Streams

Why Is Childbirth So Expensive in the United States?

Thursday, July 18, 2013

baby hand motherhood kids parenting (Bridget Coila/flickr)

Childbirth in the United States has been getting more expensive in the past decade, and according to New York Times reporter Elisabeth Rosenthal, maternity and newborn care make up the biggest category of hospital payouts for most commercial insurers and state Medicaid programs. She joins us to talk about her article “American Way of Birth, Costliest in the World,” in the June 30 New York Times, which looks at what makes maternal health care so expensive here and how the cost is affecting women and families with and without insurance. It’s the second article in a series called Paying Till It Hurts: A Case Study in High Costs.

Weigh in: Did you have unexpected costs for maternal care? What was your experience paying for maternal health care?

 

Guests:

Elisabeth Rosenthal
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Comments [23]

Jessie from Sunset Park, Brooklyn

I have three very different experiences in relation to the cost of childbirth

1-My old health insurance plan (circa summer 2011) is no longer available under health reform. Under this plan, because my pregnancy ended in a miscarriage at 11 weeks, I was not covered for any maternal services, and wound up owing $1,200 for three appointments. One ultrasound was $500+ because a "specialist" came in to confirm that I had indeed miscarried.

2-Happily, I am currently pregnant (and expecting any day now!). We were covered under my husband's insurance, and despite paying half of the monthly premium ($600 out of pocket each month), I was relatively satisfied with the service provided and wound up only paying about $200 total for maternal care (all for ultrasounds). However, the birth itself was not covered until I met my $3,000 deductible. No matter what way I sliced it, I would wind up spending about $3,000 for the birth. As a recent grad school graduate, $3,000 is not chump change!

3- Luckily, at 7 months pregnant, I was hired full time as a city employee shortly after finishing grad school. My health benefits now cost me $40 a month, and the birth is going to cost $250.

It's really amazing/disgusting how much of a difference good insurance coverage makes!

Jul. 18 2013 02:51 PM

Jeremy:

Thank you for explaining. I figured I had to have been missing something.
_______

Many good posts here.

Jul. 18 2013 12:47 PM
Nick

Depopulation Agenda at its finest. That is why. Just look at some of these comments. Always talking about money and no how the joy of life, no matter what the cost is worth it in every way. Another reason why I'm socialist. We must construct an advancing organic world for the rising population and their health, infinitely. Or you could disagree and subtly support the depopulation agenda which is not only depopulation, though preventing more population.

Jul. 18 2013 12:45 PM
ED Doc from NYC from NYC

DR Rosenthal keeps talking about the cost of a "scan" or a procedure. It is the price not the cost. If one is insured we pay premiums to publically traded insurance company their job is to make money for shareholders so they charge patients/employers more while paying the hospital and doctors less.The health care providers recoup profits by pricing procedures at mark up to self insured or self payers. This cycle will never change until we eliminate for profit insurers duplication of procedures and over pricing and inequality of care will only change when we have a single payer (govt) insurance.

Jul. 18 2013 12:43 PM
Joanne from Brooklyn

I gave birth with both a midwife md team and just used the midwife. I discovered in the hospital that the copay for the nursery was $500 per day despite the baby rooming in the room with me and my having what's considered very good civil service employee insurance. And this was 26 years ago.

Jul. 18 2013 12:42 PM
Jenny from New York

Not sure why Ms. Rosenthal seems unaware of the fact that many midwives practice in hospitals, and perform all prenatal care, and are covered by insurance. The New York State Midwifery Modernization Act, passed in 2010 no longer requires Certified Nurse Midwives to have a written practice agreement with a doctor. I had a midwife-assisted birth, at LICH, completely covered by my insurance. Home birth is a different story, with many insurance providers fighting against paying for it, but hospital births with midwives are completely covered by insurance. It would have been nice if Ms. Rosenthal had her facts correct about this!

Jul. 18 2013 12:41 PM
Amy from Manhattan

I agree about how hard & time-consuming it can be to get hospital records. It can take months, & in many cases you can't see dr's. for follow-up care until you can get the records to them. I hope this show will do a segment on this problem--I've got a lot to say about it, but not now, when I'm making up for lost time on the phone w/hospitals.

Jul. 18 2013 12:39 PM
Nick from UWS

If you don't have $4,000 for "medical extras", you probably shouldn't be having children in the first place, because you're in for a nasty surprise when you confront the actual cost of having and maintaining children. This is not a problem of the insurance companies or the economy, this is a problem of infantile or zero financial planning on the part of the parents.

