurance carrier believes it can get away with.  This would be a good think.  A murder prosecution, on the other hand, will just make matters worse, putting yet another weapon in the carriers’ arsenal to blame the legal system for all its problems and jack up premiums for the rest of us while still skimping at every possible turn.  Because that’s what insurers are supposed to do.