On Tuesday, Oct. 22, an Athens Daily News editorial commended Americans for rejecting a Canadian-style national health care plan. On Sunday, Oct. 2, Joan Beck's column "Can we save our health-care system?" discussed problems with HMOs. Neither column pointed out the real underlying problem: that without regulation neither HMOs nor the health care profession has any accountability to the public or any responsibility to see that everyone has reasonable access to the kind of health care people actually need and want.
The result is many rural counties without health care providers or facilities, people stuck in choice-limited HMOs their employers chose to save money, and new approaches to healthcare being kept out of the market.
Maternity care provides a good example of how our "free enterprise" system is not working for us, whether we are dealing with HMOs or with the "old" system of private practitioners and insurance.
Here are some facts: the US spends more per capita on health care than any other country in the world, yet we rank 23rd among industrialized countries (36th in the world) for infant mortality; Georgia has one of the worst rates in the US. We have one of the highest cesarean section rates in the world (without related improvements in outcome), of which about half are unnecessary according to both the World Health Organization and Public Citizen's Health Research Group.
In the Western European countries that have lower infant and maternal mortality, lower cesarean birth rates and lower health care costs than the U.S., midwives are the primary care providers for over 70% of births; about 5% of US babies are delivered by midwives. For years the World Health Organization has recommended that most births should occur outside the hospital, attended by midwives or birth attendants, without routine technological interventions. In the US, only about 1% of births take place outside the hospital.
Midwives practicing the prevention-oriented, woman-centered midwifery model of care in and out of the hospital provide a very effective kind of care desired by many women--a model of care that is appropriate for a majority of pregnant women and that has been proven to reduce the incidence of birth injury, trauma and cesarean section. It has been estimated that by developing midwifery care, demedicalizing childbirth, and encouraging breastfeeding from $13 billion to $20 billion a year could be saved in health care costs.
Given such facts, shouldn't midwifery care be universally available in the US?
Unfortunately, the "free enterprise" interests of the medical profession stand in the way of midwifery. Certified nurse midwives are legal in every state, but in order to practice must have a doctor's voluntary agreement to provide consultation and referral. This is rather like requiring Ford Company to have an OK from General Motors before opening a showroom. The result? By declining to engage in such agreements, doctors easily have prevented certified nurse midwives from going into private practice, blocked their hospital privileges, stopped their legitimate home birth practices (as they did in Athens not too many years ago), and stood in the way of birth centers, thus making this beneficial kind of care unavailable regardless of the demand for it.
Sixteen states, including Florida and South Carolina, also license midwives who were not nurses first, and who practice primarily in out-of-hospital settings. These midwives have excellent records. However, all attempts so far to legalize these "direct entry" midwives, in Georgia and in many other states, have met with very strong opposition from the medical profession.
Clearly, if maternal health care and normal birth moved to a more effective, preventive care midwifery model located primarily outside the hospital, doctors, insurance companies, hospitals and medical technology and hospital supply companies could eventually lose business. However, these players can (and do) use their considerable financial and political clout to prevent such a change, no matter how beneficial and desirable it would be for the women and families of this country.
The "free market" is not free when controlled by a monopoly, and "competition" with its benefits does not exist without alternatives to chose from. To suggest that "free enterprise" alone is great for health care, and that any government plan or regulation is bad, is to ignore the facts and peoples' needs. Health care is a very personal and necessary aspect of our lives; access to a variety of effective kinds of care should be guaranteed- by the government if necessary.
Please note my new e-mail address: (shodgesmwy@peachnet.campus.mci.net) Susan Hodges