Response To High U.S. Birth Costs: You Get What You Pay For



What a quick point and counter-point! First, The New York Times published its latest feature on high U.S. health costs, headlined “The American Way Of Birth Is The Costliest in the World.”  It opens with the disturbing description of a pregnant New Hampshire woman whose health insurance does not cover maternity care, and who must shop around and haggle over each treatment and test. Ugly. Here’s a taste:

Midway through her pregnancy, she fought for a deep discount on a $935 bill for anultrasound, arguing that she had already paid a radiologist $256 to read the scan, which took only 20 minutes of a technician’s time using a machine that had been bought years ago. She ended up paying $655. “I feel like I’m in a used-car lot,” said Ms. Martin, a former art gallery manager who is starting graduate school in the fall.

Now, Slate has just published a riposte, headlined: Yes, Childbirth Is More Expensive In The U.S. But You Get What You Pay For. It’s the tale of two women, both doctors, who get pregnant, one in the U.S. and one in Canada. The subhead sums it up:

“The Canadian woman couldn’t get her first appointment for eight months, although it was free. The American got an appointment right away, but it cost a fortune.”

To wit: The American shelled out more than $12,000 for an ever-available OB. And by the way, the Canadian did manage to finagle some obstetric care earlier than the 8-month mark.

Readers? Which would you choose? I’m thinking neither system is sounding very appealing at the moment…

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  • samuelpepys

    This isn’t even a question worth asking, as the facts are widely known and easily google-able. France, in which humane advanced democracy I am sitting as I type, has the greatest longevity and lowest infant mortality rates in the world. The price of medical care for patients? Zero. That’s what we gave up when we gave up single-payer health care. We’re ranked #38 in the world by the WHO in heath systems (for responsiveness, cost, and population health) right below Costa Rica and right above Slovenia. Canada is #20, France is #1.

    • mumtothree

      I’m curious, what was the childbirth experience like in France? Estimate the size and position of the fetus by manual measurements, or run a high-tech ultrasound. Post-partum private room or maternity ward (4-6 moms and babies to a room)? All-in-one room labor-delivery-recovery or moved from place to place within the hospital? Space for fathers to “room-in?” Fathers able to attend pre-natal class? It’s an ordinary process, most of the time, so there is no reason to treat each mother-baby-father group as “special,” and provide a hotel-like private room. I gave birth (twice!) in a Scandinavian country in which I was covered by the national insurance. Let me tell you it was basic. I had complications with my first, and as a result they roomed me with only one other patient, who had had a Caesarian. I could leave the hospital when I felt ready, but if I wanted something (juice, clean linens) I got it myself from the closets in the hall. Number 3 was born in greater Boston – seemed like a luxury suite to me, treated me like a queen, although they were pretty anxious to push me out the door. If you wonder why it costs so much in the US, just look around at the level of services we have come to expect, versus the standard of care in other countries.

      • samuelpepys

        Wow, I see why you preferred the care in Boston! (But you are lucky you can afford it: many in Boston cannot, and Boston and Massachusetts are the gold standard for the US.) The care in France is much more like your experience in Boston. And the care for something I know more intimately, major joint surgery, is infinitely better (including weekly free massages for life after you heal!). That high standard for everyone is of course seriously under threat after the years of Chirac and especially Sarkozy, and it’s not at all clear that Hollande has the stomach to protect it. We shall see….

        • mumtothree

          And of course, even thought the out-of-pocket payments at the time of treatment may be small or nothing for most Europeans, at least in Scandinavia it’s a cost bundled in to the taxes. Health care, state pension, good public transportation, subsidized daycare, free university, there’s a footnote to every one of them. Minimum tax rate (on everyone, not just people who actually make some money) 50%. We were lucky, being “middle class” ours was only 62%. Gas currently $8.20 a gallon. If you bought a car, new or used, it cost from 110% – 120% in registration tax to put it on the road. In general, you start with the premise that what the government provides will be good enough for most people, and if you want something more, you can always purchase it on your own. Most countries have a 2-tier national health insurance. With the basic, you get to choose your GP gatekeeper, and he or she chooses your specialists. And btw a pediatrician is a specialist, so unless something is wrong, you never see one. If you want your child to see a pediatrician or any other specialist, you can go around the GP gatekeeper by having the extra premium added to your tax bill. With university, you would have had to know that you were on an academic track very young. Once you were on that path, no variation. Want to change majors? Tough. Want to have a chat with the professor? Tough. Want to attend a class with fewer than 200 people in it? Tough. Can’t afford a car? Of course not, it’s a luxury, not a necessity. Take the bus or the train (and there IS a night bus!). Bicycle. Walk. And they are still finding, as in France, that the level of service has to be cut back even as taxes increase.

          • samuelpepys

            Sorry to hear about your experiences. They haven’t been mine, neither in health care nor in teaching/studying (nor have I ever had a car, or wanted one, when living in Europe: I live in cities). But as I say, I don’t know Sweden–except as the land of my great-grandparents! The people I know are happy with their lives compared to Americans, and have more leisure and time to think. But that’s not a statistically significant number of people I suppose.

  • MITBeta

    Use a midwife, preferably at home.

  • J__o__h__n

    US infant mortality rate 5.9. Canadian 4.78.

    • samuelpepys

      France: 3.35.

  • RMH

    I’d rather get my care in Canada. Instant access to one’s doctor of choice is neither necessary nor sufficient for quality medical care. Our American phobia of waiting in line for medical care is ridiculous as it is not backed up by solid evidence that waiting in line (at least as practiced in Canada) leads to worse health outcomes. Moreover, the price of medical procedures is hardly indicative of their quality. So we in the US do not get what we pay for.

    Both the NYT piece and the Slate piece are largely anecdotal, but the statistics strongly indicate that the US pays much more than Canada for health care and we get less, in terms of health, for our money than does Canada. I would gladly wait in line for my care if it meant I did not have to break the bank to get it.