A few weeks ago, Utah state Sen. Daniel Liljenquist caused a commotion when he suggested the state should try to rein in Medicaid spending by cutting reimbursements for epidurals and elective Cesarean sections. The outcry, of course, was deserved: Suggesting poor women should experience pain during childbirth to save money is ridiculous.
But if I can be real for a second, it's not crazy to think about curbing some elective C-sections. Rates have been climbing for some time and now stand at more than 30 percent of births. Humans have a uniquely difficult time giving birth -- it's the price we pay for walking upright -- but more and more, studies show the increase in C-sections has nothing to do with more women needing interventions and everything to do with doctor impatience and patient preference. That would be alright if the increasing number of C-sections that aren't medically necessary weren't also associated with post-natal problems for both the mother and the infant.
The increased use of C-sections highlights one of the problems with the American medical system: the tendency to think everything new is inherently better. If we're trying to spread insurance coverage to more people, we have to consider whether we're using unnecessary procedures too often. This doesn't mean that Medicaid should stop covering C-sections, but doctors should be encouraged to rethink their approach -- and patients should be better informed. That's not what Liljenquist was saying about C-sections, but it's worth knowing that a sane reassessment of health insurance in the U.S. might reach a similar conclusion.
-- Monica Potts
