Mom (Hold the Apple Pie)

July 2, 2013
Posted by Jay Livingston

As we come up on the Fourth of July, it’s time to reflect on Mom and Apple Pie.  We love them both, we Americans.  The apple pie part is easy, as easy as  . . . well, never mind.  But motherhood involves two political and economic elements – child birth and child care – that seem to give us more trouble.

Conservatives in the US still insist that in all nearly matters, private enterprise is far superior to a “government takeover.” They also believe, as do most Americans, that we are unsurpassed in our love of family and children. 

It’s hard to maintain these beliefs when we compare ourselves with other wealthy countries.  They may not eat as much apple pie.  But on measures like maternity (and paternity) leave, day care, and early education, and the general well-being of the kids, they eat our lunch. 

Compared to the scope of and level of support offered by family policies of France, Germany and Italy, the US appears to have a low level of political commitment to the well-being of families, lacking even the guarantee of unpaid leave to all workers.  (Source here.)

In these family matters, we mostly leave things up to individuals and the private sector. If your employer wants to give you paid or even unpaid maternity leave, you’re in luck.  If not, too bad.  If you want child care, find it and pay for it.  Government support comes in the form of income tax breaks, which are of little use to people with low incomes. 

As for the medical side of having children, the US is number one, at least when it comes to costs.  According to the story in Monday’s New York Times, pregnant middle-class moms are in for sticker shock, though it’s not always easy to find the sticker.

When she became pregnant, Ms. Martin called her local hospital inquiring about the price of maternity care; the finance office at first said it did not know, and then gave her a range of $4,000 to $45,000. “It was unreal,” Ms. Martin said. “I was like, How could you not know this? You’re a hospital.”

The average out-of-pocket cost for women with insurance is $3,400, far higher than in other wealthy countries.  And that’s for women lucky enough to have coverage.  Many non employer health plans (62%) do not cover maternity. 

Nor are we are not getting more for our money.

And though maternity care costs far less in other developed countries than it does in the United States, studies show that their citizens do not have less access to care or to high-tech care during pregnancy than Americans.

From 2004 to 2010, the prices that insurers paid for childbirth — one of the most universal medical encounters — rose 49 percent for vaginal births and 41 percent for Caesarean sections in the United States, with average out-of-pocket costs rising fourfold.           

Two decades ago, women typically paid nothing other than a small fee if they opted for a private hospital room or television.

This is hardly ringing support for the idea that the private sector drives down costs and brings us better service at lower prices.  Maybe that’s because the private sector runs on the profit motive; the more stuff you sell, the greater the profit.

“I feel like I’m in a used-car lot,” said Ms. Martin.
 She fought for a deep discount on a $935 bill for an ultrasound, arguing that she had already paid a radiologist $256 to read the scan, which took only 20 minutes of a technician’s time using a machine that had been bought years ago. She ended up paying $655.

The online Times asked readers to contribute their own stories of childbirth in foreign lands.  Here are three shorter ones:

• I'm an American living in Canada. Total paid for each pregnancy, (one caesarean, one vaginal birth): $15. For parking at the hospital.
• One expense, Royal Hospital for Women, Paddington, New South Wales, 1985: $5 for a phone in my room.
• I gave birth in Germany where I had a voluntary C-section (which is free for women over 35). I stayed in the hospital 3 days following the birth. I had to pay 10Euro a day for each day in the hospital. Total bill for the birth 30Euro (approx. 50$) Also all prenatal tests were free of charge.

 Obamacare is hardly a government takeover – compromise with conservatives killed the modest “public option” – but some aspects of it may help decelerate of even lower the cost of giving birth.