Sunday, October 06, 2013

The price of a baby II

The previous post, unlike the baby, was premature.  More bills arrived.  Without insurance, it now looks like I would have been billed about $19,000 for a routine vaginal birth, including prenatal care.  With insurance, I ended up paying "only" about $2,000.  So I can't complain.  But I'll complain anyway, for the sake of the future of humanity.

First, it is interesting to compare these bills with those for the royal baby.

The bills are not designed to be understood by a human.  However, some clues led me to believe that the charges fell into three main groups.  The biggest charge was for the care of the mother during a non-negotiable 2-day hospital stay.  The next-to-biggest was the charge for the "delivery" itself by the OB/GYN, and I think this included the prenatal care visits.  The smallest charge was for the care of the infant, concurrent with the mom's hospital stay.

On occasion I have heard people blame "capitalism" for the high prices.  Their implication seems to be that the problem could be solved with some kind comprehensive legislation to limit how much hospitals can charge.  The anti-capitalist reaction saddens me in at least two ways.  First, I like living in a free country, and new regulations detract from our freedoms.  Second, price controls can have surprising and terrible side effects.

The system is complex, and no single step will fix it.  But many steps will fix it, and here is one clear step in the right direction:  deregulate drugs with potential use for birth.  By deregulate, I mean get rid of the laws that say you must have a doctor's prescription to buy the drug.  If this seems like too big of a step, here is an intermediate one:  Grant all certified professional midwives the legal authority to prescribe drugs for their clients.  Such authority is currently lacking in Pennsylvania, for instance.

Why is it so important to grant prescriptive authority to midwives?  Here is a brief sketch of the common-sense cascade of effects that would follow from such a policy change:
  • With prescription authority, midwives become more appealing to people who are on the fence about attempting a home birth.  Knowing that you can get the same drugs at home that are standard accessories in the hospital makes home birth much more palatable.
  • Consequently, more people would choose to attempt a home birth.  I'm not speculating about exactly how many more, but certainly more, and this change would likely grow over time, as people become more familiar with the new legal options.
  • More home births would directly lower the average cost of birth.  Successful home births typically cost $2-3k.  With new drug options, perhaps this would rise a bit, but it is still a major cost difference, such that uninsured Americans would give it careful consideration.  In fact, some people just prefer to have the baby at home, even with insurance.
  • Making home birth a more viable option means competition for hospitals.  When hospitals notice a fraction of their patients disappearing into the home birth system, this provides natural motivation for hospitals to find ways to be more affordable.


Anonymous dr perfection said...

I don't think a certified midwife has any training in the use of those drugs. Do you not think it is necessary to be trained in the use of those drugs including contraindications for those drugs and to have the training and equipment to treat untoward response to those drugs?

Not sure these drugs are suitable for home use by anyone but that could be something you might investigate before advocating use in an outpatient setting.

5:38 PM  
Anonymous dr perfection said...

for instance:

Pitocin can cause seizures, anaphylaxis, cardiac arrythmias, probably why it is regulated to hospital use

5:42 PM  
Blogger Freakwenter said...

I agree that many prescription drugs are risky, and that advice on their use from an expert could be beneficial at times. So I appreciate your point, as I suspect most people do.

Another thing to consider is that a $19000 hospital bill can cause many of the same side affects that you listed for Pitocin. Additional side effects may include poverty, major depression, or loss of life in pregnancies avoided due to cost. Thus, a hospital birth is not "suitable" to some people.

My preference is for people to have the freedom to make their own decisions regarding the most important things in life.

6:22 PM  
Anonymous dr perfection said...

Yes, and one can have poverty and major depression without a hospital bill.

You have so much freedom and you are blessed beyond belief. Be happy.

3:45 AM  
Anonymous sk said...

These side effects, hm, interesting. Never thought of it that way.

4:10 AM  
Blogger Freakwenter said...

@dr perfection, Yes and yes. But I assume that you know what it's like to be a perfectionist.

4:36 AM  
Anonymous dr perfection said...

but, honey, YOU gave me that name.

I know I have high expectations. It's a good thing for my patients.

2:51 PM  
Anonymous Kate said...

In this scenario, there is a great potential for a sudden rise of drug dealers acting as "certified midwives." But maybe that's a pessimistic outlook.

I get what you're saying. The system isn't perfect. Room for improvement, sure. But 2,000 dollars is pennies compared to some people's hospital bills. Congrats! We won't be paying anything this year for our birth (Medicaid and Obamacare--thanks guys). That is a blessing.

3:09 PM  
Blogger KTdid said...

Unfortunately, drugs are not the only problem. Read Stephen Brill:

"Stephen Brill wrote a cover story for Time exposing the parasitic economic practices behind the Healthcare Industry. This article reveals the truth behind the Healthcare Industry's 75% profit margin.

The healthcare industry does not abide by supply on demand because the customer is taken out of the negotiation. The ambulance driver decides the hospital, the nurses and doctors decide the equipment and the medicine and they handle the entire thing with a car mechanic's approach of finding extra problems that don't really exist. The "charge-master" sets the price for everything, and suddenly a 2-dollar hospital gown becomes 200 dollars but your insurance company gets a discount so it's only 100 dollars, you pay a deductible and think you got a good deal. Ambulance companies alone rake in more money than Hollywood.

Like every other industrial parasite growing in the united states, this is not a problem singularly regarding insurance companies. Every single health related industry also rakes in astounding profits (but not the people doing the actual jobs like doctors and hospital staff). The entire industry uses the health insurance companies as a vehicle to suck the funds out of the general population at a high enough level they don't notice the burden. Then the poor who don't have health insurance end up going bankrupt.

And, by the way--CONGRATULATIONS! Her grandmother showed me photos. She's adorable!

3:39 PM  
Blogger Freakwenter said...

@Kate: Yes, abuses could happen. I guess a broader question is how much should the government try to protect people from themselves, and at what cost. With regulating drugs, there is both a direct psychological cost -- the loss of freedom -- and then there is the material cost of not being able to get the drugs you want when you need them. Is it worth it?

And, intersecting with the comment by @KTdid, I'm really not complaining about having to pay 2k. Even a midwife birth is a good deal at 2k. The really big issue here, which is intimately related to the ongoing political debate, is how much society as a whole can afford to pay for healthcare. So far, people are typically proposing more an more regulations -- rules so that hospitals can't charge to much, and such, but I'm proposing something far simpler: just get rid of a few rules, and things will start to work themselves out.

4:11 PM  

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