A new study out of George Washington University School of Public Health finds that the number of births in the U.S. covered by Medicaid has risen again, from 40 percent of births in 2008 to 48 percent—nearly half of all births—in 2010.

WOW. Just WOW.

Did you know that? HOLY SHIT.

That 48 percent is especially shocking when you consider that the maximum income eligibility for Medicaid, at least here in Indiana, is extremely low: about $288 per month for a family of three. So basically, you have to be dirt poor to receive Medicaid. (Not even “kind of poor.” Really poor.)

Our state does give pregnant women the courtesy of free prenatal care under “presumptive eligibility,” but that doesn’t cover labor and delivery, which can run into the tens of thousands.

Now on to related first-world problems! My son had ear tube surgery about a month ago — it’s one of the most common surgical procedures for kids these days. An estimated one in five (insured?) children currently gets the procedure, which stops fluid from building up in the eardrum and lessens the occurrence of chronic ear infections.

Anyway, when we got the diagnosis, I Googled the typical cost of the surgery (because god knows the hospital/doctors sure won’t give you an estimate!) and came up with a $2,000 figure, give or take. That’s a lot, I thought, so thank goodness we have insurance that only requires a $150 surgery copay. Right? Right…?

Boy, was I wrong. On top of the $150, we received a bill for $250 a couple of weeks ago from the clinic our surgeon operates out of — apparently that was 15 percent of her fee, which we are on the hook for by the terms of our insurance policy, which covers 85 percent of “procedures.” (So… what was the $150 “surgery fee” for, again?)

Okay, I can swallow that, I guess.

But then, yesterday, I get a bill for $360 from the hospital where the surgery was performed — apparently they had billed my insurance company OVER FOUR THOUSAND DOLLARS for the surgery (would now be a good time to note that the procedure took all of ten minutes?), and naturally we are expected to pay a percentage of that astronomical sum.**

Ear tube insertions are probably the most expensive outpatient surgery you can have done in less than 15 minutes…It is pretty impressive to think that patients with high deductibles are quite often personally billed $2,000 or more despite the fact that the supply and material component of ear tube surgery costs are so low [$25 to $30 for a set of two tubes].

My husband nearly choked when I told him about this latest bill, which of course I’m going to call to contest and give the hospital and/or the insurance company hell about later today. “What the f*** is so frigging expensive about a frigging ten-minute-long procedure?” he rightly wanted to know. Seriously, you could hire Bon Jovi to play at your kid’s birthday party for an hourly rate of $12,000! (Well, maybe the Doobie Brothers…?)

I could only offer my semi-informed personal opinion that it’s precisely because health care is so ridiculously expensive that so many people default on these astronomical bills, causing hospitals to inflate their costs like steroid-crazed bodybuilders and leave middle-class, diligent, bill-paying people like us subsidizing the shortfall.

NOT FAIR. NOT FAIR. NOT FAIR. (Will Obamacare fix this? I sure hope so.)

All of which is to say… my social work professor showed us this short skit in class on Tuesday. BOY, WAS IT EVER RIGHT ON.

** Looking at the actual claim on my insurance company’s website, I can see they paid only about half of that, due to a “provider discount.” So hows about a “patient discount” for yours truly?


babyThere seems to be a spate of articles and editorials lately on the U.S.’s social welfare shortcomings, specifically, its failure to recognize the massive long-term benefits of ensuring the health and well-being of babies and young children.

I wrote about the New Republic‘s excellent analysis of our daycare problem a couple of weeks ago, and today I came upon Anne-Marie Slaughter’s Atlantic editorial, “How to Make the U.S. a Better Place for Caregivers.”  For those who require a scientific evidence-based approach, Dr. Perri Klass also weighed in with “Poverty as a Childhood Disease” today in the New York Times.

I wholeheartedly agree with the argument that these authors advance, namely, that the U.S. needs better low or no-cost early-childhood programs (prenatal care, daycare, and preschool, for starters), given all the research that shows children who grow up in poverty and instability, or with poorly educated parents, are far more likely to become dropouts, addicts, or criminals.
Or as Klass elegantly puts it:

Think for a moment of poverty as a disease, thwarting growth and development, robbing children of the healthy, happy futures they might otherwise expect. In the exam room, we try to mitigate the pain and suffering that are its pernicious symptoms. But our patients’ well-being depends on more, on public health measures and prevention that lift the darkness so all children can grow toward the light.

