Now They Come For The Obstetricians

First they came for the Orthopedists. Today, the NY Times slams the cost of Maternity Care.

...  Despite its lavish spending, the United States has one of the highest rates of both infant and maternal death among industrialized nations, although the fact that poor and uninsured women and those whose insurance does not cover childbirth have trouble getting or paying for prenatal care contributes to those figures.

Some social factors drive up the expenses. Mothers are now older than ever before, and therefore more likely to require or request more expensive prenatal testing. And obstetricians face the highest malpractice risks among physicians and pay hundreds of thousands of dollars a year for insurance, fostering a “more is safer” attitude.

But less than 25 percent of America’s high payments for pregnancy typically go to obstetricians, and they often charge a flat fee for their nine months of care, no matter how many visits are needed, said Dr. Robert Palmer, the chairman of the committee for health economics and coding at the American College of Obstetricians and Gynecologists. That fee can range from a high of more than $8,000 for a vaginal delivery in Manhattan to under $4,000 in Denver, according to Fair Health, which collects health care data. 

According to the NY Times, the main issue is "a la carte" billing and payment. The solution is predictably bundled payments.

There are two problems with the NY Times analysis. The first issue gets barely a mention and, of course, is buried. That is cost of medical liability. While the US leads the world in healthcare costs, it also leads the developed world in liability costs as well.

Moreover, medical liability costs have risen faster than all other tort costs and healthcare inflation.

While the article mentions the high rate of liability insurance for obstetricians, it conveniently neglects the mention of the costs of liability insurance for what often is the deepest pocket - the hospital. Moreover, the article does not examine defensive medicine at all.

Finally, the article neglects to mention another, more troubling issue - the financing of graduate medical education. With the present emphasis on healthcare belt tightening, the costs of the training of our future doctors always seems to get the short shrift. This needs to be addressed asap and cannot be seen as an afterthought.

I look forward to future NY Times articles focusing on these two issues: graduate medical education and medical liability reform. Our lives may depend on it.