American Way of Birth, Costliest in the World

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anitram

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Simply appalling statistics and can't even be justified with the "we have the best healthcare in the world" because when it come to pregnancy and maternal health, Americans do not, by a long shot.

Anyone who is pro-life - where are your voices on this?

http://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-world.html?hp&_r=1&

Like Ms. Martin, plenty of other pregnant women are getting sticker shock in the United States, where charges for delivery have about tripled since 1996, according to an analysis done for The New York Times by Truven Health Analytics. Childbirth in the United States is uniquely expensive, and maternity and newborn care constitute the single biggest category of hospital payouts for most commercial insurers and state Medicaid programs. The cumulative costs of approximately four million annual births is well over $50 billion.

And though maternity care costs far less in other developed countries than it does in the United States, studies show that their citizens do not have less access to care or to high-tech care during pregnancy than Americans.

“It’s not primarily that we get a different bundle of services when we have a baby,” said Gerard Anderson, an economist at the Johns Hopkins School of Public Health who studies international health costs. “It’s that we pay individually for each service and pay more for the services we receive.”

...

Financially, they suffer the consequences. In 2011, 62 percent of women in the United States covered by private plans that were not obtained through an employer lacked maternity coverage, like Ms. Martin. But even many women with coverage are feeling the pinch as insurers demand higher co-payments and deductibles and exclude many pregnancy-related services.

From 2004 to 2010, the prices that insurers paid for childbirth — one of the most universal medical encounters — rose 49 percent for vaginal births and 41 percent for Caesarean sections in the United States, with average out-of-pocket costs rising fourfold, according to a recent report by Truven that was commissioned by three health care groups. The average total price charged for pregnancy and newborn care was about $30,000 for a vaginal delivery and $50,000 for a C-section, with commercial insurers paying out an average of $18,329 and $27,866, the report found.

...

In most other developed countries, comprehensive maternity care is free or cheap for all, considered vital to ensuring the health of future generations.

...

Only in the United States is pregnancy generally billed item by item, a practice that has spiraled in the past decade, doctors say. No item is too small. Charges that 20 years ago were lumped together and covered under the general hospital fee are now broken out, leading to more bills and inflated costs. There are separate fees for the delivery room, the birthing tub and each night in a semiprivate hospital room, typically thousands of dollars. Even removing the placenta can be coded as a separate charge.

Each new test is a new source of revenue, from the hundreds of dollars billed for the simple blood typing required before each delivery to the $20 or so for the splash of gentian violet used as a disinfectant on the umbilical cord (Walgreens’ price per bottle: $2.59). Obstetricians, who used to do routine tests like ultrasounds in their office as part of their flat fee, now charge for the service or farm out such testing to radiologists, whose rates are far higher.

...

Despite its lavish spending, the United States has one of the highest rates of both infant and maternal death among industrialized nations, although the fact that poor and uninsured women and those whose insurance does not cover childbirth have trouble getting or paying for prenatal care contributes to those figures.
 
God bless America,
Land of the free
Best country in the world
Beacon of democracy

:slant:
 
There is so much that's depressing about the way we have babies in America. There may have been other threads about this in the past, but The Business of Being Born is another great one on the subject.

On the upside, there's a great little film about this woman Ina May Gaskin, who's made a career out of delivering lots babies with better outcomes than hospitals at a fraction of the cost. "Birth Story: Ina May Gaskin & the Farm Midwives" Official Trailer - YouTube
 
There is so much that's depressing about the way we have babies in America. There may have been other threads about this in the past, but The Business of Being Born is another great one on the subject.

It's obscene. Part of the spiralling costs of healthcare.

We paid cash for our second baby -- I was between projects and our health care had run out. What no one tells you is that when you're a cash patient, the costs drop dramatically. But we still were in debt for two years paying that off.

When we had our third baby, we chose to do a home birth (in part because my wife watched The Business of Being Born). Thankfully, we had a reasonably healthy pregnancy which allowed that to be an option. We were amazed at how easy it was to hire a doula, and how so many of the costs associated with childbirth went away.

Some friends had a baby born at 30 weeks; she was in the NICU for eight weeks. They had no health care insurance. The hospital worked it out with them, but the costs were still insane. Two years later, they still owe thousands of dollars.

Something has to be done about the cost of health care in this country.
 
The average total price charged for pregnancy and newborn care was about $30,000 for a vaginal delivery and $50,000 for a C-section, with commercial insurers paying out an average of $18,329 and $27,866, the report found.

We paid cash for our second baby

But we still were in debt for two years paying that off.

Two years later, they still owe thousands of dollars.

Absolutely appalling.

I haven't paid enough attention to the Affordable Care Act. From my understanding, it will ensure that Americans are not left without (private) insurance - will it help resolve this issue?
 