Jul. 18 2013 12:38 PM
jeremy from NYC

Noach, you missed my point - or maybe I didn't make it clearly: it was that it cost virtually nothing if you have the right insurance... the cost of a lego set. Without ins, it would have been practically impossible to afford a baby... it was a commentary on how unfair and imbalanced our absurd system is.

Jul. 18 2013 12:37 PM
Shana from Montclair

I have pretty good insurance as a public school teacher in NJ. My insurance company paid for my first child's birth in the hospital (costing upwards of $15,000 for a normal pregnancy without an epidural) but refused to pay for my second child's birth at home. The cost for my midwife was $6000 - I was only entitled to 80% since my midwife was out of network. Even after an appeal to the company, they refused to pay, even though it would have cost so much less.

Jul. 18 2013 12:35 PM
Mary-Jane Mitchell (please don't use) from Brooklyn NY

My husband lost his well paid job in finance in 2010 and we were out of health insurance. We couldn't afford to pay our Cobra beyond six months and were living pay check to pay check with his occasional temp work. I became pregnant in 2012 (unintended) and though my husband was temping we we're hardly making rent we didn't qualify for the prenatal assistance program so we're presented with the choice of paying out of pocket (which was impossible) or terminating the pregnancy. A horrific choice for a working family. My husband quit his job so we would qualify for the prenatal program. He is now working again and we once again have health insurance and a healthy baby boy but the experience was terrifying. We are all one layoff away from no insurance.

Jul. 18 2013 12:34 PM
Amy from Manhattan

Another thing many people don't think about is that, for example, the doctor may be in an insurance co's. network, but the anesthesiologist or other auxiliary professional may not be. I've heard of cases where the patient had to pay a huge amount out of pocket because they didn't realize some of the personnel caring for them weren't covered.

Jul. 18 2013 12:33 PM
Liz from Brooklyn

I gave birth to my daughter a year ago in Australia, after receiving prenatal care in NYC. Our birth experience in Oz was excellent and totally counter my friends experiences giving birth in American hospitals. My daughter was born in a small country hospital, with a GP and midwife. No specialists, no obstetricians, but excellent care, and follow-up home care as well. While I was covered by Australian Medicare, their national health-care system, if we had paid out of pocket the expenses were capped at $7000.

Jul. 18 2013 12:32 PM
Nina from Jackson Heights

I'm so glad you're having this conversation. My first delivery cost me $4K. I'm due with #2 in December and this time around I'm hoping to use the birthing center and no anesthesia because, for one thing, it's cheaper. Unfortunately, I feel like I'll need a doula if I want to make it through the birth pain medication-free. The cost of a doula will probably make up for what I save by using the birthing center and not getting an epidural.

Jul. 18 2013 12:29 PM
sarah

Thank you for responding to my comment but my point was not just how much money the doctors make, but how issues stemming from malpractice and litigation lead directly to the overuse of many costly procedures as another listener pointed out. Doctors are pressured by this system to take every precaution imaginable so that they don't get sued and they are not really profiting from it.

Jul. 18 2013 12:27 PM

The New York Times health insurance for employees may not cover epidurals during delivery? Seriously?!

Jul. 18 2013 12:23 PM
John A

Host/Guest seem to be unaware that rates for the uninsured are frequently 3-5x what the insurance companies pay.

Jul. 18 2013 12:19 PM
sarah

OBGYNs have astronimical malpractice insurance rates and make far less than most doctors salaries. Please point out to your listeners how this affects what you are discussing!!!!

Jul. 18 2013 12:18 PM

@ Jeremy:

You consider a little over $100.00, today, a lot to pay a hospital for giving birth?!

If so, I have to wonder how you plan to manage the costs of even a month or two of /raising/ an infant.

Jul. 18 2013 12:17 PM
Jill from Montclair NJ

Please speak more on the overuse of ultrasound and the overuse of inductions and the impact of birth interventions on the alarming c-section rate.

Jul. 18 2013 12:15 PM
Stephen from Manhattan

Does Ms. Rosenthal anticipate the merger of Continuum and Mount Sinai hospitals to cause the cost of childbirth at the resulting combined hospital system to skyrocket even further? Does she know if any organization has strongly objected to this merger and asked the federal anti-trust agency to carefully review what the result of this merger will be?

Jul. 18 2013 12:12 PM

Ll, compare life expectancy to USA vs the rest of the world. Then long at how much we spend.

Jul. 18 2013 12:11 PM
Jeremy from NYC

When my little boy wants a Lego set that costs over $100, I tell him, "What? That costs more than you did!" Because to the best of my recollection, that's how much the copay was for his birth.

If we didn't have insurance? Wow... I probably would have had to make my own baby out of Lego.

Jul. 18 2013 12:10 PM

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