I was utterly shocked by the information in "American Way of Birth, Costliest in the World" ("Paying Till It Hurts" series, front page, July 1), even though I regularly follow news about health care. The lack of price transparency was not as surprising as the figure of $37,341, the average 2010 billed charges for having a normal pregnancy and delivery.
It is so important that we Americans learn more about health care costs and try to understand what is behind them, because their growth is outstripping the growth in our gross domestic product. The Affordable Care Act will help bring good sense back into health care spending by providing mechanisms to evaluate new and better ways to provide care.
Entities such as the Center for Medicaid and Medicare Innovation, the Independent Payment Advisory Board and the Patient-Centered Outcomes Research Institute can provide recommendations toward this goal.
But in the end, Eugene Declercq, a Boston University professor whom you quote, is right: "We've met the problem, and it's us." We all need to examine our health care bills and question our medical providers about what care we do need, and what we might not need.
ELIZABETH POWELL
Berkeley, Calif., July 1, 2013
The writer is a retired primary care doctor.
To the Editor:
"American Way of Birth, Costliest in the World" doesn't mention a critical nuance of childbirth expense. The risk tolerance of pregnant women and their caregivers is exceptionally low. Childbirth is fraught with risks, yet the expected outcome is perfection — healthy baby, healthy mom, regardless of the circumstances. At the same time, catastrophic outcomes can be very challenging to predict.
Unlike our less expensive European counterparts, most birthing centers in the United States maintain elaborate blood banks, intensive care units and access to specialists. These "just in case" resources add to the total cost whether they are used or not, and their ready availability leads to overtreatment.
To solve this problem, we must focus on where the value lies in the care we provide and make this information transparent to families. Then we may have a fighting chance to eliminate needless services and make childbirth more affordable.
NEEL SHAH
TONI GOLEN
Boston, July 3, 2013
The writers are obstetricians at Beth Israel Deaconess Medical Center. Dr. Shah is the founder and executive director of Costs of Care, a nonprofit that tries to reduce medical bills.
To the Editor:
Price gouging of pregnant women has joined the litany of profiteering opportunities by the health care industry. Unnecessary tests during pregnancy add to patients' financial burden.
Women don't have an innate preference for medicalized births and shouldn't be blamed for overuse of services. The root cause rests with companies that sell equipment and supplies for intravenous therapies, ultrasound and anesthesia used in high-tech births, along with other industry players that have every financial incentive to make birth as unnatural as only the unfettered marketplace can do. Investors reap higher returns and sales representatives bag bigger bonuses. Everyone wins except women, who don't stand a chance against the medical-industrial complex.
Little wonder that women interviewed for your excellent article express dismay about the greed that has mutated the miracle of birth.
ROSEMARY GIBSON
Arlington, Va., July 2, 2013
The writer is a senior adviser at The Hastings Center, a bioethics research institute, and the author of "The Treatment Trap." To the Editor:
Thank you for calling attention to the challenges America faces in providing affordable, quality maternity care. An overhaul of our maternal care system is long overdue.
As a midwife who has practiced domestically and abroad, I have seen that reserving high-tech, expensive diagnostic tests for high-risk women or women presenting with worrisome symptoms serves women and their families best. It shields women from unnecessary invasive procedures, false alarms requiring even more testing and the associated spiraling costs of care.
It's time for us to learn from others beyond our borders about high-quality systems that keep costs within reason. In most countries with excellent maternal and newborn health outcomes and universally affordable care, midwives lead maternity care — referring high-risk and complicated cases to specialists.
REBECCA HERMAN
Watertown, Mass., July 1, 2013
The writer is special adviser to the president at Pathfinder International, which focuses on reproductive health.
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