Absolutely appalling.

It was. I think we wound up paying half of that -- we got onto a different plan -- but even $15K was insane. I know that some churches and religious organizations have formed co-ops for their members, but it's all on an ad-hoc basis. Something needs to be done about the fundamental business model that undergirds the healthcare system; I'm not sure that even Obamacare addresses the core problem.
 
No, it doesn't. Part of the problem is that in the US we bill per procedure. So the more a doc does, the more they get paid. Financially speaking, a person who stays sick forever is an ideal patient. In the UK, as a counter example, they bill per patient and docs are financially rewarded for having good outcomes.

Also, of course, our model is for-profit, which Obamacare doesn't touch at all. It's notable that in countries with nationalized healthcare, they are scandalized and disgusted by the idea of for-profit medicine.
 
wow... that is insane...

i had all the bells and whistles when my first child was born, every type of pain relief ticked on my medical records from a TENS machine, pethidine, gas and air, epidural, morphine to GA lol - they nearly lost us both in the process, but the medical care was amazing and thankfully we didn't have to worry about the bill or cutting corners... i didn't have to pay a penny!
 
What is the point of this article? Do we need to address the costs of healthcare? Or do we just want to carve out another aspect of life that the government should take care of for us (i.e., other people pay)?

(I found it amusing that the couple first cited in the article - two professionals - purchased insurance, but obtained a policy that did not cover maternity care – how is that for planning!)

Let’s face it; we no longer live in a world of health insurance. Insurance is a method by which an individual can mitigate risk by spreading costs over time. We now get sucked into a pool of health care coverage. Increased regulation of health care through mandated coverage, among other things (malpractice coverage, extensive overhead, etc.), leads to the inane pricing structures quoted in the article ($4,000 to $45,000) as the costs of mandated coverage must be made up somewhere.

Costs of maternity care are really no different than the costs of other health care in the US. Until we shatter the current mindset (healthcare is good, more is better, someone else should pay), we will never resolve the issue.

Despite the high costs, I haven’t seen any evidence that people are traveling to other countries to deliver their child. To the contrary, we still seem to have people traveling to the US for maternal care.
 
does someone who gives birth in the Netherlands feel as if someone else has funded their birth, or do they feel as if they've paid into a system that guarantees access to all at a reasonable cost possible only when, like social security, the young and healthy pay for the sick and old (or the pregnant, or the unlucky, or the accident victims, or those with cancer) until it is their time to derive the benefits they have already paid for? why in the US do we have a mentality where we so dislike our fellow citizens we assume that any social service somehow comes at a direct cost to ME -- "on my dime" -- without any ability to empathize that, what if not but for the grace of God there go i?
 
does someone who gives birth in the Netherlands feel as if someone else has funded their birth, or do they feel as if they've paid into a system that guarantees access to all at a reasonable cost possible only when, like social security, the young and healthy pay for the sick and old (or the pregnant, or the unlucky, or the accident victims, or those with cancer) until it is their time to derive the benefits they have already paid for? why in the US do we have a mentality where we so dislike our fellow citizens we assume that any social service somehow comes at a direct cost to ME -- "on my dime" -- without any ability to empathize that, what if not but for the grace of God there go i?

i'm not in the Netherlands, but have lived in the UK and France, and benefited from national/non-private healthcare systems in both countries - in the UK it was different as the NHS stamps (health insurance contributions) were very low compared to France for example (we do pay a small fortune in France for full 100% reimbursed health cover, but it's been worth every penny)... i do basically pay into a system which guarantees us protection when me and my family need it, no questions asked - i feel very lucky to be able to benefit from that, and we have always had access very high quality healthcare, especially in France... it's a given over here that it's the active working population who are paying for the elderly and infirm... i hope it can continue, although it is worrying what with the current economic crisis...
 
given the US's size, diversity, and wild difference between, say, California and Mississippi, i wonder how a French or UK-style system would work here ... however, what baffles me is the resistance so many Americans seem to have about paying into a system from which all eventually benefit, even if unequally.

or, perhaps, the real danger with Obamacare and the hysteria on the right is that it will work, and it will become as wildly popular as Social Security and Medicare, two programs that Americans certainly love deriving the benefits from.
 
Just a couple of threads over, any regulation affecting a medical procedure is deemed "anti-choice".

Here, some have no problem denying an individuals choice to manage their own healthcare (I would prefer to carry catastrophic coverage and pay out of pocket for the rest) in favor of yet another big government program.
 
Just a couple of threads over, any regulation affecting a medical procedure is deemed "anti-choice".

that's an enormous distortion.



Here, some have no problem denying an individuals choice to manage their own healthcare (I would prefer to carry catastrophic coverage and pay out of pocket for the rest) in favor of yet another big government program.


why?
 
