Tuesday, July 02, 2013
Health Care Quandary # 428
According to the New York Times, pregnancy care in the United States is much more expensive than in other countries, though the care itself is about the same. Here is part of the article:
[C]harges for delivery have about tripled since 1996, according to an analysis done for The New York Times by Truven Health Analytics. Childbirth in the United States is uniquely expensive, and maternity and newborn care constitute the single biggest category of hospital payouts for most commercial insurers and state Medicaid programs. The cumulative costs of approximately four million annual births is well over $50 billion.
And though maternity care costs far less in other developed countries than it does in the United States, studies show that their citizens do not have less access to care or to high-tech care during pregnancy than Americans.
“It’s not primarily that we get a different bundle of services when we have a baby,” said Gerard Anderson, an economist at the Johns Hopkins School of Public Health who studies international health costs. “It’s that we pay individually for each service and pay more for the services we receive.”
It is clear we need some changes. What should they be?
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This does not answer the question posed, but let me just inject it into the discussion:
According to my rough calculations, Medicaid funded approximately 1/5 of those 4 million births in 2012.
I have also seen studies with Medicaid recipients removed in which the quality of American healthcare in general, but, presumably, including neo-natal care and infant mortality rates, jumps back up to "best in the world" levels (although I have no idea what that does in terms of costs).
IMPORTANT NOTE: Of course, I am not suggesting that Medicaid is the prime mover behind poor healthcare. Rather, a more logical explanation for poor health care among Medicaid recipients is that Medicaid is a safety net for the poor who tend to be the least healthy and least informed and the least likely to be engaged in preventative care.
So, considering this great divide between government safety net healthcare and private healthcare, does that change anything in terms of where we go from here?
According to my rough calculations, Medicaid funded approximately 1/5 of those 4 million births in 2012.
I have also seen studies with Medicaid recipients removed in which the quality of American healthcare in general, but, presumably, including neo-natal care and infant mortality rates, jumps back up to "best in the world" levels (although I have no idea what that does in terms of costs).
IMPORTANT NOTE: Of course, I am not suggesting that Medicaid is the prime mover behind poor healthcare. Rather, a more logical explanation for poor health care among Medicaid recipients is that Medicaid is a safety net for the poor who tend to be the least healthy and least informed and the least likely to be engaged in preventative care.
So, considering this great divide between government safety net healthcare and private healthcare, does that change anything in terms of where we go from here?
One More Thought More Apropos to the Question:
In terms of intercepting and controlling the skyrocketing costs of healthcare, there seems to me two main avenues of redress:
1. Make medicine much more responsive to market forces by making medical care recipients pay for basic medical care with out of pocket money (which could include limited government subsidies).
OR
2. Nationalize healthcare and take the profit out of the system. Allow the government to maintain medical facilities, train medical personal, and fund the system through taxes.
Either one of these methods would solve the problem; they would also produce myriad inconveniences and unintended consequences. But, as we are on an unsustainable path, we can expect something fairly draconian in our fairly near future.
In terms of intercepting and controlling the skyrocketing costs of healthcare, there seems to me two main avenues of redress:
1. Make medicine much more responsive to market forces by making medical care recipients pay for basic medical care with out of pocket money (which could include limited government subsidies).
OR
2. Nationalize healthcare and take the profit out of the system. Allow the government to maintain medical facilities, train medical personal, and fund the system through taxes.
Either one of these methods would solve the problem; they would also produce myriad inconveniences and unintended consequences. But, as we are on an unsustainable path, we can expect something fairly draconian in our fairly near future.
I have a lot of issues with the NYT article. I'm not sure about New Hampshire, but paying out of pocket for a birth was a pretty straightforward process for my wife and I during law school in Texas. We paid about $8k total for care including a c-section. Anecdotes aside, the article failed to mention that most non-maternity policies cover major complications due to the pregnancy/birth.
I also thought this part was interesting: "One factor that has helped keep costs down in other developed countries is the extensive use of midwives, who perform the bulk of prenatal examinations and even simple deliveries; obstetricians are regarded as specialists who step in only when there is risk or need. Sixty-eight percent of births are attended by a midwife in Britain and 45 percent in the Netherlands, compared with 8 percent in the United States." Maybe we just need the government to hire midwives...I suspect that won't help mortality rates, though.
The mortality rate comparisons do seem suspect already: see http://health.usnews.com/usnews/health/articles/060924/2healy.htm
RE: AWF, I disagree about whether drastic changes are needed (though drastic changes are coming from BHO...even as he keeps delaying them). We already have more than 1/3 of healthcare costs paid by the government and the HSA setup has provided a valuable option for those who want a policy more responsive market forces (I'd be happy with mine, but for the premium increases attributable to obamacare). The 3rd party payer system, combined with massive existing government regulation cause the distortions in costs.
Even with our flawed system, I'll take American healthcare over any other country...until BHO destroys it.
I also thought this part was interesting: "One factor that has helped keep costs down in other developed countries is the extensive use of midwives, who perform the bulk of prenatal examinations and even simple deliveries; obstetricians are regarded as specialists who step in only when there is risk or need. Sixty-eight percent of births are attended by a midwife in Britain and 45 percent in the Netherlands, compared with 8 percent in the United States." Maybe we just need the government to hire midwives...I suspect that won't help mortality rates, though.
The mortality rate comparisons do seem suspect already: see http://health.usnews.com/usnews/health/articles/060924/2healy.htm
RE: AWF, I disagree about whether drastic changes are needed (though drastic changes are coming from BHO...even as he keeps delaying them). We already have more than 1/3 of healthcare costs paid by the government and the HSA setup has provided a valuable option for those who want a policy more responsive market forces (I'd be happy with mine, but for the premium increases attributable to obamacare). The 3rd party payer system, combined with massive existing government regulation cause the distortions in costs.
Even with our flawed system, I'll take American healthcare over any other country...until BHO destroys it.
Our perspectives on several of the issues contributing to the Medicare costs are so distorted by the ideological biases on both sides that it is difficult to have a rational discussion of alternatives.
For example, the simplest (and cheapest) way to lower medicaid birth costs is to offer free or low cost screening, birth control, abortion, and prenatal care in all areas of the country, especially those areas medically underserved.
Yet we are busy putting up all the possible roadblocks to such services. Witness the right wing nut circus going on it Texas, in spite of the majority opposition.
I guess prevention of health problems before they cost billions is too logical for many to grasp.
Lee
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For example, the simplest (and cheapest) way to lower medicaid birth costs is to offer free or low cost screening, birth control, abortion, and prenatal care in all areas of the country, especially those areas medically underserved.
Yet we are busy putting up all the possible roadblocks to such services. Witness the right wing nut circus going on it Texas, in spite of the majority opposition.
I guess prevention of health problems before they cost billions is too logical for many to grasp.
Lee
# posted by 
: 12:34 PM
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