The ‘Best’ Healthcare In The World (Or, “At Those Prices, It Should Be!”)

A number of folks have pointed me to this article in the New York Times: “American Way of Birth, Costliest in the World.”

via nytimes.com
via nytimes.com

If you’re the kind of person who scrolls through the comments section–not an activity I recommend!–you’ll see that I commented twice in response to the clever little embedded questions in the article. Having given birth once in the US and once in the UK, I had some things to say. In the case of this article, the comments are really telling. For example:

Screen shot 2013-07-02 at 10.54.35 AMI suppose one could justify the extraordinarily high cost of maternity care in the United States if the United States had corresponding extraordinarily high rates of maternal and infant health.

Instead, we have extraordinarily low rates of maternal health among developed countries. We’re 49th in the world.

A few years ago–before the Affordable Care Act had passed–I inadvertently facilitated another woman’s ire when I mentioned how excellent my maternity care had been in the UK, and how much I thought the US could improve maternity care. It’s not possible–America has the BEST healthcare in the WORLD! she cried–before calling me a ‘delusional Communist.’

To which I can only say: read Amnesty International’s report, Deadly Delivery (available free) and then we can talk.

In fact, I can say more than that, because I have actually experienced more healthcare services in more countries than anyone I know, and of the developed countries in which I’ve experienced healthcare, the US is the most expensive and least efficient.

As I wrote in jubilant response to the SCOTUS decision on healthcare, it’s by dumb luck and generous government insurance programs in liberal states like California and New York that healthcare bills haven’t bankrupted me and my family.

It should be within everyone’s ability to take care of their health–and that of their children–without going bankrupt.  A recent guest post on Timothy Dalrymple’s blog suggested that Christians who lean left in politics are “Loud on Poverty” and “Quiet on Abortion.”

But might not those things go hand-in-hand? Can anyone read the Times article and not wonder how many abortions happen  because women cannot afford maternity care, and can’t envision alternatives?

Last year I said:

As far as partisan politics go, no less a Republican than Richard Nixon tried in 1974 to make a ‘Medicare for all’ move. You know who opposed it vocally? Ted Kennedy. So what is this about? Massive change in what each party stands for, or total partisan bullsh*t all around?

I really don’t care which initial is in parentheses after a politician’s name. I just like to see policies that are good for the people who don’t have enough money to buy a dental cleaning, MUCH LESS A SENATOR. Besides, didn’t Jesus expressly say something about doing good to those who CAN’T do anything in return?

If we truly value human life, we must strive to find ways to put quality, humane, and affordable care within everyone’s reach.

I’m sorry this post is turning out a bit rambly and excerpt-happy, but my dad recently shared with me reflections on his first visit to a VA (Veteran’s Association–dad is a proud Air Force veteran) doctor, and I think it is relevant:

As I drive home I think back through all the people I have spoken to who have been in this particular
health care system for a while—men and women, young and old, healthy and sick, pregnant or not—and all have said,
without reservation, that they have found the care to be excellent.  In fact, to date I have not heard a
single complaint.  That’s correct: not a single complaint.  Compare this with the constant complaints we
hear about health insurance plans, and the difference is stunning.

But how can this be?  This is a federal program—it’s socialized medicine!

Of course I’m brand new to the system, so perhaps my initial impressions mean nothing.  Perhaps
tomorrow I’ll find myself face to face with the infamous “death panels” of which we’ve heard so much.  

But somehow I doubt it.

On Faking It, Pharmaceuticals, and Whistleblowing

I’ve been feeling crappy for a while.

Can I blame my awful, terrible allergies on my parents? Because I have always had awful, terrible allergies, and, yes, I have tried everything you’re going to suggest, from allergy shots to Allegra to local honey to non-dairy to acupressure to neti pots, to no avail. (Maybe it’s unfixable, and I just have to cope.) And cope I do, which is why I often have trouble distinguishing between the sort of crappy feeling that one dismisses as “allergies” and continues to slog through and the kind of crappy feeling that justifies, nay, necessitates lying in bed.

