Monday, July 27, 2009

A Word About Birthers

Ha! Made you look!

No, this post is not about those birthers. Saturday night I happened to catch Ricki Lake’s fabulous documentary "The Business Of Being Born”. I highly recommend it, whether you are an expectant mother or not, because it addresses a lot of what’s wrong with our healthcare system in this country.

Nothing highlights the problems of a for-profit healthcare system more starkly than when a woman gives birth. Women have been having babies since the dawn of the species; they’ve been giving birth at home, aided by experienced practitioners such as midwives, for thousands of years. Yet in the past 100 years, the trend toward hospital birth has escalated, and not always with good results. For example, the rate of Caesarian sections in America is an astonishing one-in-three births. This is off the charts, especially when studies indicate there is no medical reason for this level of C-sections.

Despite the movement toward natural childbirth in the 60s and 70s, today women choosing to give birth at home assisted by a midwife are not supported by our healthcare system. Many healthcare professionals seem to feel threatened by midwifery, despite the fact that midwifes have been bringing babies in to the world for centuries. Insurance policies don’t cover midwife-assisted home birth, and the medical lobby seems to treat midwifery with outright hostility.

This is despite all of the evidence that shows non-hospital births are both less expensive and have better outcomes. The American Prospect looked at this issue earlier this month:
Midwives like Bartlett are often the only option for pregnant women who are underinsured, as many in her state are. She's seen a growth in her midwifery practice in recent years, and many of the women who come to her fall between the gap of the privately insured and those who qualify for Medicaid. These women choose to enlist Bartlett's services (a bargain at around $3,000) rather than pay out of pocket for a hospital birth (around $8,500) or even the high deductible for their insurance plan.

Bartlett and her clients aren't the only ones who see the cost benefits of midwifery. David Anderson, economics professor at Centre College in Kentucky, has run the numbers and says that midwifery care could save us billions of dollars annually, without affecting quality of care (maybe even improving it). Anderson posits that if we increase the percentage of women giving birth out of hospital by 10 percent (currently at only 1 percent nationally) we could save close to $9 billion per year. He points to the difference in baseline costs for out-of-hospital birth -- a difference of more than $6,000 when comparing the average cost of a home birth to an in-hospital one. Another main cost reducer, according to Anderson, is the significantly lower rate of C-sections for out-of-hospital births.

It's not just the costs that are lower, according to these advocates. The outcomes are better too, which in turn, further lowers cost by reducing additional care needed by sick babies and mothers. Anderson adds that if CPMs are allowed to practice in all 50 states, competition will drive down prices for maternity care, since more women will have access to a low-cost alternative to hospital births.

This is just one of the many things that frustrates me about our whole healthcare reform conversation. Today I saw Congressman Jim Cooper on CBS’ Face The Nation, and all I heard from him was how much he supported covering all Americans, the need to make health insurance more affordable and make health insurance more available and to offer Americans a variety of different insurance plans. This is his idea of reform. It’s all about insurance and it’s not about healthcare.

That’s not my idea of reform. Health insurance companies are part of the powerful medical industry lobby that is basically dictating to women what kind of care they can have and where and how they can deliver their babies, despite the fact that it’s cheaper and safer to do it another way!

That makes me wonder: what other medical procedures are cheaper, safer, more effective, less traumatic for patients, etc. which we are denied access to by our medical gatekeepers? (Acupuncture?)

I don’t have the answers. I don’t know if this means we need to include some kind of health savings account component to cover things like home births and treatments not currently blessed by insurance companies or what. I just think if we’re talking about giving people choice, then choosing among a bunch of different insurance options isn’t really “choice” to me. I think our problems are bigger than just "choice." Our entire system needs to be overhauled.

If you’d like to learn more about the birth issue, a good place to start is the documentary’s trailer: