Sunday, July 20, 2008

A healthy birth is not a US birthright

I read a post that made me cry. It was about a child that died. But what stunned me and made me feel both sad and angry was the fact the post implied that babies are safe in the US. Unfortunately according to a CNN headline, the The U.S. has second worst newborn death rate in modern world.

My baby was almost one of the newborns that died. It took three hours to stabilize him, then he was whisked away to another hospital. My husband frantically followed the ambulance in our car. As I sat bereft in my maternity room, a doctor called and told me "We have to operate on him to save his life." and "He probably won't make it."

My son has faced death several times since then and survived. I'm very thankful and I feel I must whisper this lest I jinx anything. --I start 2007 for the first time not worried he might die.

Like many newborns, a contributing cause of his problems was inadequate prenatal health care. A simple prenatal ultrasound done at any point in the second trimester would have shown there was a problem. And a vaginal birth was nearly impossible. His left arm had a massive tumor of 24 cm. Larger than the usual cervix dilation of 10cm. No one knew until his arm got stuck as he was born, and he was deprived of oxgyen for three minutes. In addition the strain of being squeezed during birth exacerbated his condition of low platelets and red blood cells. He was completely depleted of clotting factors by the time he emerged and almost died at birth.

For a time I was very angry about this but at least in my case I realised that no one would have expected me to carry this child to term. He with a blood tumor and me with a blood condition where half of my blood cells are smaller than others. It's a miracle. So much of pregnancy is still unknown.

But when I tell women from other industrialized countries about the lack of ultrasound, they're horrified. Most routinely offer two ultrasounds - one at about 13 weeks, and another at 20 weeks to look for physical abnormalities. At 13 weeks, my son's tumor was too small. At 20 weeks, his left arm would have been visibly deformed.

We have good insurance. My husband is a software engineer. If my family was like millions of Americans, and my husband had the typical 80-20 insurance or no insurance, the costs of our son's medical care would have bankrupted our family, even with my husband's relatively high income. The billed costs (not the costs the insurance paid) for my son's medical care are over a million dollars and are still ongoing. He visits a specialist about once a month (down from 5-6 a month). Billed cost:$300-500. The insurance pays about $60 a visit.

However the insurance company pays for very little of his care, because a dirty little secret is that while HMOs whine about the high cost of health care, they don't actually pay for their most expensive patients. For very expensive patients like my son, the HMO has secondary insurance that pays for all of his care.

But we're the lucky ones. The number one reason for bankruptcy is medical bills. The Washington Post states,"Most of the medically bankrupt were middle-class homeowners who had been to college and had responsible jobs -- until illness struck."

Before my daughter was born, I had this naive idea that "babies don't die anymore". Unexamined, but I suppose due to our advanced health care. Now I know several children who died as newborns. In fact two babies died while my son was in the NICU.

In all these cases, except one, there was a failure of our medical system. In all the cases I know about, the mom desperately tried and failed to get the help she needed. But due to bureaucratic problems designed to "save hospitals money" or lack of insurance, the mother didn't get the medical help she needed in time. I dunno if getting help earlier would have prevented the baby's death. I'm not a doctor. I do know it caused the mom a great deal of unnecessary anguish.

In my darkest moments I can imagine what it feels like to experience the loss of a child. But my experience was like gazing down at a huge abyss versus falling into it.

But I can't imagine what life is like for the millions of expectant mothers who don't have insurance and literally can't afford to get adequate prenatal care. I can't imagine what it must be like to have a child born with serious health problems and have to worry about money to pay for it all. I can't imagine the anguish of wondering if my child would be healthier if only I had scraped enough money to go to the doctor earlier. I can't imagine having to go into bankruptcy to pay for my family's medical bills.

We have the latest and greatest neonatal intensive care, but do so little for most pregnant mothers.

I'm thankful for the good birth, the healthy birth I had with my older daughter. My daughter had jaundice, a common problem. For most babies, jaundice is resolved easily if treated quickly. In this country getting quick treatment for jaundice is a privilege I have due to my relative wealth, the fact that our family has health insurance unlike 13.4 of pregnant women. Furthermore, this March of Dimes article says the income thresholds for infants are often higher than for moms, so moms are denied health insurance as soon as their babies are born.

Our health system is the most expensive in the world and it is the worst in providing basic health coverage. It ends up costing a lot more, because an ounce of prevention often costs a lot less than treating something after the fact. The US spends billions of dollars treating NICU babies. I wonder how many are there simply because the mom wasn't treated adequately during her pregnancy. It all makes me cry when I think about that. It also makes me very angry.

I'm definitely not a socialist. I believe in the free market. However I also believe a few things are public goods. For example most people accept the idea that everyone is entitled to a free education through high school, because it's a public good. Everyone is worse off if education isn't provided to everyone. I don't understand why unlike the rest of the industrialized world, people in the US don't feel that health care is also a public good. This country does accept health care is good for senior citizens and children in very low income families.

I originally wrote "Will it take a national health crisis before the country wakes up?" Then sadly I realized we already have one. The rate of premature births is rapidly rising. 1 in 8 babies are born prematurely. No one knows why. Based on my experience, I'd have to say a contributing cause is inadequate prenatal care, even for women who have insurance.

I read recently that Assemblywoman Sally Lieber (sadly a representative of my town) and a Democrat wants to ban spanking. Meanwhile our Republican governator is proposing state health insurance. I will not vote for Sally Lieber ever again although I have voted for her every single time she ran for office and I could cast a vote. Before this proposal I would never have voted for Arnie. However I will if he gets this though.


Anonymous said...

Well, you know how I feel about all of this.

Preventative diagnostic care done adequately even in supposedly low-risk pregnancies can save women a whole lot of heartache. Shame that the doctors don't recognize that.

Anonymous said...

I hope you will look up SB840, by California Senator Sheila Kuehl. She tries to move us towards the "universal medicare" system that succeeds in Canada, France, Taiwan, all the other industrailized nations. Unfortunately, Arnold's plan will just require Californians to but the very insurance policies that you have seen as problemtatic. That's why the California Nurses Association support SB 840 and opposes Schwarzen-care!

LD said...

What a great post! My husband is an economist, and he always says that the free market cannot solve the healthcare problem The goal of the free market is for companies to maximize their profits, but the only way insurance and health care companies can do that is by minimizing what they pay out.

Gidge said...

My mom lost a baby during delivery when I was 9. There were complications upon complications....everything that could go wrong did.

Healthy birth is not a birth right, even with great prenatla care.....which she had.

And you never really understand that,until you are staring at a beautiful baby a casket.

Her Bad Mother said...

GAWD you made me cry.

*applauding madly*

Terra said...

I agree with you, including the anger and outrage at babies dying at birth. We ARE an advanced country; what gives?

The problem is, that free and overarching health care will be almost as bad as the current health care is. Yes, everyone will be covered, but the coverage of everyone will place an overwhelming strain on an already strained medical / health system - it will be the proverbial straw breaking the back of the proverbial camel. Doctors who were seeing a patient every 15 minutes would have to have their emergency patients make appointments 3 or more weeks in advance. Have to go to the ER? Expect a day of waiting as opposed to hours. Ask England or Canada how long it takes to see a specialist. Live in London and need to see a cardiologist? Hope it isn't serious, because it will be 4-6 months to get in to see one when your country has blanket insurance coverage.

Yes, many industrialized nations have coverage for everyone. But that coverage only works well for preventative care and not for serious issues. You may find cancer early, for example, but good luck getting it treated. Those doctors are all booked up.