Add to that the fact that I generally assume I’m being a hysterical, hypochondriac faker, and you can see how it is that even as I held my newborn Graeme in my hands I had this sort of “no waaaay!” look on my face, like, “WOW! I wasn’t faking with all that shouting and grunting; I really was experiencing labor!”

I’m not even going to ask if I can blame this on my parents, because my mother already knows that I blame her ENTIRELY, and yet, do not love her any less for it. If anything, I love her more. If you can’t love the person who, at the age of 10, so convincingly faked an attack of appendicitis such that she persuaded a team of New York City surgeons to remove her perfectly good appendix, thus making it seem that nearly anything could be faked, and quite persuasively, too, really, who can you love?

So, anyway, a few days ago, it became clear that the unbearable pressure in my head and constant nausea was in fact a sinus infection, and that it had gone on long enough. I will allow as how I am one of those people who does, in fact, try things like swallowing whole cloves of garlic before running to the doctor, but when things get to the point of CANNOT LIFT HEAD OFF PILLOW WITHOUT WANTING TO PUKE, I’m like, hand me the ciprofloxacin, STAT.

{An aside, but please read it or the end of the post won’t make sense: as someone who does support the notion that women and families should have the choices to birth as ‘normally’ as possible, if that is their wish, I do NOT check all the boxes that homebirthy women often check off–anti-vaccine, anti-antibiotics–for the simple reason that I read a lot of history, often about disease. Sulfa, penicillin and vaccines are on our side in the Big Picture. It does not follow that every woman giving birth should have an enema, a shave, a disinfecting wash, and a constant drip of antibiotics into her veins, but it doesn’t mean that everything that modern medicine has wrought is bent on destroying your Birth Goddess moment. In fact, if you’re in a developed country, chances are you have the luxurious possibility of luxuriating in your ‘birth experience’ BECAUSE of the lovely, effective medications that would LOVE the chance to save your life should some Streptococcus or Mycoplasma have the audacity to invade your newly delivered nether bits, and because of the scientific progress that helped people understand why they oughtta wash their hands after dissecting cadavers before dealing wish those bits in a hospital context.}

I’m feeling much, much better now (thanks to above-mentioned ciprofloxacin) and ready to arise from my bed without barfing. Clearly, I need therapy that’s not pharmaceutical to figure out why I always just assume I’m faking it, but whatever.

As I was in the midst of this, one of my writing colleagues alerted me to this post (Peggy Orenstein on the sexualization of Candy Land on The Atlantic) in a way that suggested either excitement or distress. On reading it, at first I was like, “oh, how nice, some of my ideas and images made it onto The Atlantic!” And then I noticed that my name wasn’t there, nor any link to my blog (this has since been addressed.) And then, because I’m me, I wondered if I was FAKING, making it all up; if, in fact, this was an incredible coincidence and I had somehow been inspired by Peggy Orenstein without having ever read a word of hers or heard her speak and so on.

So I made a chart. I talked to this friend and this wise colleague and some other friends, and, of course, my resident scholar. 

Am I just being crazy? I asked everyone.

I will leave the curious to explore Jana’s post and Ellen’s post as they choose, and I have but little else to say on the matter except that in the course of discussing this with others, I’ve discovered that (sometimes unintentional) borrowing and bold-faced plagiarism happens WAY more often than many of us suspect.

Screen shot 2013-04-30 at 10.16.28 AM

I’ve also discovered that it is a thankless job to point out such things (which is why I am profoundly thankful to Ellen and Jana) and, while one or more of us involved have been accused of trying to “self-promote,” the MORE LIKELY SCENARIO is that when people “blow the whistle,” so to speak, others will view them as–well, as ethical hypochondriacs–as people who are attempting to con surgeons into removing perfectly good organs; people who want to turn hay-fever into influenza; to take antibiotics for their allergies.

Look, I’m under no illusions that Jana and Ellen are Woodward and Bernstein, or that this little incident matters much at all in the HUGE scheme of things, except that it does, and here’s why: because if telling the whole truth matters in Big Things, it matters in little things. If it matters on the front pages of the New York Times it matters on little tiny blogs like this one. Women dying by the thousands and millions from puerperal fever wasn’t God’s punishment for immorality, as people suspected. It wasn’t from a Big Thing. It was from the tiny streptococcal spooks that people didn’t even know they should care about. And yes, the discovery of antibiotics helped, but just WASHING HANDS did, too.

