Pro-Life Healthcare
I came across an excellent essay on Busted Halo, written by a young mother dealing with the healthcare system in Texas during her pregnancy. I’m more accustomed to arguing from principles and statistics, but the human story really is more powerful. This is a young woman who wanted to be a stay-and-home mother, and so relied on her husband’s single income. His employer-based health insurance turned out to be extremely expensive, and would have eaten a third of their income. So they shopped around for cheaper alternatives on the individual market, and found one…or so they thought. For among other things, this plan did not cover maternity care — prenatal care, prenatal lab tests, labor and delivery, or postpartum care. The woman was on her own, swimming in a sea of sharks.
What does pregnancy cost? Perhaps in the range of $20,000? This woman said it cost the same as a new car. What does an abortion cost? Something like $450. What kind of society would ever want to present women with these kinds of “choices”?
Today, pregnancy is considered a pre-existing condition, and the individual market won’t touch it. The Affordable Care Act will make two key changes. First, there will be no more discrimination based on pre-existing conditions. Second, the basic package on the individual exchanges will cover maternity care. This is pro-life reform. This is pro-family reform. It would be nice to hear the people who claim to cherish these things to acknowledge that every now and again.
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My recommendation to her? Go to a midwife!!! For other women? We need reform. I don’t even like what was passed. We need a single payer system. As of now, I will be required to have health insurance, which I cannot afford to buy. We need serious change.
Pregnancy as a pre-existing condition is not a new phenomenon. The timing of my second son (in the mid 1990s) was driven by exactly this. We wanted to have another baby, but the health care plan we had at Purdue treated pregnancy as a pre-existing condition. Since I had a temporary job and was looking for another position, we wanted to make sure our baby was born before we left Indiana, because we were afraid the insurance at my new job would also treat pregnancy in the same way.
Where I am in Texas, maternity costs (doctor and hospital, sonograms, etc.) for self-pay patients run about $10,000, but that’s the cost with no complications and with the self-pay discount, which you only get if you pay everything up front and have a zero balance upon leaving the hospital. The costs are much higher if you have to go on a payment plan and therefore lose the discount.
I tend towards market-oriented solutions in general, and thus would strongly oppose single-payer. But I also strongly oppose the current system, since it also is not market-oriented in the sense that it does not empower the consumer of healthcare services, but makes him subject to middlemen who, having already taken his money, get to choose whether or not to spend it on him when at some particular time, he had need of care. It goes without saying their incentives are mostly in the wrong direction!
I think some kind of market must be preserved because price-signals need to be transmitted without distortion. Otherwise we pay too much for X and not enough for Y, and get gluts of things we don’t need and shortages of things we do. You can’t violate the laws of economics for long without creating such problems; they’re among our current problems in fact.
But I don’t see that as incompatible with government assistance of some kind, and particularly for the infant, the elderly, and the poor. (Most particularly for the infant.)
Just as a possible proposal, I can envision a system in which all health care expenses for a pregnant woman and a newborn child are reimbursed by the taxpayers at the following rates:
For the pregnant woman: (10 times M)% of the cost of care, where M is whichever month she’s in. (1st month, 10%; 9th month through delivery, 90%.)
For the child: (90 – (N * 7)) percent of the cost of care, where N is the age the child will turn on his/her next birthday. (2nd birthday, 76%; 10th birthday, 20%.)
…or some such thing. I’m not wedded to the particular numbers, except that I think it important to never reimburse 100% lest all incentive to shop around vanish.
But the principle is an overall pro-life one: Keep market forces in place by encouraging purchasers to shop around a bit (thus transmitting price-signals), but encourage childbearing in opposition to abortion by making children less ruinously expensive to have.
Our daughter is having the exact same trouble with Blue Cross and Blue Shield of Alabama. It is a personal policy, not one associated with an employer, and most routine things ARE NOT COVERED. (Going in for a cold, or or getting a flu shot, isn’t. Going in and being hospitalized for something like pneumonia is covered.) BUT, when shopping for a policy, she checked, and had us verify, this policy came with having pregnancy COVERED!
