Having Babies

A Kaiser Foundation study claims to show how awful Health Saving Account plans are for women who experience pregnancy and child birth.  It focuses only on the extra out-of-pocket costs HSA plan members face, while completely ignoring the premium savings from choosing such plans.  (If you have an endowed foundation and don't have to compete for funds, I suppose you can get away with this stuff.)

According to Kaiser, an uncomplicated pregnancy by vaginal delivery costs $9,660 in Maryland.  A C-section costs $12,453.  If a lot of things go wrong, the cost is $287,453.  The researchers calculate the out-of-pocket costs in those cases for different types of health insurance plans.

Surely the interesting question is not, "What is the patient's share of the bill?" but rather, "Why is the bill so high in the first place?"

Let's see, women have been having babies for how long?  100,000 years?  Perhaps more than a million years, if you stretch the definition of humanoid.  After all that time, folks in Maryland have not figured out how to deliver a baby for less than the price of a new car?

Parkland Memorial Hospital in Dallas delivers 16,000 babies a year – more than any other hospital in the country.  Average cost: less than $4,000 – including prenatal care and averaging over all deliveries, the healthy and the unhealthy.  Moreover, Parkland mothers are almost all at risk.  In fact, they are very at risk.  They are all poor.  About 82% are Hispanic and an estimated 70% are illegal.  Yet among those who complete prenatal care (about 90% of the total) the infant mortality rate is half the national average!

Most prenatal care at Parkland clinics is administered by nurses.  Most deliveries are handled by midwives.  Yet Parkland is so good at this that the doctors there update an annual how-to-do-it textbook that is used all over the world.

The real lesson to be learned here is one that completely eludes the Kaiser policy wonks.  If all Maryland women were managing their own maternity care dollars, most Maryland hospitals would go out of business in a flash.  Either that or they would all rush down to Dallas to learn how to deliver babies efficiently.  They would also discover how to charge one, low-cost package price, covering all contingencies.  At the very least, they would read Parkland's textbook.



For the Kaiser Family Foundation study:


For the description of Parkland, see "Health Care without Insurance," p. 26, in the NCPA's Handbook on State Health Care Reform at:

Comments (8)

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  1. Roger Beauchamp says:

    Good piece! Responsible citizens, those who earn their benefit dollars, need to realize they will be better off managing their own health care financing dollars.

  2. Mashiko says:

    one of the many things that can be done to reduce the bill is on “having babies” is to run a volunteer doula program in each delivery unit. A doula coaches a laboring mom by providing relaxing techniques and labor progressing support (i.e. staying off the bed, walking, squatting, showering etc. ). A laboring mom needs a lot of support and having a woman helping by her side makes a huge dramatic difference. A mom-doula team’s goal is to have a completely natural delivery. Published evidence shows that doulas help reduce the bill. Sutter Hospital in Davis California run a Doula Volunteer Program, I was a former volunteer and can testify first hand what a difference we make, without earning a dime, in helping moms and bringing down the bill by reducing the number of C-sections and other complications. We do it because we care.

  3. Dr. Bob says:

    Again, reality rears it’s ugly head…

  4. Roger Ream says:

    Excellent commentary, John. I hope the policy wonks at Kaiser take you up on your suggestions and come to Dallas to learn about well-managed, market-driven health care.

  5. J. Graham says:


  6. Stanley Feld says:

    You are really good. Keep slugging.

  7. Not Michael Moore says:

    I agree with much of John’s diagnosis, just not his prescribed cure. I’m just not convinced individuals are geared to be be smarter decision makers than the existing payers of health care.

  8. Amy Bassett says:

    I am a Certified Nurse Midwife (CNM) in Illinois and totally agree with this model. In most European countries, (Sweden, UK, Netherlands) 70% of mothers are attended by CNMs, 30% (mostly high risk mothers) by OB/GYNs. Physicians are trained in school to treat and look for pathology. Most of the time, birth is normal process without pathology. It becomes pathological when we start looking for problems and jump to (sometimes) unnecessary interventions, causing a domino effect. This often leads to more interventions. I believe this is why the Cesarean rate in this country is increasing drastically every year. For more information, watch the recent documentary by Ricki Lake, the Business of Being Born. Women get the best care and have the best outcomes when they are cared for by CNMS in collaboration with physicians.