The Childbirth Industrial Complex

[lawdog77]

It's amazing how easily bought and paid for our politicians are, isn't it?

Judges too
https://www.rollingstone.com/politics/politics-features/clarence-thomas-rv-loan-health-care-1235059440/

[Jockey]

Judges too
https://www.rollingstone.com/politics/politics-features/clarence-thomas-rv-loan-health-care-1235059440/

He has always been open to bribes. And he's only the 2nd most corrupt justice. Combine that with the weakest Chief Justice in history and our democracy disappears if trump is elected.

[WarriorFan]

From Sarah Kliff in today's NYT The Morning e-newsletter:

Americans spend more on childbirth than nearly anything else that happens at the hospital. The average delivery is $13,000. Even after insurance pays, patients who have babies still end up on the hook for nearly $3,000.

I've spent 15 years covering the high costs of American health care, an industry in which patients routinely encounter $600 Band-Aids and $3,000 Covid tests. Recently, I've been amazed at how much hospitals, doctors and medical device companies are charging families for newborn care.

They are eking out more money from each step of having a baby. They often tap into the anxiety that so many parents feel as they form new families. "People are willing to do anything to ensure the well-being of their kids even before they meet them," said Neel Shah, chief medical officer at Maven, a women's health clinic.

Health care companies have several chances to make their pitch between a positive pregnancy test and the birth of a child.

In the first trimester, genetic companies sell tests that claim to detect serious and rare problems from a few vials of the mother's blood. But these tests, which can cost thousands of dollars, are usually wrong when they make grave predictions about an infant's health. The inaccurate results can lead parents to spend thousands on more tests and even to consider abortion.

The second trimester often brings a pitch for umbilical-cord blood banking. Brochures in obstetricians' offices describe how paying to freeze and store a newborn's stem cells may be vital if the child becomes ill later in life. But the few parents who try to use their samples often find that they are unusable, either because they have too few stem cells or because they are contaminated. Azeen Ghorayshi and I investigated these companies in a story The Times published today.

Most spending on childbirth goes toward delivery and newborn care. Cesarean section delivery remains the most common surgery in American hospitals, despite years of advocacy to lessen its use. About 30 percent of kids are born this way, more than twice the World Health Organization's recommendation.

One reason is that we have bizarre incentives. Hospitals earn 50 percent more for C-sections than for vaginal deliveries, even though recent research shows they cost less than vaginal deliveries. When cheaper medical care earns more money, that warps behavior.

Neonatal intensive care is also proving to be very profitable. Nearly 40 percent more babies went to these units, supposedly reserved for the sickest kids, from 2008 to 2018. But the infants weren't sicker. Some doctors worry that hospitals may send healthy babies to the NICU because it pays better. Investors, seeing the opportunity, have been buying up neonatology practices.

The experts I talked to have a few explanations for why these efforts work. To start, there are millions of births every year. Hospitals know that childbirth will always make up a large share of their revenue.

Another reason is that the most successful messages — the case for banking cord blood, buying advanced genetic tests or spending a few extra nights in the NICU — are selling safety for your child.

Lastly, these pitches tend to come from a trusted source: our doctors. They distribute brochures that overstate the benefits of cord blood banking or genetic testing. Cord blood banks even pay obstetricians to collect the stem cells. When your doctor endorses a new and promising technology, it is awfully hard to say no.

Example from living in a non-US country which has a not great public health care system that's very low cost, and an active private health care system for those who want to pay:  When you find out you are pregnant you go to a birth consultant at the hospital of your choice and pay for a "package" including all services.  The cheapest packages using the public system and minimal care and no guarantee of the same doctor and normal wards are in the $250 range.  The most expensive package which guarantees the same doctor throughout, covers all tests and ultrasounds and birthing and private room afterwards... and all the 'panic' visits for early contractions and bleeding and all that kinds of stuff... essentialy the top package covers everything except the conversion of the birthing process to c-section.  $3000.  C-section (which we had to do, that's a different story) was $1200 extra.  This was for "Professor-Doctor" care throughout, from the head of the department!  There was nothing about this experience that was even a tiny bit worse than a top US hospital.

The problem is not the hospitals or the doctors, it's who is paying.  When there is no such thing as insurance (like the country we were in) and the user pays for the service, the user will pay the best price for themselves, and the providers must meet every possible price point.  When insurance is paying and people don't even know the cost nor the revenue of the services provided, the accountability is gone, and prices go up!

[MU82]

From the Wall Street Journal:

Some private Medicare Advantage insurers pushed nurses to run screening tests and add unusual diagnoses that entitle the companies to extra money, a WSJ investigation found. The roughly hourlong stops turned into $1,818 more per visit, on average, from 2019 to 2021—about $15 billion in total.

Many insurer-driven diagnoses were wrong or highly questionable. Private insurers denied using inaccurate diagnoses to jack up their payments. The Medicare Payment Advisory Commission, a nonpartisan agency that advises Congress, recommended not using home-visit diagnoses toward extra payments, and the overseeing inspector general advised reconsidering using these diagnoses.

The Centers for Medicare and Medicaid Services said the agency recently increased its diagnosis audits and is making some diagnoses ineligible for extra payments.

[MU1in77]

From the Wall Street Journal:

Some private Medicare Advantage insurers pushed nurses to run screening tests and add unusual diagnoses that entitle the companies to extra money, a WSJ investigation found. The roughly hourlong stops turned into $1,818 more per visit, on average, from 2019 to 2021—about $15 billion in total.

Many insurer-driven diagnoses were wrong or highly questionable. Private insurers denied using inaccurate diagnoses to jack up their payments. The Medicare Payment Advisory Commission, a nonpartisan agency that advises Congress, recommended not using home-visit diagnoses toward extra payments, and the overseeing inspector general advised reconsidering using these diagnoses.

The Centers for Medicare and Medicaid Services said the agency recently increased its diagnosis audits and is making some diagnoses ineligible for extra payments.

We have Medicare Advantage through United Healthcare and get at least a call a week wanting to set up a home visit. My wife did it once and got a $50 gift card but after talking to my Dr, I  just schedule a 6 month visit with him.