America's broken childbirth system

Now that the Republicans have shaken the dust from their feet following all 497 of their failed attempts at repealing the Affordable Care Act, we are probably due for one of those long spells where we pretend that all the issues that were so urgent last year until the GOP lighted upon "tax reform" are worth ignoring for a while.

This would be a mistake. It is the perennial folly of columnists to allow politicians to decide what is and is not worthy of our readers' attention, to whip ourselves into fits of spasmodic rage whenever they propose something bad and sink back into indifference as soon as it looks as if they have changed their minds. The provision of medical care in this country was an important issue in 2017 and it is an important issue now.

Just how far we have to go before we can think of ourselves as a civilized people is made clear by two recent pieces in The Guardian's excellent parenting section, "The Mother Load."

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Few issues demonstrate the callousness and absurdity of our current public-private system as the way we "finance" the birth of children. The cost of the average birth in the United States is more than $32,000 for a standard delivery with no complications. This is higher than any other country in the world, and it has nothing to do with the quality of care we provide to mothers and children. Parents such as Stella Apo Osae-Cwum and her husband who find themselves in difficult and unpredictable circumstances end up footing the bill for amounts that are even more unimaginable — $877,000 for the premature birth of their triplets.

This is not to say that we have made no progress in what is now nearly a decade since the passage of the Affordable Care Act. Eleven years ago Jen Sinconis gave birth to twins 16 weeks prematurely. As she puts it in a touching recollection, her boys "were smaller than a Beanie Baby. Their skin was translucent, still covered with a downy hair, their eyes were fused shut, they hadn't developed cartilage yet so their ears were just little flaps of skin, and their thighs were about the size of my pinky finger." They were also human beings made beautifully in God's own image. That we now have the ability to save their lives is just short of miraculous. No parent should be asked to choose between the health of their children and financial ruination, but that is exactly what happened to the Sinconises, middle-class people with good-paying jobs and decent insurance. After only a year they had exceeded the (since abolished) $2 million cap on their insurance policy and gone $450,000 in further debt, even after liquidating all their assets, from their retirement accounts and vehicles down to every piece of furniture they owned, even their bed.

How is it that we allow this to happen?

Part of the problem is surely that, for a variety of reasons, we have made birth more difficult and expensive than it needs to be. All of the usual villains — from insurers to hospital boards to gazillionaire doctors — who profit by jacking up the costs of giving birth deserve blame. But so do we.

I am certainly not going to pass judgment on the decisions of women who can afford to spend two or more nights in a hospital. But believing in socialized medicine means acknowledging that there is a difference between what we might want and what we actually need. Resources — personnel, equipment, facilities, medication — are limited. Far too much of what is available is expended on those who do not need it at the (sometimes life-destroying) expense of those like the Sinconises and the Apo Osae-Cwums, who do and cannot afford it because they are not Jeff Bezos. This is to say nothing of the frequent post-delivery complications that arise following the use of epidurals even when they are necessary, or of the suspect, possibly even eugenic, overuse of caesarean sections among women receiving Medicaid, which exponentially increase the difficulty of further pregnancies.

America should follow the example of the United Kingdom, where midwifery is becoming the norm for healthy women whose pregnancies have not presented complications. Even if you don't agree that, like exclusive use of infant formula, tacky carpet rolled over wood floors, TV dinners, and Pat Boone, hospital births by lab-coated MDs are a ludicrous anachronism in 2018, a holdover from a bizarre cultural moment whose passing none of us should mourn, it is worth at least considering the benefits of a different approach to birth.

Our daughters were born not in a brutalist hospital complex but in an attractive little townhouse apartment complete with bedroom, kitchen, sitting room, and multiple bathrooms in the Old Town neighborhood of Alexandria, Virginia. They spent the first hour of their lives on their mother's breast. They never lay sobbing and confused on top of a gun-metal scale to expedite the assembly-line process of hospital delivery. My wife did not receive an epidural, but she did drink several glasses of wine while sitting in the bathtub, having her hand held by various friends. We were all home sleeping within three hours. The total cost for our first daughter, all of which we were lucky enough to pass on to our insurers — who were happy to pay in full for what was far less than a tenth of what we would have been charged in a hospital in the Washington, D.C., metropolitan area — was $3,600. Our second was slightly less. For many American families this is not exactly loose change, but it is far better than the current norm.

As I have written ad taedium in this space, a single-payer health-care system is not only the only moral option; it is inevitable. In the meantime, however, expectant parents who are lucky enough not to have difficulties on the horizon should consider availing themselves of the existing sane and decent alternative to the medical industrial complex. No midwife is going to bankrupt your family. And if those of us who are lucky enough to need less take less, there will be more left for those who are less fortunate.