Today, let me share my thoughts evoked by a recent patient story that has been weighing on my mind.
The patient's name is Carole Tayler, a Tennessee teacher in her 40s and mother of two, as in the photo.
Unfortunately, she has stage 4 lung cancer. After some failed therapies, surgeons at Vanderbilt University Medical Center (VUMC) offered a double lung transplant (DLT) as her only hope (as long as the cancer remains in the lung). Luckily, the surgery got approved by her insurance company, Cigna. Also, a donor’s lung was found!
This is when this photo was taken, as they came to VUMC for the surgery excitedly, just before Thanksgiving.
Cigna's Despicable Act
Then, Cigna did an unthinkable thing. As Carole was prepped in the OR, they told Carole that the surgery approval was a mistake! Guess what VUMC did after that? They canceled the surgery and sent poor Carole home! Wasting the precious donor lung and dashing her hope of DLT would save her life…😭
A reporter friend of hers posted a plea to Cigna to reverse the decision on X. That’s where I found out about her. I joined the pressure campaign against Cigna along with thousands of people. Then, Cigna caved and said they would cover the surgery after all.
It was a victory by the people, but it still felt hollow to me.
Carole now must go back to the waiting list for a donor's lung while her cancer is spreading… She may not qualify for the surgery by the time she gets another lung. 😡
VUMC's Dubious Act
While Cigna was cast as the villain (as it should be), I also had a nagging question about VUMC. If they really thought the surgery would save Carole’s life and cared about her, why on earth did they cancel the surgery when the patient, the donor lung, and the whole staff were ready to go? Sure, I understand they’d prefer to get paid a large sum of money for the surgery, but does this even make sense under the circumstances?
A big ‘non-profit’ (this term is a joke, btw) hospital like VUMC must provide a certain number of charity care to justify not paying any taxes, anyway. Why couldn’t they think about using this resource for this kind of extraordinary situation? That would’ve certainly made VUMC a true hero?
I couldn’t help but wonder, if I were at her side as her advocate, I could’ve persuaded the doctors and administrators to do the right thing. Based on my experience, these people sometimes seem to require a ‘gentle reminder’ of their obligations and the bigger picture, beyond their bureaucratic processes... 😒
There were also questions raised by some doctors about VUMC offering DLT to Carole. The concerns are related to the immunosuppressant that is required with a transplant would actually help cancer and shorten her life. In any case, I sure hope the VUMC doctors spent enough time explaining the risks of the surgery specific to her, and it was her informed decision to go forward with the surgery.
The Fundamental Flaw of US Healthcare: Profit First, Patient Second
Carole's ordeal is emblematic of the fundamental flaw in US healthcare. No matter what they may say, our healthcare system's focus is not patient's health. Oftentimes, patients get caught between insurers and providers and suffer greatly, as both prioritize their own profits without considering their actions' impact on the patient's overall health (and on the public who end up shouldering the cost of uncoordinated, wasteful care, indirectly).
That’s why American's healthcare cost has skyrocketed ($4.4 trillion, or $13,413 per person, in 2022).
That’s why Americans' life expectancy has been going down in the last decade; even our healthcare spending keeps going up!
It's a deeply unfair system not only for the patients but for the whole American society. Patients simply cannot defend themselves against the industry that prays on patients' lack of knowledge, especially well, by definition, that they are sick! Every patient needs a strong advocate on their side.
US Healthcare, the 'Tapeworm' of the American Economy
Seriously, as long as the US spends almost 20% of the GDP on our extremely wasteful healthcare, there is no way we can invest in and tackle our existential threats, such as the Climate Crisis. In short, we're all doomed... aren't we? 😭
At this point, I personally believe the only way to reverse this sickening trend is to ban insurers and providers from making profits, if we can pull that off! (Obamacare already tried to control insurers, but it made things worse. The law requires the insurers to spend at least 80% of their revenue on patient care, but they actually don’t mind expensive, wasteful care as long as they pay just around 80% in total (Roughly 20% goes to their admin fees, such as executives' salaries)! The following year, they will surely increase the premium to cover all the spending, and their 20% (profit) will be bigger!
It's truly maddening, considering 41% of U.S. Households have some amount of medical debt, and about half of U.S. adults say they have difficulty affording health care costs1. I want the American people to know our current healthcare trajectory is absolutely unsustainable for the people and the government (and a bonanza for the industry). But we can and must take some actions to protect ourselves from becoming a victim of US healthcare (I will be talking a lot more about this soon!).
As for Carole, I just pray she will get the best possible treatment, and Cigna will pay for all her care without a fuss. I also hope she gets to enjoy her life with her beautiful children as long as possible... 🙏