Tuesday, February 01, 2011

Time for your responses

Sometimes I get comments that make me chuckle, roll my eyes, and/or say to my husband "you've got to read this!" Instead of writing up my own responses to these two comments, I'd love to hear yours!

From ACOG issues new opinion on home birth:
In response to a comment from "Kimberly" about health care in her country, "Rocky" wrote:
You don't have free health care - it is paid out of your taxes and the quality of care is by far substandard to that of all the health care given in the U.S. Your assumption that U.S. Health care worsens every year is not founded by fact - the United States has the best and highest quality of health care in the world and that is why people come from all over the world to get it. I am sorry that you are so misinformed - stop watching the news and find out for yourself. As usual, education is needed to turn the tide of ignorance and dependence on government intervention back to self reliance and self governance. The government isn't the answer and neither is ACOG. To be grateful for your free health care over the "freedom" to choose for yourself who treats you or cares for you when you are sick or are having a baby is the issue here. FREEDOM is the key and there is no freedom from government intervention and control. GOD BLESS AMERICA! 
From Don't ask, just do:
"Nan" wrote:
Do you ignore all physician's advice or just Obstetricians?

They are the ones that you will sue if something happens to your baby during its birth, right? Even after you have ignored all of their instructions.

I personally interviewed my OB physician and chose one that I knew was knowledgeable and experienced. Keeping secrets from and ignoring their expert advice is counter productive. If you don't want their help and expertise, then just stay home and deliver. Just be careful which midwife you choose. A friend of mine found out too late that her midwife had been responsible for several infant deaths from inadequate prenatal care and mishandled deliveries. Usually the parents of these infants are too guilt ridden to pursue charges against the midwife, so the public never finds out.
You get a gold star for especially funny/witty/insightful responses.


  1. Yes, good comments. And while Rocky makes many good points, the pathetic (and worsening) maternal mortality rate in the US does not support the "best health care in the world" statement.

  2. Freedom to choose! For best example see the documentary Sicko, and a handyman's freedom to choose either of his two cut fingers due to his limited coverage. That's what I call freedom!

  3. "Rocky" has clearly never read anything by Atul Gawande. More $ does not make for better care.

    FWIW a loved one of mine recently needed urgent surgery. He was referred to the local hospital, had surgery that night, and was home two days later. Total bill? €75 i.e.: just over $100. And that's with no private health insurance at all.

  4. also, daily visits from the public health nurse to change the dressings for 4+ weeks? Also totally free.

  5. I'll let someone else be funny, but to "Kimberly", the U.S. may have some of the best healthcare in the world as far as training and machines that go "ping", but it's not worth a load of horseshit when the 45 million or more people don't have access to it because they can't afford insurance or the insurance they do have doesn't pay for their care.

    I haven't had insurance for 5 yrs, so I haven't had reasonable access to the "best healthcare in the world". I will qualify for insurance thru my employer soon, but even then, the plan I can afford will have a $5,000 deductable. This means I will still go without regular check ups and will avoid going to the doctor for all but the most dire circumstances.

    Now, my daughter qualifies for Medicaid and it is awesome. A little bit of paperwork plus my tax dollars along with everyone elses, and wow. She has access to healthcare. I don't need to wait until she is gravely ill, and she gets regular exams. She even was able to see a pediatric orthopedist without question. Ahh, dirty, commie, government paid for health care, how I love thee!

  6. Now, "Nan" brings up an ineresting question. Why would people be willing to sue an OB, but not willing to sue a midwife if she is neglegent? Oh right, that's not true. Midwives are just as likely to be sued which is why the have to care malpractice insurance like OBs do.

  7. How about that I totally agree with the first comment.

  8. Yeah Rixa, why don't you just stay home and deliver? :). And forget about that midwife you'll end up suing, do it yourself. But then who would you sue?

  9. I've been living in Canada (I'm a U.S. citizen)for 5 years now and I *still* can't figure out what "freedom" I'm giving up by not having to pay as much out of pocket here as in the U.S. I've had babies here (homebirth with a registered midwife? Covered.) and my husband is currently dealing with an ongoing health crisis. We've found help, choice, and excellent care at every turn.

    I know many, many HMOs in the U.S. that are more restrictive than the Canadian system only you (or your employer) PAY for the privilege.

    Dear Rocky, what freedoms exactly are you so afraid of losing that you've let yourself become a brainwashed pawn of the Tea Party?

  10. Yeah, I sure love my US healthcare. But wait, it seems like I pay 80$ a month for the "right" and the "freedom" to also pay 20$ every time I need to go to the doctor, and every time I need to take my daughter to the doctor. Oh, and also my insurance doesn't cover licensed midwives, so I gave birth in a hospital, and despite the fact that I

    -walked in pushing and birthed my daughter in 20 minutes with no assistance and into my own hands
    - roomed-in for 24 hours (no nursery)
    -had no newborn procedures done
    -left with the same stuff I came with

    I was charged a FREEDOM-LOVING 2000$ after insurance had covered their portion. Oh yeah, got to love that American health care.

    Oh yeah, and the insurance company says that they still won't cover a homebirth even though it's less than half the price of a normal vaginal delivery in a hospital.

  11. Rocky must not have proofread, because there was clearly something missing from his comment. It probably should have read "the United States has the best and highest quality of health care in the world, if you're rich."

    I work with people every day who cannot afford basic health care. Their freedom to choose? Gives them the choice to go the community health clinic, which is terribly understaffed, and can't really help anyone with anything beyond the basics. Which is to say, of course, that they have exactly one choice, and a bad one at that. God Bless America!!(?)

  12. "if you're rich"

    Right on. Sure you can have amazing health care if you're one of the lucky few. But I am a very strong supporter of nationalized health care--and if people want it, sure, let them pay for a private option. I've been super impressed with the care in France, where I have worked for the past 10 summers. For example, we had to bring a student in for a broken finger. We went to the ER, she was treated right away (x-rays, physician's exam, cast, medications, etc) and done in about an hour. The total bill was around $120 USD--and this is paying for everything out-of-pocket. If you were French, you'd have most if not all of that reimbursed. We've brought students in to see both generalists specialists with no problems and very little wait.

    My husband is from Canada and has seen first-hand how that health care system works. He gets so frustrated living in the States and having to deal with the crazy rigmarole that we call health insurance here. He has relatives with long-term health issues who would been doomed had they lived in the States and needed to rely on private health insurance companies.

    And don't get me started on my own insurance here in the States. Freedom? Not even close. More like restrictions, exemptions, crazy clauses to navigate around, refusal to pay for things that should be paid for. And this is *good* insurance by most standards.

  13. I totally agree with Olivia.

    I can't afford health insurance. Now that I'm pregnant, I'm going it alone 'cause I'm not going to get the state insurance that I can get now that I'm going to have a kid. I don't want to be limited to an OB and have them question why I'm turning down ultrasounds or don't want them doing this or that during birth.

    But that choice can be made anywhere, so I don't see how the US is necessarily better.

  14. When I lived in Mexico I had to go to the ER because I had contracted typhoid. I went to the "rich" hospital, had blood tests, urine tests, IVs, antibiotics, and numerous prescriptions. The total bill including my prescriptions... $600!! This is without any insurance. I was pretty impressed with how cheap it was and the quality of care I received in a country that is supposed to have substandard conditions compared to the United States. In fact, if I had to choose between that ER in Mexico and an ER in the US I would take the one in Mexico without a second thought.
    I won't get into the fight I had with my US insurance trying to get them to reimburse me. What a pain!
    Lastly, I have WAY better coverage under Medicaid than I ever had under excellent private insurance. I have eye and chiropractic coverage as well as no copay. The only downside is that it does not cover homebirth midwives. :(

  15. Well Rocky is right. Health care in Canada is not free, my mistake. It costs our family $40 a month for coverage that includes chiropractic are physiotherapy care as well as free general doctor visits, maternity care with a GP, OB or midwife, and options like choosing ANY hospital in BC for ANY procedure. There are no deductibles and no caps. You get sick with anything-it's covered. (we don't make much money so our care is subsidized, but the most a family of two pays is about $150 a month)

    There are problems though, because of the doctor shortage it can be hard to find a doctor that you have a good fit with, however overall I've been very impressed with Canadian care. And that problem would be true with an HMO, because of their restrictions you can't see ANY doctor, only doctors approved by the HMO.

