My wife and I had our second baby this year. This time around we decided to have a home birth instead of a hospital birth as we had done for our first child. We chose this in spite of the fact that our insurance didn’t cover one penny of the birth. The pre-insurance costs of a home birth ended up being pretty close to the post-insurance costs of having a baby in the hospital. In fact, there are quite a few advantages to home birth:
1) Midwives come to your home and spend at least an hour per visit talking about the birth. Unlike doctor’s offices, the entire experience is very personal, very relaxed, and very thorough. There is no waiting room, no sick people sitting next to you while you wait to see the doctor, and no rushed, exhausted doctor unable to spend more than a few hurried minutes with you.
2) There’s always the risk that the doctor you see for prenatal care won’t be the same doctor you see in the hospital. This isn’t always a big deal, but there’s something comforting about having the birth with someone you know at least a little. Midwives are much more likely to be there for the birth. They usually aren’t nearly as overworked and overbooked as doctors.
3) No drugs. This can be a pro or a con, but it is definitely cheaper. I won’t go into the other advantages of a drug-free birth, but the savings alone are huge. And drugs aren’t actually that necessary if you come prepared.
4) Your’e at home. No hospital stay after the birth. You finish the whole exhausting experience, and there you are in your bed in your house. No nurses or doctors coming to check up on you. No crappy hospital food.
5) Home birth is much cheaper than hospital birth. You don’t have to pay for the room, the bed, the doctors, or the drugs.
All of this brings me to this excellent post by John Goodman of the National Center for Policy Analysis on the cost of amenities in the American healthcare system. He excerpts a portion of his book, Handbook on State Health Care Reform, discussing the cheap and successful birthing model of Parkland Memorial Hospital in Dallas, TX. Parkland Memorial Hospital delivers lots of ‘high-risk’ babies – mostly uninsured and often those of illegal immigrants. And yet they do it cheaply and with a very low infant mortality rate by focusing on prenatal care and using low-cost providers like nurses and midwives to perform the actual births. Two things are important to note about this.
First, midwives delivered babies for thousands of years before modern medicine transformed delivery into the realm of doctors. And second, most insurance companies – both private and public – won’t pay for midwives:
Prenatal care delivered by nurses rather than doctors might not be allowed under many states’ Medicaid rules. Ditto for deliveries performed by midwives. And under typical state insurance regulations, patients with private coverage would be encouraged to see OBGYNs (because of zero patient cost sharing), where the cost would be higher and the overall quality of the pregnancy/delivery episode might not be as good (because of fragmented care).
Breaking the stranglehold doctors and other supply-side cartels hold over modern healthcare will be tough. The structure of our system of insurance basically ensures that the strong special interests will always win out over alternative methods of care – such as low cost clinics or home birth providers. Unfortunately, the new healthcare law does nothing to change, entrenching the worst parts of the system even further and limiting choice more severely than it already has been limited by decades of bad healthcare policy. There are ways to make the law better, but it will be an uphill battle against special interest groups from the insurance companies to the American Medical Association.
