Monday, August 10, 2009

Birthing in the USA : part one of two

Since we discussed health care, let's discuss one of the most expensive procedures people routinely have...childbirth.

Childbirth in the country has started to go a little something like this: you arrive at a hospital, because you are being induced. You are changed into a hospital gown. You are hooked up to something to cause contractions, usually Pitocin. You are monitored at least once an hour, but sometimes continuously to ensure that the Pitocin isn't stressing the baby. You are made to stay in or near your bed, in your room. A nurse checks on you regularly. If you don't progress quickly enough, you're recommended for C-section.

The number of babies induced in this country is placed somewhere around 40% in most cases. So, let me just reiterate...nearly half of all babies born are brought into this world not because the mothers body, which has grown and nurtured the baby for 40 weeks unconsciously knows that it's time to go and begins the process, but because a mother is forced into birth. Usually shortly after, and sometimes even before her due date.

That's crazy talk.

Don't get me wrong. There are many, many valid medical reasons for inducing a labor. But those valid reasons don't happen in forty percent of births. Instead, women are usually induced out of convenience. Either because they want to know when hey baby will be arriving so they can get time off, or pan it out or whatever, or so their doctor can have it planned. Doesn't seem so bad, when you put it that way.

Except that induced births can have many, many complications. First of all, your due date is a guess. Very, very few people have sex so infrequently that they can be sure of the date. And most women have literally no understanding of when they're fertile, so they can't accurately pin it down to even a few days. So, you could have gotten pregnant earlier or later than you're imagining, rendering that due date totally inaccurate. Also, most women, especially new mothers, "bake" their babies a little longer, often going to 41 weeks. Most pregnancies have no problems with going beyond the due date, as long as you're not beyond 42 weeks, where complications can begin to occur.

Also, inductions are painful. Contractions are worse. The mother often requests drugs, even if she was totally adamant about not getting them before. There's more stress on not just your body, but also on your baby.

And since it's known that extra stress will be on the baby, you're usually stuck in a bed, being constantly or semi-constantly monitored.

This is a bad plan.

When you lie in a bed, your pelvis is actually almost compressed, so the opening is smaller. You want your pelvic opening to be big, so you can get the baby out. Also, you don't get any help from gravity, which, in other positions, helps the baby move down and out. It also encourages fetal malpresentation, and can mess with the oxygen supply to the baby. All of which can push you towards getting a c-section.

Plus, all of this is way, way more expensive than a normal delivery would be.

This is going to, unintentionally, be a part one of two. I'll expound more later, because there's a lot more I want to say on this topic. Until then, I suggest checking out The Business of Being Born, or A Thinking Woman's Guide to a Better Birth.

Saturday, August 8, 2009

Healthcare in the USA

Let me tell you about a defining moment in my life.

A few years ago, I worked generating leads for a small health insurance brokerage. The pay was good, I was decent, and I liked doing it. So I decided to get my license and sell insurance.

I was cold calling people one day, talking to farmers and small businesses in southern Missouri when I called a man named Jim. Jim was a farmer, he had two kids, and his family had owned that land for something like two hundred and fifty years. That might be an exaggeration, but it seriously was a crazy number like that. Well, crazy for America, at least. Anyways, Jim had an eight year old son who had cancer. Luckily, Jim had health insurance and always paid his premiums, and Jim's son's life was saved. And they all lived happily ever after.

Well, that's how it should have gone.

Instead, Jim's insurance company, who he'd been insured through for twenty seven years, denied the son's cancer treatments, calling them experimental. So, Jim was actively looking to sell his farm to treat his son. They took up a collection at a local church and had some other fundraisers, but it wasn't enough. Cancer treatments are pricey. They were also fighting the insurance company, but they didn't have much hope of getting anywhere, and they feared it would take too long anyway.

Jim's son did get treatment, after he sold his farm and collected more money, but by then it was too late. He died.

When you live in a country like America, with wealth and riches and groundbreaking advances in medicine, you don't expect to hear something like that. You don't expect the reality of the fact that to insurance companies, you are an investment, and they don't want you if you're a bad one. You don't expect that someone would aid in keeping a kid from getting healthy, from seeing their ninth damn birthday, just because of the almighty dollar. That all happens somewhere else, right?


No. It happens here, way more often than you'd ever, ever imagine. It happens primarily to self insured people who run small businesses and farm, who are supposed the backbone of the nation. And in case you don't care about them, there's also the estimated 45 million Americans who have no insurance at all.

45 MILLION. That's an insane amount of people.

Also, let's take a look at the World Health Organization's ranking of the worlds health. Numbers go best to worst. In the interest of fairness, this was done in 2000. However, not much has improved since then.

1 France
2 Italy
3 San Marino
4 Andorra
5 Malta
6 Singapore
7 Spain
8 Oman
9 Austria
10 Japan
11 Norway
12 Portugal
13 Monaco
14 Greece
15 Iceland
16 Luxembourg
17 Netherlands
18 United Kingdom
19 Ireland
20 Switzerland
21 Belgium
22 Colombia
23 Sweden
24 Cyprus
25 Germany
26 Saudi Arabia
27 United Arab Emirates
28 Israel
29 Morocco
30 Canada
31 Finland
32 Australia
33 Chile
34 Denmark
35 Dominica
36 Costa Rica
37 United States of America
38 Slovenia
39 Cuba
40 Brunei

This is why I believe that we need a government plan of action. President Obama's is explained here, here, and here.

Here's what I like about Obama's plan:
*Offers coverage to all
*Allows private insurance to compete (private insurance, though riddled with corruption currently, is a field that many people are employed through or by. Plus, some people are going to balk at anything involving health insurance and the government, and, hey...they aren't forced into anything. Good call. I also think the competition will help keep private insurance playing fair. They have to do better to hope to compete.)
*I like the idea of funding primarily from repealing tax cuts to the wealthy. The idea is great. But I'm pretty sure it, like everything else, won't be as crystal clear cut as all that.
*I LOVE that you couldn't be denied for a preexisting condition or assigned nine million riders on things. Right now, for me to get private insurance, it'd be about $90/month. I'm 27, non-smoking, 5'9" and 138 pounds, and in good health. That's with a $5000 deductible. Also, did I mention it wouldn't cover anything involving maternity, asthma, or anything related to migraines, since I've suffered them in the past, or anything involving the area where my C-section was? So I'd be paying for, well, not a whole lot. If I wasn't totally denied coverage based on the aforementioned health concerns.

What I don't like:
*It doesn't appear to be addressing medical malpractice. Medical malpractice insurance is RIDICULOUS and a large part of the reason that bills are also ridiculous.
*I'm not sure I really have heard much about the funding besides cutting unnecessary programs and repealing tax cuts. I'd like more information, please.
*I'm very against the idea of mandating that you must have insurance. I'd understand for kids, but I'm conflicted on the rest. I can see how it's better...people being uninsured is a huge issue that makes up another chunk of why we pay so much for health care. But I also think that we have choices, and if you're so against insuring your own health...well, that's you. Obama first said he wouldn't mandate it, but implied later that he wouldn't rule it out.

I don't have all of the answers concerning health care. I think Obama's on the right track, but, like I said, improvements could happen. I also think we need to be given a more realistic, less rose colored glasses view of things. But America doesn't, as a whole, like to hear the whole story. As country, we seem to only listen to a small portion of a plan, generally manipulated by some source (ie, Obama's plan is socialized health care) and then embellish and repeat it, over and over. Until we start, as a country, becoming more interested and less apathetic towards all things political, there's not much chance of us ever easily getting the whole story, though.