How Much Is One Baby Worth?
Medicine is constantly changing
on two important fronts. First, the way it has always changed, involves
the very progress of better drugs, techniques, and instrumentation, usually
involving higher costs. The other way medicine is changing is the newer
phenomenon called "managed care." In an ideal world, the two would go hand
in hand; but since we don't live in an ideal world, we're still sitting
out the outcome of the inevitable conflicts between the two directions.
For example, the runaway
costs of mammogram screening are contained by insurance companies based
on limiting the tests to those who would gain the most benefit. This makes
sense when we readily accept that a fourteen-year-old girl shouldn't get
a routine screening mammogram. But it doesn't make sense if the ones paying
a woman's mammogram bills say they won't pay for one because several hundred
screens may only detect a few pre-cancerous breasts, so it's really not
worth the cost of all of the negative screens. In this way we're now subscribing
to medicine according to the bottom line. I suppose that something had
to be done to curtail a medical testing world run amuck, but try explaining
this to the few women who would have their cancers missed without all of
needless testing on the rest.
In the July 18, 1996,
issue of Medical Tribune, Obstetrician and Gynecologist Edition,
the controversy over routine screening of pregnant women for group B streptococcal
disease was the front page article. In it, the CDC, the American College
of Obstetricians and Gynecologists (ACOG), and the American Academy of
Pediatrics have finally come out with guidelines for screening for this
common vaginal bacteria which is harmless to the mother but could cause
fatal meningitis to her baby. The actual guidelines are not what this article
is about. Guidelines are just that and will periodically change when this
or that study indicates so. But what I found interesting was a statement
in this article by Linda Carroll:
If physicians follow these guidelines, one
million pregnant women each year may end up receiving antibiotics to prevent
just under 300 infant deaths."
Just?
That figures out to
3,333 treatments for each infected baby that would die. If we multiply
the cost of the antibiotic times 3,333, we soon will see how much some
people feel a baby is worth. Or above which a baby is not. Try explaining
that to the one mother who will have lost her child to this easily treated
maternal condition. Suddenly, bottom line hits the brick wall of philosophy,
for the bottom line refutes the idea that a baby is priceless. But it has
to; otherwise, a bankrupt insurance company can't afford to pay for anything
at all.
I really don't know
if there's any better way to still make paying for medical care work. The
old way of doing things has been maligned by everyone, from the fiscally
responsible insurance companies to the politicians who feel that too many
people delivering the care make too much money. But this pejorative term
"runaway medical costs" is a little unfair, because at least half of the
unbridled expenditures came about because of the inherent conviction that
everyone is priceless. And the hardest job in the world will be the one
in which someone somewhere has to decide how much that woman, this man,
or that baby is worth.