Just a couple of threads over, any regulation affecting a medical procedure is deemed "anti-choice".

Here, some have no problem denying an individuals choice to manage their own healthcare (I would prefer to carry catastrophic coverage and pay out of pocket for the rest) in favor of yet another big government program.

Honest question: do you feel that other 'socialized' services deny your ability, as an individual, to choose? Some examples include your local police department, fire department, library, etc.
 
does someone who gives birth in the Netherlands feel as if someone else has funded their birth, or do they feel as if they've paid into a system that guarantees access to all at a reasonable cost possible only when, like social security, the young and healthy pay for the sick and old (or the pregnant, or the unlucky, or the accident victims, or those with cancer) until it is their time to derive the benefits they have already paid for? why in the US do we have a mentality where we so dislike our fellow citizens we assume that any social service somehow comes at a direct cost to ME -- "on my dime" -- without any ability to empathize that, what if not but for the grace of God there go i?

Good points here. One thing you reveal, Irvine, (even though I know it's not your personal belief) is America's assumption that being pregnant and raising children is on par with being sick, old, unlucky, an accident victim or having cancer. Like it's fucking problem. One thing I hear pretty consistently from folks who have lived in the UK and Europe is that they don't have the same attitude that having kids is "your problem." It shows up in all sorts of social policies that support the notion that children are good and necessary for society, and that enabling parents to do a good job will benefit everybody in the long run.

And the answer to that question Gg, is yes. We pay out the nose to have babies just like we do everything else. We have the most expensive maternity care in the world with outcomes below every other developed nation. An average uncomplicated vaginal birth in a hospital costs something like ten thousand dollars, but a surgical birth easily runs into the twenties. A new parent caught uninsured will be paying that back to the hospital at a monthly payment for years.
 
Or do we just want to carve out another aspect of life that the government should take care of for us (i.e., other people pay)?
Why does every argument like this have to be simplified to "I want other people to pay for it"? If you are going to make the assumption that everyone, or at least most, on the other side of this argument just want the government to take care of their expenses, you're going to ruin any chance of a reasonable debate.

This isn't about the government bailing out people who have kids. That's a strawman argument.
 

I find that our current system (i) parses out healthcare based on actuarial tables and (ii) is overly pharmaceutical driven. When almost 70% of Americans take prescription drugs, there is something wrong with the system.

I visit a non-insurance doctor twice a year. The cost of the visits, blood tests and supplements are well below the cost of my contributions to a health care plan. My doctor is not constrained by accepted minimums and can make recommendations for optimal health. Add in healthy eating, regular exercise, minimal alcohol consumption, no drugs and avoidance or risky or thrill seeking behavior and I remain very health for someone who is almost 50.
 
Honest question: do you feel that other 'socialized' services deny your ability, as an individual, to choose? Some examples include your local police department, fire department, library, etc.

Very good question.

I really won't call those "socialized" services. Historically, police and fire are core services provided by any form of government. They provide a benefit to society as a whole rather than to the individual. We actually have similar elements within healthcare such as mandatory vaccinations.

Healthcare has traditionally been an individual responsibility. I don't see a cross over between the two.
 
We paid cash for our second baby -- I was between projects and our health care had run out. What no one tells you is that when you're a cash patient, the costs drop dramatically. But we still were in debt for two years paying that off.

This is a completely alien concept to me. I hadn't even considered it. What the fuck, America?
 
My doctor is not constrained by accepted minimums and can make recommendations for optimal health. Add in healthy eating, regular exercise, minimal alcohol consumption, no drugs and avoidance or risky or thrill seeking behavior and I remain very health for someone who is almost 50.

You are also a lucky person. Not everyone shares the same outcome.
 
Add in healthy eating, regular exercise, minimal alcohol consumption, no drugs and avoidance or risky or thrill seeking behavior and I remain very health for someone who is almost 50.

health isn't something we can take for granted though - you never know when you will need emergency or life-saving treatment... i think healthcare needs to be available to all as a safety net in those worst times of our lives... i've never planned to be ill, but have certainly been very glad to have good cover when i've needed it... a healthy lifestyle isn't always a guarantee of good health either... a friend of ours has just died from pancreatic cancer - he was really healthy - he didn't drink, smoke, did regular exercise - he died within weeks of being diagnosed, and had only recently retired - just one of those completely unexpected things...

i really would hate for any of my loved ones to be caught unprepared - being ill is bad enough, but being unable to cover the costs would surely make it a whole lot worse, i can't imagine...
 
I find that our current system (i) parses out healthcare based on actuarial tables and (ii) is overly pharmaceutical driven. When almost 70% of Americans take prescription drugs, there is something wrong with the system.

