One half of the babies in this country are born under the Medicaid system. This means that the young mothers are poor. Some are married, but more often the man, who once told her she was the love of his life, is now daunted by what he feels is overwhelming responsibility. The father can barely support himself, and now is expected to support his girlfriend and a new baby? Often, he just disappears. These women have a tenuous support system with guaranteed poverty and despair unless someone intervenes to help. The taxpayers cannot possibly support everyone, and the government welfare system is a cold substitute for a loving husband and daddy.
A distressed father of a 24-year-old daughter called because she had just declared that she was pregnant. She thought she had 4 more months but it turned out she was due in 5 weeks. The baby's father wanted no part in this. Many phone calls to agencies and legislators yielded a Medicaid card and an appointment at a Medicaid clinic-2 weeks past the due date. No reasoning or cajoling would entice the robotic secretary to move things up, so a crisis pregnancy center referred the baby's grandpa to me, a specialist in internal medicine. I told him he does not want me to plan to deliver his grandbaby, something I have not done since medical school.
Private practicing obstetricians are disappearing, and young highly trained doctors are finding that they cannot pay medical malpractice premiums of more than $100,000 per year when they start out. Medicaid pays a total of $800 per delivery-including all the pre- and post-natal care. No wonder it is difficult for this pregnant woman, now by definition high risk, to find a physician who will care for her. Under the best of circumstances, with those payments, how can a doctor expect to pay his student loans, office overhead, and staff, much less have something left for himself? But add the specter of infinite liability, and the denial is automatic.
I have heard some newly minted obstetricians claim that, because they cannot afford to pay the premiums, they are able to do the prenatal care, but then instruct the young mothers to go to the emergency room when they go into labor. There an ER doctor, nurse, or resident can do the actual delivery. It turns out that medical school residents and students are protected for medical malpractice by the state, protection that disappears once they complete their training. It is hard to believe that the ER care can be as good as that provided by someone who has completed the rigorous obstetrics training. It defies logic.
We need more obstetricians to deliver our babies, and we need to find a way to be sure that their compensation is adequate to allow them to be there for us, whether we are insured and can pay them or not. Society certainly benefits from healthy babies and happy mothers.
Is there a solution? What if we had many non-government prenatal centers dotted throughout each county, places where volunteer grandmas and nurses could get to know these frightened young uninsured women as they came in regularly for their pregnancy visits? Learning more about their backgrounds, struggles, and pressures could lead to teaching opportunities and a sort of parenting that many of these women never had. The concept of getting young women connected to adult role models before they take on the daunting task of raising children seems worthy of more attention.
What if the state provided malpractice protection to fully qualified physicians as well as medical students, say in return for donating a certain amount of care? Without the huge burden of liability premiums, many more physicians would likely return to delivering babies-and would not need to bring in so much revenue to keep their doors open. The taxpayers would be spared the costs of loading more patients onto the broken Medicaid system-administrative costs as well as medical. Uninsured women not eligible for Medicaid could get better care. It would be a win-win-win for physicians, taxpayers, and mothers and babies.
Why not try it?