The Miracle of Childbirth Costs

In 2011, the Save the Children foundation (Mothers’ Index Rankings) examined the top most developed countries and applied its analysis to determine the ranking of the best places in the world to deliver and raise children. “The scores were determined by measuring seven indicators for women in each developed country: risk of maternal death, how many women use modern contraception, life expectancy, years of schooling, maternity leave benefits, how much women earn as compared to men and the percentage of women in government. The study also measured three indicators for children: primary and secondary school enrollment numbers and childhood mortality rates in each country.” Huffington Post, November 8, 2011.

Out of the 43 countries measured, the United States didn’t make the top ten. Or the top twenty. Or the top 30! At a paltry number 31, the United States is an also-ran for children. Why? “Safety for infants is an issue, with an under-5 mortality rate of 8, compared with the 4 or fewer seen in most other industrialized countries. The maternal mortality rate is similarly disturbing, with a ratio of 1 in 2,100 versus a typical 1 in about 7,500 often found in other industrialized countries. The US has a high c-section rate of 31%, double the World Health Organization’s recommendation of 15%. But beyond medical care, American moms still get the short end of the stick, with no paid maternity leave, a benefit that even moms in Afghanistan enjoy (90 days at 100%), the country rated the absolute worst for mothers at #164. In fact, the US is the only country in the developed world without a mandatory paid maternity leave. While it isn’t the worst place in the world to give birth, the US is a long way from making our top 10 list.” MedicalBillingandCoding.org, January 22, 2012.

While the United States may rank relatively low among the above measurements, there is one clear place where we are ranked number one: in the cost of medical care associated with giving birth. Simply put, Americans pay the most and deliver what is at best an exceptionally mediocre product, a fairly consistent statement of average healthcare in the U.S. “The cost of giving birth is one place where the U.S. really stands out. Total hospital and physician costs for having a baby are $1,291 in Argentina, $1,967 in Spain, $8,495 in Switzerland and $9,280 in the U.S.” HealthNewReview.org, March 5, 2012. We may have the best medical facilities, the best trained doctors, the latest techniques… but what we don’t have is access to such superlative benefits – euphemistically “the best medical care on earth” – unless you are in the highest strata of American socio-economic status.

To make matters worse, the cost of childbirth in the United States continues to spiral out of control. “[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…

“‘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.’…  Those payment incentives for providers also mean that American women with normal pregnancies tend to get more of everything, necessary or not, from blood tests to ultrasound scans, said Katy Kozhimannil, a professor at the University of Minnesota School of Public Health who studies the cost of women’s health care…  Financially, they suffer the consequences. In 2011, 62 percent of women in the United States covered by private plans that were not obtained through an employer lacked maternity coverage… But even many women with coverage are feeling the pinch as insurers demand higher co-payments and deductibles and exclude many pregnancy-related services.

“From 2004 to 2010, the prices that insurers paid for childbirth — one of the most universal medical encounters — rose 49 percent for vaginal births and 41 percent for Caesarean sections in the United States, with average out-of-pocket costs rising fourfold, according to a recent report by Truven that was commissioned by three health care groups. The average total price charged for pregnancy and newborn care was about $30,000 for a vaginal delivery and $50,000 for a C-section, with commercial insurers paying out an average of $18,329 and $27,866, the report found… Women with insurance pay out of pocket an average of $3,400, according to a survey byChildbirth Connection, one of the groups behind the maternity costs report. Two decades ago, women typically paid nothing other than a small fee if they opted for a private hospital room or television.” New York Times, June 30^th.

Increasingly, the United States is being defined less by its excellence and more by its mediocrity. We seem to be hell-bent on insuring that the coming generations will continue to carry this standard of growing mediocrity as their international ID badge. We have no problem tilting the playing field in favor of the overpaid or those with the vast bulk of our economic assets (the 1% of our population who own 42% of our wealth), but for the rest of the country, bad schools, expensive and second-rate healthcare, impaired employment opportunities and a tax system that favors U.S. companies when they keep operations and values overseas are the norm.

We are going to see a continued escalation in anger and bitterness – amplified by politicians seeking to shift blame away from the obvious body of laws and benefits that favor the power elite who provide campaign contributions – with simplistic slogans and ineffective plans to correct, waived about as if they mattered. But unless and until we grapple with the real issues and promulgate real solutions, we can sit back at watch as life for average Americans continues to unravel.

I’m Peter Dekom, and the above numbers project an obvious problem with an equally obvious solution… one that campaign-contribution-driven-politicians are unlikely to follow.