Got it. Which is why I felt kinda yucky at having the eye-roll reaction I did when reading Mira Ptacin’s piece for Guernica, “Is Baby a Luxury?” Ptacin’s predicament is that she and her husband are too well-off to qualify for Medicaid, but balk at the cost of private health insurance, which they tried to purchase after learning she was pregnant (only to find out that pregnancy counts as a preexisting condition, and as such, would not be covered by her husband’s plan). She expresses outrage that she, a pregnant woman, should go without coverage:

To me, the moral is clear: pregnant mothers should have the right to adequate prenatal care to ensure that they, and their developing babies, stay healthy through pregnancy and birth. All of us are better off when that is the case. All of us are worse off when that is not the case.

When Medicaid turns Ptacin down, she calls them in bewilderment, only to be “greeted with a dry, breathy laugh, followed by, Just because you’re pregnant doesn’t mean you get healthcare.”

Um, so, yeah. Did the author not know this before she “realized that [she] might actually make a really good mommy, and raise a really good human?” Because personally, I could never have dreamed of getting pregnant without being covered by health insurance– whether by private insurance, which I was fortunate to have at the time through my employer, or by Medicaid.

Look, I’m not unsympathetic (and I told Ptacin so in the comments section). I’ve heard the “too poor for this, too well-off for welfare” argument millions of times, many of them more than justified (for example, for a single mother working full-time, without child support, who just misses the mark for sorely needed food stamps).

But to make the assumption, based on a perceived moral imperative, that Uncle Sam would be lining up to pay for your pregnancy? There’s just something repugnant about this kind of act-now, think-later self-righteousness. So to Ptacin, I say: get real. And most importantly… get yourself (and your kid) some insurance.


The New Republic‘s Jonathan Cohn has an investigative piece out this week on the abysmal state of American day care that I can only describe as shocking, enraging, and heartbreaking.

In the United States, despite the fact that work and family life has changed profoundly in recent decades, we lack anything resembling an actual child care system. Excellent day cares are available, of course, if you have the money to pay for them and the luck to secure a spot. But the overall quality is wildly uneven and barely monitored, and at the lower end, it’s Dickensian.

I’ll never forget when my husband made the offhand comment that there were probably “no single mothers” as parents of kids in my son’s daycare class. Why on earth would you think that? I asked him. “Because it costs too much,” he answered simply.

Indeed. As Cohn points out:

It comes down to this: day care is a bruising financial burden for many families—more expensive than rent in 22 states.

As a mother who spends the vast majority of her salary on day care expenses, I can attest to that.

And there are the metrics, of course, especially buzzed about of late: children who spend their early years in an environment where they are not talked to, cared for, encouraged, or made to feel safe are more likely to become truants, dropouts, and criminals. And at the very least, they will suffer from a spectrum of emotional and intellectual setbacks.

The piece focuses on a particular Texas case in which several children died in a fire at the home day care of a woman who was known to be almost criminally negligent. Of course, that’s astounding and frightening and brought me to tears, but in the everyday debate we should probably be focused on not just the worst-case (and admittedly rare) scenarios, but in the mounting deficits our children may be incurring because they are crowded into day cares staffed by grossly overworked, grossly underpaid staff. Here’s the real takeaway from the article:

The lack of quality, affordable day care is arguably the most significant barrier to full equality for women in the workplace. It makes it more likely that children born in poverty will remain there. That’s why other developed countries made child care a collective responsibility long ago.

And while I’m at it, Obama’s Pre-K proposal doesn’t go nearly far enough– for starters, it only applies to children 3 or over.

RELATED: Hear reporter Jonathan Cohn’s interview with Terry Gross on “Fresh Air.”

This is one of the tragedies of the situation, is that parents need these day cares to work to make a living. You’re talking about single parents a lot of the time. You’re talking about families that aren’t making a lot of money. They desperately need someone to watch the kids, or they’re not going to be able to make it. And there just are not a lot of options out there.