Some things are, some things are not, she has been very frustrated between the doctor’s office and the insurance company’s “approving procedures.”
Wow, am I glad to live in Canada!
What kind of insurance do most university students get in the States? (Meaning, of course, the ones not covered by their parents plans.)
We’ve been over this quite a bit, but a review never hurts.
a) Most financial and poverty experts believe that spending over 10% of a family’s income on health care is difficult to manage financially and likely to induce poverty. The median family income is around $45K. I don’t have the 80% number off hand, but for arguments sake, let’s call it $25K. Taking 10% of those two numbers, you end up with a $2500-$4500 range for health care expenditures. A standard family policy runs about $12K per year in premiums with upwards of $5K in out of pocket expenses. In other words, popular believe is around 300-500% away from reality. Reconciliation won’t happen until people start working with reality.
b) Birth and delivery run around $10K on average. Given this and the prime demographic for having children still being women in their twenties, we are now at the point of 40+% of pregnancies being covered under some government program. There are programs in various states set up to specifically cover pregnancy and well-born care.
I really think Americans only put up with this because they think the rest of the world is worse – simply because they are told it is.
I left a comment over on her article to this effect yesterday, but as RCM also points out, one of her best bets being in Texas would be to look into doing her prenatal care and delivery with a midwife via a birthing center or homebirth. My wife and I paid for three homebriths in Texas out of pocket, and though it was expensive (in the realm of 3k) it’s not nearly as prohibitive as going to a hospital and you get much more personal attention.
Clearly, there are a couple big problems here, where you look at it from a statist or a market perspective. Among these is:
- The structure of our private insurance market (as it’s currently regulated and taxed) has encouraged medical facilities to push the cost of care sky high. There’s no good reason why a perfectly normal pregnancy and delivery package should cost 10-20k, but the combination of regulations and incentives we have right now pushes things in that direction. (Nor does Obamacare do much about that other than trying to pay for people to participate in the current system. Though in the short term, this would be enough for this author and many others like her.)
- Most Americans are trained to shop for health insurance in a very backward way, and regulations on what insurance has to cover backs this up. People routinely look to see if they will have to pay $20 or $30 out of pocket for a doctor’s visit which will be billed at perhaps $120 and consider that one of the main aspects of affordability. The big question is, what happens if you have an expense of more than a couple thousand dollars. At least as of 7 years ago when I was looking for a personal policy while between jobs, it was possible to get coverage in Texas pretty affordably which would cover maternity with a $2-3k deductible — but a lot of people didn’t want that kind of coverage because it didn’t cover much of anything until you’d spent your first 2-3k for the year.
- This also underlines the human cost of the decision on the part of the congressional Democrats to design a health care bill in which all the expensive parts were phased in after Obama’s re-election and half way through the financial window the CBO was using. There was really no reason (other than these cynical political concerns) this author couldn’t shouldn’t have the 2014 options available to her now.
You are quite right that the costs of privaet insurance is out of control, and that the structure of the private insurance market makes it worse. Everybody focuses on Medicare, because the costs are visible in the government budget. Nobody focuses on private insurance, which is growing quite a bit faster. Why? Because the true costs are hidden, and come in the form on lower wages.
Grappling with the delivery system is going to be increasingly important, irrespective of what the insurance market looks like. It’s time for doctors to start drawing a salary, or pooling resources Mayo clinic-style, instead of having compensation tied to quantity of treatment. The Affordable Care Act actually has a nunber of “wonky” experiments to reform the delivery system. They are small-scale, but some experts are quite excited by them – see the analysis done by Peter Orcszag last summer.
Despite the gravity of cost escalation, this is still of secondary importance to the problem of access – the inhumane rationing based on cost, the scandal of uninsurance and underinsurance, the bankrupting of millions, and yes, the existence of private sector death panels in places like Arizona.