    For example: I had a UTI when I was living in Utah. No health insurance. It cost $600 for a doctor to dip a strip into a urine sample and tell me I had one. Then another $200 for the drugs to fix it.

    Fast forward 6 months. I'm in Canada without health insurance. The same problem. It only cost $100 for everything-drugs included. And I paid out of pocket, I didn't have BC health care yet. How on earth is the US care better in that situation?

  16. I'm not a "brainwashed pawn of the tea party" and I cannot comment on the standard of care in other countries. However, I can say that I am in agreement with Rocky that it's not the government's job to provide health care and we need to return to self reliance. I am not heartless, but I would love to see medicaid and other government welfare programs go away. I think if it did, we would see a very different (and more affordable) health care model emerge.

  17. Steff, it may be true that if we allowed health insurance to be completely privatized and open to capitalistic competition, we may have better options. My concern is what happens when you try to switch over, and what about the poor.
    In capitalism the poor will always be stepped on and left in the dust. The insurance they would be able to pay for (if they could afford to pay) would be substandard at best.
    A rough analogy would be like buying a car. The capitalistic principle of supply and demand is present in the car market. You can get pretty decent cars for a decent price, or you can dish out a lot of money and get the souped up car. But there are a lot of people who just cannot afford a decent car and have to walk, bike, use public transportation, or buy a clunker. Cars may be cheaper and better quality because of capitalistic competition, but they are still not affordable for everyone.
    Health care is far more serious than buying a car because it is a matter of life and death. While I am really undecided on the whole debate or privatization versus socialistic health care, I feel that the argument that health care would be better without government involvement is shallow.
    You have to remember that America was once a completely capitalistic country. At one point health care was not controlled by the government in any way. Obviously it was not a Utopian health care system because there was a NEED to provide some kind of coverage for the poor and that is why Medicaid was instituted.

  18. Steff, please site how healthcare would be more affordable, particularly for the poor and working-poor in the U.S. Eliminating government programs won't magically provide the bootstraps people are supposed to pull themselves up by. Having self reliance doesn't mean much when there is widespread unemployment and underemployment. Self reliance doesn't mean anything to the insurance companies that keep raising rates and denying coverage.

    You may not be brainwashed, but I assume from your comment that you have health insurance coverage. This means you are speaking from a position of priviledge, and it is a good idea to consider one's own priviledge(s) before admonishing millions of people to just "be self reliant". That is a simplistic statement made without really considering the struggles many people have by virtue of being born poor, or being chronically ill, or metally ill, or being injured and unable to return to work, or losing a job, or having a sick/injured spouse/child/parent, or being abused/controlled by an intimate partner, etc.

    Lastly, I personally abhore the idea of "every one for themself". I choose to care for my fellow citizens, all of them, and I want them to have access to the "best healthcare in the world". I continue to hope they wish the same for me.

  19. My family has good US insurance only because my husband is in the military, so we qualify for Tricare. There is a small deductible and (except for when he is active duty) a monthly premium of about $180 for four. No co-pays, and we paid almost nothing for each $10,000 birth. I need to find out what they do, if anything, for out-of-hospital births.

    To Rocky: How did you become "informed" and how can you suppose that Kimberly HASN'T found out for herself? I am an American living in my country, and I know we are not #1 when it comes to maternal and newborn outcomes. Read the Amnesty International report on maternal health (http://www.time.com/time/health/article/0,8599,1971633,00.html?artId=1971633?contType=article?chn=sciHealth) and tell us how you feel.

    Nan: Please read The Thinking Woman's Guide to a Better Birth, and anything by Ina May Gaskin.

  20. I can't help but connect the two comments. Like Rocky, I would prefer that the government kept its nose out of my health care business. However, the freedom that we have to try to sue the pants off our health care providers is one of the major factors driving up health care and health insurance costs in the U.S., and many of these costs get shifted to the insured and the taxpayers anyway.

    And it also gives us defensive medicine practices that are more for the legal benefit of the providers than for the medical benefit of the patients. So there -is- a good reason to take all of your OB's advice with a large grain of salt. Seriously, would you go jump into a lake just because your OB told you to?

