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.

A couple of weeks ago I read, with great interest, what seemed like a very comprehensive piece by NPR’s Chana Joffe-Walt that was critical of the way people are using (or abusing, as the case may be) disability benefits in this country. It was both shocking and enraging to me on first glance, mainly because it highlighted how doctors are so quick to deem someone eligible for disability benefits and Medicare, even when they’re affected by something seemingly minor, like a bad back. It also profiled a number of people who seemed pretty complacent about staying on disability indefinitely, people we might associate with Reagan’s “welfare queens.” And to top it all off, Joffe-Walt condemns the federal government for playing the chump in giving states the incentive to push disadvantaged people into the disability pool and off their welfare rolls.

But it’s hard for readers like me, who know very little about the issue, not to be taken in by what in hindsight seems like an unfair generalization:

Disability has become a de facto welfare program for people without a lot of education or job skills. But it wasn’t supposed to serve this purpose; it’s not a retraining program designed to get people back onto their feet. Once people go onto disability, they almost never go back to work.


The NPR graphic that got me all fired up.

I posted a link to the piece on Facebook, which my mother, the bleeding-heart liberal, saw. She immediately fired off a response, a link to a Baseline Scenario piece by James Kwak.

Kwak concludes that “the [NPR] story as a whole suffers from… facile extrapolation from the individual story to national policy.” Ouch! Moreover, he insists,

[Joffe-Walt] overlooks the big story. Federal welfare reform set lifetime benefit limits, meaning that, after a few years, you get completely cut off. After some welfare recipients got jobs, this was the factor that ensured that welfare rolls would go down. Many people who couldn’t work and got welfare now can’t work and get disability. That’s a good thing—especially if the alternative is pushing them onto the streets.

Just something to think about. Many thanks to my mom for helping me think a bit more critically about this issue (and, of course, for all the other great stuff she does for me).

Further sort-of-related reading: Today’s excellent Daily Beast piece by Stuart Stevens, “Poverty Plagues Obama’s America, Press Based in Booming Cities Shrugs.” I’ll just give you a taste:

[Obama] wakes up in the morning eager to focus on jobs the same way George W. Bush woke up eager to focus on health care.