Rude is rude no matter who is being rude, and to whom

Calling POTUS a liar from the floor in the middle of a speech to a joint session of Congress is not only uncivil, but politically dumb. Congressman Wilson at least had the good grace to apologize afterward.

I'm still waiting for all the apologies Dubyah is due for the uncivil way he was treated by the other party during his administration.

My prediction is that if a health reform bill is passed, it will bear little resemblance to anything the administration is aiming for.

I just hope we recognize that a nation with our wealth which nevertheless ranks worse than twentieth among the nations of the world in infant mortality and has as many folks as we do with no access to decent health care at all is indeed in need of reform for its health care system. At the same time, any "public option" will put the government in direct competition with private industry- never a healthy thing- and private insurance companies don't have pockets deep enough to compete with the government.

If we wind up with a single-payer system after all, where will the Canadians go?

Comments

Eric said…
Granted, my information may be coming from a biased source, but I am told that infant mortality is higher in the United States than in other nations because we are the only nation in the world where women routinely deliver babies in hospitals under the care of medical doctors. That assertion comes (directly or indirectly, I can't remember) from our midwife.

I do tend to attach some credibility to that assessment, however. If you do a little research I am sure you will find that the United States also leads the world in deliveries by C-sections. Why? Why would we expect to find a greater medical need for C-section births among American women than among women in, let's say, Japan or Great Britain? I suspect it is because most births (by far) are attended by medical doctors whose training nurtures the instinct to take a proactive stance in at the first sign and slightest indication of a potential crisis. Doctors are trained to intervene. It is the very nature of their craft. And when doctors call the shots in an environment where the operating is just a short walk and elevator ride away, a greater number of precipitous interventions lead to higher rates of complication and death. Of course, intervention is sometimes necessary, but during the trauma of delivery I don't want mothers or fathers or doctors (alone) making that call. I want the panic button in the hands of a well-trained, practicing midwife. I think the United States would see dramatic improvement in infant mortality statistics if we were all conditioned to take that approach.

What makes the hospital such a good place to have a baby anyway?
With all due respect both to you and to midwives, the notion that midwives are, as a rule, anywhere near as well trained as obstetricians is ludicrous. What makes a hospital such a good place to have a baby is that the risk of something going wrong is high enough that it's prudent to have every resource available in case it does.

No, "precipitous interventions" are not the reason for our high infant mortality rate. Quite the opposite, in fact. The problem is that a substantial proportion of prospective mothers can't afford decent prenatal care. The problem isn't that the health care professionals are too well trained and equipped; the problem is that two few moms have sufficient access to them during the critical period when the baby is developing in the womb.

Notice that I'm not saying that midwives are not perfectly qualified to perform routine deliveries, and some far more so than some obstetricians. A case might even be made that a better use of our limited resources might be to have midwives perform them as a matter of routine- in a hospital, with an obstetrician nearby. But while yours is an interesting theory, I'm afraid it doesn't bear close examination.
Oh. One more thing about C-sections.

If I'd been delivered at home by a midwife, I'd have been born dead. I had a prolapsed cord, and would have strangled on the way out.

The one strength of our healthcare system is in fact in its technical capabilities. It makes sense that a greater percentage of births would be by C-section in such an environment. It would be tough making the case, though, that there are many situations in which the opposite that was true in my case occurs: that babies die very often because they're delivered by C-section rather than vaginally! Yet that's what your thesis implies.

Of course, it's true that at least in the past doctors preferred to perform C-sections on all women who have had them in the past. That tended to drive up the statistics. I understand that this is no longer so much the case. I don't know whether the number (or percentage, which might be a more valid statistic)is declining or not. But I am glad that I was delivered in a hospital, with the facilities on hand to save my live by delivering me that way (my mother tended to be a fan of the procedure, too- for obvious reasons!).

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