> But what really confuses me is why the Insurance companies are putting
> up with it. I mean, not only do they have to pay more, but there are
> proven, workable alternatives.
The NYT article says the insurance companies have found their own workable, market-based alternative: just don't cover women who've had C-sections:
"She was turned down because she had given birth by Caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had been sterilized after the Caesarean, or if she were over 40 and had given birth two or more years before applying, she might have qualified." ... "Insurers often accuse women and obstetricians of scheduling unneeded Caesareans for their own convenience — to deliver the baby at a certain time, or to avoid labor. But it is not known how much of the overall increase in Caesareans is because of a rise in unnecessary operations, or how many Caesareans are done at the mother's request, according to a 2006 report by the National Institutes of Health.
"I think it's really a very small amount, but we need more data," said Dr. Mary D'Alton, chief of obstetrics and gynecology at Columbia University Medical Center, and an author of the report. "
> Any ideas? I do recommend the documentary. It's not super great, but
> it's good enough, to get you thinking. Netflix has it.
I am loath to implicate lawyers in this kind of shit, but my hypothesis is that American doctors are performing C-sections at a higher rate than those in other developed nations because they're afraid of being sued. From the NYT article:
"Although many women who have had a Caesarean can safely have a normal birth later, something that Ms. Udy's group advocates, in recent years many doctors and hospitals have refused to allow such births, because they carry a small risk of a potentially fatal complication, uterine rupture. Now, Ms. Udy says, insurers are adding insult to injury. Not only are women feeling pressure to have Caesareans that they do not want and may not need, but they may also be denied coverage for the surgery."
...So doctors and hospitals are imposing a blanket rule (C-sections for any patient who has had a previous C-section) to avoid a rare but serious complication. This isn't necessarily good for patients, but it allows doctors to avoid a costly lawsuit if a patient does have uterine rupture. In the event of such a law suit, you can be damn sure the plaintiff's attorney is going to be asking "why didn't you perform a c-section if you knew this patient had had a previous c-section and that this made her more vulnerable to uterine rupture?"
I suspect the higher rate of American c-sections on women who haven't had c-sections before is for the same reason: Doctors are afraid of being sued if the baby ends up developing cerebral palsy, which can happen if you botch a vaginal delivery.
Of course, such lawsuits are only necessary because the U.S. doesn't have universal healthcare and the risk of these kinds of medical complications is borne privately.
I swear, nothing gets me in a bloody, put 'em against the wall mindset like reading articles about private health insurance. :-) -WD