The Valley of the Shadow of Death Panels

I suffered heart failure back in September.  I had had a cough for some time but nothing more, and I figured it was a case of allergies run amok.  One morning I woke with breathing trouble and a fizzing sound in my chest, and went to the E.R., where I learned that my heart had given out.  The doctors were puzzled; I had no arterial blockage, just cardiomyopathy, an arrhythmia, and a low ejection fraction.  I was the walking dead; at any moment, my heart could have just stopped, and I would have been gone, much like Andrew Breitbart, who died of the same problem (Sudden Death Syndrome).  The doctors wanted to operate and place a pacemaker/defibrillator in my chest, but as I was so young (aged 47) and made it clear I was eager to avoid this, they opted for a wearable external device designed to do the same thing.

Made by the Zoll corporation, the Lifevest is a miracle of high technology.  It transmits a real-time record of the wearer's heart rate to the company, who then can supply it to your doctor.  It automatically defibrillates the patient if his heart stops.  Mine went into defib mode a couple of times but never had to shock me back to life, fortunately.

I suspected it would be pricey, and I had some fears of what the insurance would do, but the point was moot; the hospital was letting me leave only with that on, or with a pacemaker/defibrillator inside my chest.  They were not sending me home any other way; they could not justify taking that kind of risk with a man's life.

But the accursed insurance company can.

They have refused to pay the hefty price tag (thirty three hundred bucks a month, and I had to wear it for four months -- a price range ultimately determined by Medicare), even though my heart has improved quite a bit and I am out of danger.  I would have had a permanent pacemaker/defibrillator installed, with all the dangers and infections that go with it and with the device having to be replaced every ten years, had I not worn the Lifevest.  While it never brought me back to life, in no way do I regret the decision to wear it -- or pay for it.  I could well have died.

(I was religious about my diet and medication regimen, even though the medication made me horribly sick and still does.)

We appealed the decision up the chain of command at the insurance company, and are now in arbitration with the State of Missouri insurance bureau.  This decision will be binding, and if they rule in favor of Anthem Blue Cross, then I'll have an enormous bill I simply cannot pay.

What astonished me was the reasoning they employed to deny coverage.  They said that this was medically unnecessary.  It was unnecessary because, according to their guidelines, such a device is justified only in the event that a permanent pacemaker/defibrillator cannot be installed for medical reasons.  They said I was not qualified to receive a permanent unit because that requires six months of careful observation to determine the necessity, and I hadn't had six months of observation.  Now, a man with a heart that is about to stop hardly has six months to satisfy the insurers.  So I was supposed to hope I didn't die while waiting for Anthem Blue Cross to approve a permanent pacemaker/defibrillator I ultimately did not need!  My need was immediate, and I saved them a huge amount of money long-term by not getting the implant.  The whole point of this device is to protect you in the meantime.

Here is the kicker: the cardiologist told me that the insurers have all stopped paying any Lifevest claims.  Apparently there is an ongoing study that will determine how much the device saves the insurers, and they are refusing to pay until the study is complete.  Prior studies have shown benefits.

But I suspect there is more to the story.

I think I may have been death-panelized, more or less.  I strongly suspect that the insurers are starting to restructure, ending coverage for "unnecessary" medical procedures, unnecessary meaning that said procedures do not justify the costs to save someone's life.  Most Lifevest wearers are, I am sure, elderly, so this is the perfect thing to cut.

ObamaCare is, of course, dangling from a judicial precipice at the moment, and it may be overturned, but the insurance companies would have been foolish to wait to implement aspects of it until it officially took effect; the transition to legal compliance with the law would be most time-consuming.  They had to get started on it as soon as it was signed into law, and I am fairly convinced that the refusal to pay claims for Lifevests is a part of the transition to the new law.  It's the beginning of death panels, I am sure, and there are cardiologists who seem to agree.

Sudden death has the virtue of being completely unexpected - and therefore very cheap. Victims of sudden death will not have spent the last six months of their lives selfishly consuming all our healthcare resources. Likely, they will have spent that time earning money, consuming goods, and paying taxes. These patriots are doing what every healthcare policy expert agrees we should all do - to go directly from being productive citizens to six feet under. For sudden death is free, and if everyone did this we wouldn't have a healthcare crisis at all.

Furthermore, consider the kind of patient who receives ICDs [like Lifevest] Some of these, of course (probably less than 10%) are young individuals with some sort of genetic propensity for sudden, lethal arrhythmias. But by far, most people who get ICDs are older folks, generally in their 60s, who have underlying cardiac disease. These are people who, if their sudden deaths are prevented, will go on consuming large amounts of Medicare dollars for the maintenance of their sundry significant medical conditions, who will go on collecting monthly Social Security payments, and who, when the end finally does come (possibly a decade or more into their ICD-extended life) will do so in the classic American manner - in an ICU, supported by incredibly expensive machines, drugs, and medical professionals.

Oh, and the Obama health care law places a 2.3% tax on such medical devices.

Fortunately, my story had a happy ending, except I may still wind up owing considerably more than any of my cars is worth.  I am thankful to be alive, but will that be the case for elderly people on Social Security?  How many of them will end up dead because they can't afford this piece of equipment and the State has judged them not worth the cost?

Timothy Birdnow is a St. Louis-based writer.  His website is www.tbirdnow.mee.nu.