  21. As a Canadian, I know that our primary healthcare is not "free", it's tax-funded. But it is certainly NOT atrocious!!! Yes, we might have to wait awhile, and actually some things are not covered (chemotherapy drugs! vision exams for adults! dental! hearing tests for children! and any frills like chiro.). But at least I'm not paying thousands for insurance and then still having to pay more at the ER or doctor's.

    We have a better neonatal mortality rate, fewer immunizations, lower use of "specialists" like OB/GYNs and Peds for routine care, which means our births tend to be more birth focussed instead of profit driven. Sure, I didn't have access to midwives due to shortages, but I had great, low intervention births in hospital...and was not left with a huge bill on departure.

  22. Mrs. Schaible -- I don't have all the answers, and I have many concerns, like you, about what happens when you try to make radical change to health care, etc. I do believe regulation would be necessary to health care reform. I also believe that insurance reform and tort reform are essential to this debate. This is a hard conversation to have in a few paragraphs of a blogger comment section.

    To briefly sum up my response... There will always be poor. I don't believe we'll be able to eliminate the poor. That doesn't mean we can't/shouldn't help them. I think the poor should be helped through charities, churches, generosity of family and friends, etc. rather than through government programs.

    I see your point with the car analogy. Yes, private health insurance (as we know it) will always be out of reach for some, even if prices went down. But I still disagree that the government should provide it for them. I think we both want to take care of the poor, the difference is in how we believe we should do that.

    We are not, and have never been (at least as according to Marx's definition) a completely capitalistic society. It has been less than 50 years since the US government got involved in health care heavily with medicaid. You are right, it was not (and still is not) a Utopian health care system and many of the poor did not (and do not) have private coverage. But, do we want a Utopian society? Where do you draw the line? Does the government then step in to provide equality in everything? Housing? Cars? Jobs/Income? Etc?

  23. Olivia-- Frankly, I really resent that anyone who comes out against a government-run health care system is painted in the way you painted me. I'm not compassionate. I don't care about people, etc. etc. etc. That couldn't be further from the truth, yet just because we disagree, you automatically ping me as some privileged snob who wouldn't know anything because I've never had to do anything hard and everything in life has been handed to me.

    How do you know I am speaking from a position of privileged? For the great majority of my childhood, my family did not have health insurance. For the great majority of my marriage, I have not had health insurance. My mother has a chronic illness that left her bedridden from the time I was 8 years old until I was 20. My parents are swimming in medical debt from my mothers illness, but also take the same side as I do on this issue. My parents never participated in a single government program, but did receive assistance from generous family members, friends, and charities over the years. I certainly know what it is like to be poor-- to have little to eat --to not have clothes -- to go to school for years with my broken glasses duct taped together-- the list goes on. I have compassion on those with chronic illnesses, mental illness, injuries, etc. But that does not change the fact that I do not believe the government should provide health care (or food, or birth control, etc.). I do believe the private sector would fill this gap (for many, many people--you're right though--not all) if the government stepped aside. I have faith in people and in their generosity and willingness to help others. And, I also think more people would get themselves out of the poverty cycle if they were forced to.

    I can't admonish people to be self reliant, but it's okay for you to admonish people to accept (and pay for) something they don't believe in? If you really care for "all" of your fellow citizens, then maybe you shouldn't be so hard on me for having an opinion that is different than your own.

  24. Steff, I think the big difference is that I do not have much faith in the generosity of people. My husband lost his job 2 years ago when the economy tanked. I was 7 months pregnant at the time as well. I have never seen people so heartless and uncaring than at that time. We were kicked out of our home, cheated, and taken advantage. Most of the people who did these things to us were church going people and even family!
    We held off and did not get government help for as long as possible but there came a point when we had no choice.
    People are mean, heartless, and selfish. There have been some who helped us a little and others who helped us a lot. Others tried to hurt us, but the vast majority of people really did not care one bit. They knew we did not have food, or a place to live and they did nothing.
    It is a sad day when the government cares more about your welfare than your church but that is just how it is.
    I hate using government aid with a passion, but without it we would be homeless and starving.
    BTW on a good note, my hubby just got a job!!! :D

  25. Oh, thank you, Steff! I thought this thread was going to be predictable, but you've pleasantly surprised me :). In my opinion, it's unfortunate that all home/natural birthing mamas are expected to have liberal views, as if it's the only "thinking woman's" way. Obviously, there are problems with our healthcare system (Which does not simply revolve around maternity care or labor and delivery, btw... There are some things we're still #1 in, cancer research, for example.), the poor continue to live among us, etc. There are many different ways to solve problems, and I think as a country we'd get farther if we didn't dismiss those who don't agree with us as uneducated, morally corrupt, naive, or what have you. Anyways, thanks again, Steff!

