As some of you know, a couple of weeks ago my wife gave birth to our first child (a boy). For anyone who’s already a parent, all I can say is: Now I get it. The first couple of weeks of my son’s life have been a whirlwind of pure euphoria, coupled of course with perpetual tiredness. I feel a strange urge to brag about him and have to restrain myself. Luckily, I have already told multiple coworkers to take me out if I ever show signs of turning into one of those dads who, unsolicited, whips out pics of his kids from his wallet. I used to be mildly annoyed by that type of thing. Now there is legitimate danger that I’m headed in exactly in that direction.
But beyond all the warm fuzzies about fatherhood, the past several months of my wife’s pregnancy leading up to the birth served as an education in what is wrong with our healthcare system, and specifically the enormous opportunities for morally corrupt behavior to ruin the system for everybody. (Thankfully, my wife and son are both healthy, I should make clear.) Sure, there are huge technical problems with American healthcare that can be corrected by the right policies. But over the past few months, the pregnancy and childbirth experience has helped illustrate the moral dimension of the issue. Here are just three broad examples, which some of our readers will undoubtedly recognize from their own personal experience, I’m sure…
– Pressure to test for everything. My wife is in her mid-20s and perfectly healthy. Statistically speaking, she is probably in the bottom 0.1% in terms in terms of pregnancy risk. And yet, over and over her original doctor scared her into what I can only conclude were a completely unnecessary number of ultrasounds and other procedures. During one visit, we expressed our preference to forgo a particular ultrasound after my wife had already had a bunch during her first trimester, to which the technician told us that our insurance company would not cover the rest of the pregnancy if we did so. I can’t find anyone who can understand how this would be possible, but in the moment we got scared (and neither of us is in the medical profession) and just went ahead with whatever she said. On another instance, my wife was strongly encouraged to do a supposedly standard genetic screening which, if it had detected anything, would have been followed by a more invasive amniocentesis (thankfully it didn’t). This was after we clearly told our doctor that because of our religious beliefs and we would not abort the fetus under any circumstance unless it threatened my wife’s well being. Of course, the economic incentive in these cases is clear: The doctor’s office and the hospital collect a hefty sum from the insurance company for each procedure (why the insurance company is willing to pay is a more complicated question that maybe one of our readers can help answer), and protect themselves from malpractice lawsuits in the very improbable chance that some test detects an issue. The cost burden is dumped on the insurer and the individual, economic incentives are warped, and the end product is massive waste and higher healthcare premiums for everyone.
– Our insurance company just being terrible at processing claims, to the point that there is no way that we can conclude that it’s entirely by accident. The economic incentive for the insurance provider (healthcare or otherwise) to make a mistake towards putting the financial burden on the policyholder, rather than itself, is huge. In order to correct these problems, you’ve got to not only be well-versed in what you’re covered for but willing to spend huge amounts of time on the phone. Such a clearly profitable strategy, and yet so corrupt and so destructive to overall economic welfare.
– Our collective aversion to natural childbirth. My wife discovered while she was pregnant that the World Health Organization has estimated (in 2010) that no more than 10-15% of pregnancies should ultimately require a cesarean section. Meanwhile, the US Department of Health & Human Services has estimated that 32.8% of births in 2010 in this country were via cesarean. My wife’s first obstetrician’s rate was somewhere in the 40%-50% range. Luckily my wife (once again, young, healthy and extremely low-risk) selected to give birth naturally. There was no cesarean, no drugs to speed up the delivery, no epidural, and no fetal monitoring beyond a hand doppler, all of which would have been extremely costly. The total cost for giving birth billed to the insurance company was a mere $2,500; we paid $250. Let me state very clearly, there are very legitimate reasons for these types of procedures. But they are clearly overused, and that overuse results in huge amounts of waste, not to mention adverse health consequences in some cases (for instance, a baby having difficulty breastfeeding as a result of an epidural or synthetic oxytocin).
I’m far from an expert on childbirth or healthcare economics, but this experience really opened my eyes. Something is amiss here, and from my perspective it’s not just the system’s widespread market failures, but the selfish exploitation of those market failures. Like I said, some clever technical solutions are sorely needed. But I’m not sure these problems will ultimately be solved if that type of selfish motive that is so rampant in the health care system isn’t ultimately extinguished.
2 thoughts on “Baby thoughts”
Dear blogger, this is a healthy event. Can you imagine if there is a disease situation like “chest pain”. This is a problem that like many other, can not be solved by legislation only. It has to have spiritual solution on the part of the consumer and provider though this sounds naive at the first glance . There is supposedly cost benefit analysis techniques to guide us but reality is not that simple. Recently credible analysis suggested that screening for prostate cancer is not cost effective. I doubt if this has had an impact on the way we practice. Change in this paradigm is not going to be painless. There is some inherent risks in health care for profit alone. Recently government has created Accountable Health Organisations (ACO) which incentivizes cutting cost and providing quality care. While these efforts have merits the problem is that practitioners are only motivated by profit alone. The premise is that insurance or Medicare should pay less and providers should charge more within certain disputable legal boundaries. Now imagine the entanglements of these sharp profit seeking minds. Some people think somehow consumer is going to get healthier with this arrangement.
Iraj Aghdasi, M.D.
Congratulations, my friend, on your healthy son! Although the delight of parenthood yet eludes me, tragic complications in a close friend’s experience of pregnancy and parenthood may give me another perspective. Put another way, your expression of concern following a wholly successful pregnancy are somewhat reminiscent of a wealthy politician telling his constituents that meritocracy is alive and well. On testing, in particular, I recognize that too much can be done, but I’m reluctant to chasten the many layers of risk management at play.
As far as caesarians go, I understand rates vary wildly between doctors, as you appear to be well aware. Do we know if this is also the case in other countries?
Speaking of other countries, it’s worth noting that most of the industrialized world controls profit-seeking behavior by nationalizing either health care or the payment therefor. As profit-seeking seems to be the root of most of your concerns, I’ll defer to Liz Lemon: “I’d like to go to there.”