And so I’m feeling less and less crappy, thanks not only to the cipro, but to those who risked being called ethical hypochondriacs, risked contaminating their hands enough to raise some questions as to whether the invisible spooks–the bacterium–of untruth had tainted my work, and to insist that those who write keep their hands clean of unintentional borrowing.

It’s not the kind of thing that earns a Nobel or any other kind of prize, but, then, neither was the hospital handwashing station, or the bar of soap.

Addendum: This is as good a place as any to say that both Ellen’s book, No Easy Choice, and Jana’s most recent book, Flunking Sainthood, deserve a place on your Amazon or indie bookstore wishlist, or, at the very least, on your library’s loan request system. I’ve written about both before on this blog (Ellen’s here; Jana’s here) but as usual I have more to say:

  • Ellen’s book is absolutely a must read for people of faith dealing with infertility, the possibility of using techniques like in vitro fertilization (IVF) and genetic screening. It is a meticulous exploration of bioethics that’s written in a way that everyone can understand AND that shares her own story of living with a genetically caused disability and fearing passing on that disability to her children. As a meditation on human limitations and disabilities, it’s great. As a book on the questions facing those with infertility and other issues, it’s great. Essential, really. So, buy Ellen’s book.
  • Jana’s book is laugh-out-loud funny in that vulnerable yet serious way of Anne Lamott, with the observational humor of a David Rakoff or a David Sedaris. But it is also a fantastic, entertaining look at many of the spiritual disciplines that people of faith (particularly Judeo-Christian faith) have followed for millenia, and all the more engaging because Jana actually did these disciplines, a different one each month, with mixed success. And if you should come across the fact that Jana is Mormon as you search for this book online, DO NOT TELL ME OR EVEN THINK that if you are evangelical, Anglo-Catholic, Catholic, or some kinda Reformed or Baptist Christian, that she has nothing to say to you. Her book is BIG TENT in the best sort of way, which is to say, it’s very much about seeing spiritual disciplines as a way to live like Jesus. It’s fabulous. So, buy Jana’s book.

Better Births Beyond Mommy Wars

Why, oh why, do discussions in the US–especially discussions that take place on the Internet–pit one side against the other as ferociously as possible? Egalitarian v. complementarian! Republican v. Democrat! Vegan v. Bacon-ist!

(Is that a thing? Because it seems like a thing. I’ve always liked bacon, but then one day I went on Facebook and saw that people were putting bacon in their margaritas and in their cinnamon rolls and stuff. What’s up with that?)

Anyway, discussions about all sorts of things can quickly turn to extremes. One of those extremes is in the area of birth. I will grant that sometimes to change things we need to take extreme measures (BACON IN EVERYTHING) but just as often, or more often, change comes slowly (humanely raised, non-nitrite bacon as a Sunday morning tradition. Or something.)

Those who’ve followed my writing know that one of my interests is better birth: safer motherhood for women in developing countries, more humane, high-touch childbirth for women in high-tech countries. Here’s my latest Huffington Post article on the subject:

Discussions of what is best in maternity care are often polarized as a choice between elective c-sections in high-tech hospitals and unattended home births in bathtubs, dismissed as a “battle zone in the Mommy Wars” or, worse, as a “status symbol” of hipness. But these lines are artificial, having been drawn not by mothers but by midwife-maligning men who believed that women’s wombs were diseased and dangerous, and there are better models, models that don’t pit one “side” against the other. And we don’t even have to look to Sweden or the Netherlands to find them.

We can, for example, look to midwife Ruth Lubic, who used her MacArthur Genius award to found the Family Health and Birth Center in Washington, DC. Lubic attributes the Center’s success — it has outcomes twice as good as DC generally — to their “high touch, low tech” support. Still, she says: “we can’t function [without obstetricians] and really need to be a continuum. Families can’t have the best care without this partnership.”

It’s not a question of who’s “right,” or which “side” you’re on. It’s about finding policies and practices that make it easier to do what’s best for women, which is to say, what’s best for everyone.

