Clip 2 – Fighting for Coverage: One Patient’s Story
Health insurers love to advertise themselves as guardians of care, but the real story often begins when a patient’s life no longer fits neatly into a spreadsheet. In oncology especially, “coverage” isn’t a bureaucratic checkbox—it’s the fragile bridge between a treatment that finally works and a relapse that can undo years of grit in a month. The modern prior-authorization regime was sold as a way to ensure evidence-based medicine, yet it too often functions like a time bomb: once a trial’s follow-up window ends, the system treats continued survival as an anomaly instead of the goal. Immunotherapies like Keytruda have rewritten the rules of cancer for some people, turning terminal diagnoses into long, uncertain marathons, but insurance policy still behaves as if every patient runs the same two-year race.
When a stranger—usually a physician contracted by an insurer—can halt a proven therapy without hearing the patient’s history, it reveals a quiet transfer of power away from the exam room and toward corporate risk management. That imbalance is why public pushback matters: not because social media is ideal, but because sunlight is sometimes the only lever patients have against a process designed to be faster than outrage. A healthcare system that only restores treatment when shamed, while refusing to change the rule for the next person, isn’t practicing stewardship—it’s rationing by invisibility, and calling it care.