  26. Health cannot be guaranteed by virtue or hard work. Disease does not care that you never drink or work out or don't eat junk food. Malnutrition doesn't care that you can't get to a supermarket with vegetables that aren't rotten. Injury doesn't care that you've only had time to save up 200.00 when it's going to cost 2,000 to repair your shattered knee.

    People who are sick don't work. People who die for lack of access to care leave behind families that may become destitute without their income. Mentally ill people without money or family support to provide them access to care roam our street and freeze to death on our sidewalks.

    So yes; if you are against a system that would actually take care of actual people, the people who are dying, right now, in homes and hospitals and on streets across the US, then *you are not compassionate.*

    You are more concerned about some rarified ideal of monetary purity and myths of independence and virtue than about actual human beings who are hurting and dying at rates astonishing for a country as advanced as ours.

    I scorn this logic, this "virtue"; it is cruel, it is shortsighted, it is massively wasteful of human life and potential, and it is shamefully indifferent to the reality of human suffering.

    I am technically no longer a Christian, but I remember that Jesus was unequivocal on how we are to treat the poor, the hungry, and those in prison. I'm pretty sure the man who told the rich man to give all he had to the poor would not be impressed with pious speeches about holding down medical costs by allowing the unworthy to suffer and die in the name of the free market.

  27. Emjaybee,

    With regards to your last paragraph -- you're exactly right how Jesus told His followers how to treat those in need. But He did not tell them that they needed to make others do so. There is a huge difference between me giving to a charity or a person in need because I want to, and the government taking my money just because it can, slicing off a hefty portion to keep for itself and pay for bureaucracy, and pass on the remainder to those in need.

    Capitalism without charity would be a horrendous system, indeed. But capitalism with charity is the best system in the world.


  28. Steff - this line from the Republican party playbook is growing tired.

    "There will always be poor. I don't believe we'll be able to eliminate the poor. That doesn't mean we can't/shouldn't help them. I think the poor should be helped through charities, churches, generosity of family and friends, etc. rather than through government programs."

    You know where people depend on churches and charities to take care of the sick? India. I've never been there, but I've heard stories of people living horribly crippled and disfigured. Of dying from disease which would otherwise be curable. Of having to scavenge in the streets for garbage to eat. Excellent medical care is available in the India - but not for the poor because they can't afford it.

    Really? Is this your vision for America? Don't let your ideals crowd out the reality. Communism, too, is a lovely theory and we've all seen how THAT turns out.

  29. mm. US healthcare from either an ethical or a political standpoint is ridiculous. Other countries believe that at least a modicum of health CARE is a fundamental right of the citizenry. Certainly, you cannot be a leader if you oppress more than half your people through lack of health due to access issues.

    For thought: http://articles.latimes.com/2011/jan/30/opinion/la-oe-smith-thomas-paine-20110130


  30. Freedom? :D Rocky's comment is one of the most self-centered and ignorant I've ever seen.

    I live in, and am a citizen of, one of these "terrible socialist" countries in scandinavia. Our maternal mortality rate is only 50-60% of the american rate. On top of that, we have far greater breastfeeding success, our children do better in schools and everybody is insured for whatever disease might hit them.

    Sure, it costs money, but guess what? It's still cheaper than the american way! :D Americans spend more money on their healthcare than any other country in the world. Result? Unnecessary inventions in an effort to make more money. A system that strives to be as cheap as possible also strives for the best results: Healthy customers/citizens. A system that is designed to generate money leads to striving to make patients more ill, albeit in inconspicuous ways. Like failure to progress. Like the "big baby" syndrome. Like the assumption that after one C-section, a mother couldn't birth vaginally anymore.

    American "freedom" and "choice" may be awesome for the rich and the reasonably healthy. Anyone who deosn't fit both of those categories - or is either really super rich or really super healthy - you're screwed. It also helps to be super educated and live in the right area, too. Here, everybody has access to one of the world's best health care systems.



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