{This is the end; click through to read from the beginning.}

The Groaning Table

I have a guest post on the Slow Church blog, which is written by my friend and fellow forthcoming IVP author Chris Smith (also of Englewood Review of Books. Chris recently asked a number of friends to read, reflect, and write on Wendell Berry’s essay “Health is Membership.” Here’s my contribution.

The Groaning Table

My grandmother was born at home in New York City in 1925 – exactly the time when more and more women, especially city women, began to choose hospital over home as the place to have babies. It wasn’t that my great-grandmother was afraid of the hospital or of doctors; or that she wanted to keep the baby away from sick people who might have contaminated the hospital halls. Rather, it was that she’d heard that the hospital didn’t have very good food.

I remember great-grandma Katherine the way you remember a dream by the mid-afternoon, in random yet related pieces. When I think of her, I see first a shadowy image of her – a tall, square-shouldered woman – in a chair, which cuts quickly to a snapshot of her smiling over a plump, baby version of me in a garish vinyl seat. There’s also a 5-second clip of the two of us laughing over the black dog, Chloe, who prances and plays a piece of red blanket. And that is it. The rest of what I know is what I have been told.

She was born in the 19th century to a mother who had left Ireland in the potato famine and who then married a horse trainer that she met on the steps of the 42nd Street library. She had influenza in the pandemic of 1918; she spent a year in bed and recovered. This is a fact my grandmother will refer repeatedly to as evidence, first, that we are the inheritors of ‘hardy genes’; second, that resting in bed is the best medicine for a cold; third, that, before going to bed with a cold, you should have a hot toddy made with Christian Brothers brandy, a remedy of Irish Catholic grandmothers, never known to fail.

I want to believe all of this so much; to exist someplace where the advice to drink a hot toddy and go to bed when I’m feeling achy and congested is solid wisdom (not antiquated and vaguely irresponsible) while the advice to take some drops of echinacea and zinc and continue dragging myself through my routines is dangerous and faddish. To live in a world where a woman’s decision to give birth at home because she knows that, at home, the food will be good is sensible, not selfish.

{Continue reading the rest at the Slow Church blog…}

Why We Need Birthing Videos

I have a new post up at Christianity Today’s women’s blog, her.meneutics, on birthing videos and whether or not they are ‘modest.’ My answer? Of course they’re not modest, but they may serve an important purpose. Here’s a taste:

Candice, a regular Her.meneutics reader, wrote to me recently in response to this post, asking what I thought about women sharing their photos and videos of giving birth. Another Christian website had called this practice “immodest”; Candice, who is pregnant and planning a natural childbirth, told me that she has found these videos “inspiring and educational, since I’ve never seen an actual birth of any kind.” She also wondered whether categorizing birth videos as “immodest” might be related to the ongoing discomfort in North America with public breastfeeding. Does Christian “modesty” really mean not viewing or posting pictures depicting these intimate events?


Birth videos show women accomplishing some of the hardest work women ever do. They show great pain resolving into great joy. They show us an event that many of us never see in “real life,” an event that Hollywood can depict only in clichés. In movies, labor begins suddenly, with a frantic cry of “it’s time!” or an embarrassing gush of amniotic fluid. In reality, for many if not most women, labor is so gradual that it is only later that they can look back and say, “Oh, that’s when it started.” Usually there is no need for rushing around panicking; it’s more a slow leak than a blowout. Also, doctors don’t deliver babies from under a sheet anymore, not every woman screams, “you did this to me!” at her husband, and women don’t need to be shouted at to “push.” But crises make for better drama and, not infrequently, comedy.

Because birth is for most Americans an event that takes place in the hospital—and, increasingly, in the operating room—there are simply fewer opportunities for women to see other women give birth. By contrast, in early America, as in virtually all traditional cultures, to attend another woman’s birth was expected and routine, more or less like attending a baby shower today. You would help your friend during her “lying in,” knowing she would help you at yours, a phenomenon that historians and anthropologists have called “social childbirth.” It’s worth noting that that while, officially, only women who had already had a baby were included in social childbirth, homes and society were structured in such a way that it’s unlikely a woman would go into labor without a strong understanding of the process of labor (if not the, ahem, crowning moment).

{Read more here.}