I visit a non-insurance doctor twice a year. The cost of the visits, blood tests and supplements are well below the cost of my contributions to a health care plan. My doctor is not constrained by accepted minimums and can make recommendations for optimal health. Add in healthy eating, regular exercise, minimal alcohol consumption, no drugs and avoidance or risky or thrill seeking behavior and I remain very health for someone who is almost 50.



much of this seems reasonable to me.

what happens if you get cancer?

i was in a freak accident a few years ago. i have medical insurance that i pay for out of pocket since like nathan i have a creative job, and i still paid easily over $10,000 getting to a recovery.

i (and i assume you, as a lawyer) have an excellent job where i can afford to shell out 5 figures if the need arises.

most people can't.

i've had catastrophic coverage only in the past as well. i once saw an out-of-pocket doctor for a full physical and while i was delighted with the experience and level of care, the bill for the physical and all the blood tests was over $700. now, i pay a $25 co-pay, but it's a rushed and hurried experience with a doctor who has no time to answer any questions at all. i'm quite healthy on the whole, and i'd almost prefer the $700 once a year rather than the $270 a month for insurance.

but then, i've been on the other side where someone else's negligence puts you in the ICU for a week.
 
i (and i assume you, as a lawyer) have an excellent job where i can afford to shell out 5 figures if the need arises.

most people can't.

I don't know how it is in other countries, but in the US the most common trigger for homelessness is a single episode of medical emergency that screws a person's finances so completely that they literally lose everything. One uninsured cancer or catastrophic accident is all that stands between most Americans and the shelter.

nbcrusader, I'm interested to know how a healthy population doesn't benefit society as a whole. I'm willing to admit that American medicine is deeply fucked- no arguements here- but in fact national health insurance works a lot like a fire department. Everybody pays. Not everybody uses it all the time, but everybody can rely on the ability to use it when they need it. Everybody benefits from the increased safety and is protected from the errors and mishaps of their neighbors as well as their own, whether it's a fire spreading from one house to another or controlling the spread of an epidemic.
 
I find that our current system (i) parses out healthcare based on actuarial tables and (ii) is overly pharmaceutical driven. When almost 70% of Americans take prescription drugs, there is something wrong with the system.

Absolutely agree. When people/companies can get rich from the very diagnosis they can give to someone - we are left to trust human nature to run its course, and we know how that usually turns out.
 
does someone who gives birth in the Netherlands feel as if someone else has funded their birth, or do they feel as if they've paid into a system that guarantees access to all at a reasonable cost possible only when, like social security, the young and healthy pay for the sick and old (or the pregnant, or the unlucky, or the accident victims, or those with cancer) until it is their time to derive the benefits they have already paid for? why in the US do we have a mentality where we so dislike our fellow citizens we assume that any social service somehow comes at a direct cost to ME -- "on my dime" -- without any ability to empathize that, what if not but for the grace of God there go i?


I haven't given birth, but here as far as I'm aware nobody feels anything like that. We don't even consider it, since it's the system as we know it that we all contribute to healthcare and those things are taken care of.

We don't share your mentality, at least not for the most part. Personally I would't want to pay for the diseases caused by lifetime choices(ie smoking, heavy drinking or morbid obesity), but we still do as it's the system. If we all pay our share, healthcare stays avoidable for everyone.

The entire point of insurance is that you HOPE you never need it. But we can never know this for sure, we don't know what lies in the future. Even the most healthy people can still get in accidents, or get cancer. Even if you minimizez the risks, there's still a chance. Sure, I bitch sometimes about paying for insurance I don't use. But then I think how goddamn lucky I am that I don't NEED to use it. It means I'm still healthy.
 
If I was paying into the system for health care I actually benefit from, I'd probably bitch less about the amount of my paycheck that comes out for it. A good chunk of money comes out every two weeks for my own health insurance, where I still have to pay good-sized copays and deductibles if something happens, in addition to the portion that comes out so the assholes I drive to the hospitals don't have to pay for 1) their ER visit for their sore throat or ear infection 2) the ride itself 3) the over the counter medications that would cure their non-emergent condition in thw first place. It could be the same amount of money under one name, it could be a slight bit more. If I didn't feel like I was getting penalized on te healthcare front for having a job, I'd be ok with that.

If I have my appendix out and I get a script for Percocet after the fact, I believe it runs me about 80 bucks with my "real" health insurance. I wanted to punt a woman through the 72 inch tv in her apartment who once called because she had her appendix out two days ago and "felt sore." I asked her why she didn't get her pain meds filled, and her response was because with mass health, it used to only cost a dollar, but with "obamas bullshit welfare state" (oh fucking irony), she now has to pay 3 dollars and why should she do that when she can go back to the ER and get more for free? She's far from the only person I've heard first hand express similar sentiments. I haven't been able to wrap my head around that one and see how the healthcare system here isn't broken.
 
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