Will another bureaucracy be better?

Michael you act as if a public option is the only solution to this problem. A public option is not the only solution to the problem your friend's patient faces, and, in fact, it may not be a solution at all - a government option can, and probably will deny coverage in certain cases as well. It is likely that today your friend's patient can appeal the insurance company's denial, and it is likely the appeal can be "fast-tracked". If he does not have this option today, regulations can be changed such that patients have a recourse when coverage is denied. To answer your FB response, "The difference between non-medical people making treatment decisions in a public system vs. our current profit-driven system has to do with the fiduciary responsibility of the decision maker. In a public system, that duty is to the patient, rather than the company shareholder." I don't find your argument persuasive. Just because an insurance company has a duty to its shareholders does not mean that it cannot also have a duty to those people it covers. In fact, insurance companies do have that duty. All companies serve multiple stakeholders. And many insurance companies serve their customers and shaeholders well (a large percentage of people with private insurance are very happy with their insurance companies). Regarding the insurance company's denial of your friend's patients colonoscopy - I don't have enough information to determine if I would agree or disagree with the coverage denial. Perhaps there are alternatives to a colonoscopy for younger patients. Perhaps the body of doctors that make recommendations on pediatric oncology has guidelines that recommend against colonoscopies for young patients. Etc.