Healthcare Reform - Maternal Mortality

December 16, 2022

Dec 16, 2022

Mission

The Healthcare delivery system in the United States is a patchwork that leaves much to be desired. It is the most expensive system among the top 35 industrial countries and covers far fewer participants delivering lower levels of quality care than many of our peer nations. This blog will provide:

· Current problems in healthcare

· Actions you can take

· Background information on healthcare

· References

Current State of Affairs – Maternal Health

Mothers have a harder time in the United States than in almost any of our 35 peer industrialized nations. Maternal mortality is higher than any other peer nation. This is a serious quality measure of our healthcare system. Good sources for this discussion is mom-congress.com and the commonwealthfund.org in the references below.

Maternal Mortality

Maternal mortality is measured in the number of pregnancy/birth deaths per 100,000 live births in a year. As an example, in Europe, Germany has a rate of 3.2 and France is at 8 (high).

The US was at 17 in 2017 and 23.8 in 2020. The situation is worsening. Black women deaths were at 55 in 2020. The CDC tracks these data by law.

Clearly there are at least 2 problems we have identified. One is that the numbers in the US are way too high, the second is that there are populations in the US whose numbers are even more than double the average.

The problems in the US are complicated by a number of factors including economic, access to healthcare, access to child related support systems including paid maternal leave and post delivery assistance, as well as doctors not doing a good job of listening to women.

This situation could have been better but around 1900 the American Medical Association worked hard to ensure that their physicians were the only ones working with pregnant women and sought to have Doulas and mid-wives excluded from practice.

Remember we discussed healthcare and hospital deserts yesterday? Those parts of the country where it is hard to be seen by a doctor and takes a long time to get to a hospital only exacerbate the problems we are discussing today.

I should also point out that restrictions on reproductive care in the last year are expected to be responsible for about 1000 unnecessary deaths due to pregnancy complications.

There are a number of legislative remedies in the works and I encourage you to contact your representatives and express your support. They are called the Momnibus package and here are the bills that make up the package:

H.R.1551 – Quality Care for Moms and Babies Act, Rep. Engel (D-NY); Rep. Stivers (R-OH) - Improve the quality, health outcomes, and value of maternity care under Medicaid by developing maternity care quality measures and supporting maternity care quality collaboratives.

S.116 – MOMS Act (Modernizing Obstetric Medicine Standards), Sen. Gillibrand (D-NY) - Reduce maternal mortality and morbidity by standardizing the use of best practices and supporting quality improvement initiatives.

H.R. 1897 / S. 916 – MOMMA’s Act, Rep. Kelly (D-IL), Sen. Durbin (D-IL) - Assist states adopting best practices in maternal mortality review; extend Medicaid coverage to a year following childbirth; expand maternity care quality improvement initiatives; and establish Centers of Excellence for implicit bias and cultural competency education.

S. xxx – MOMMIES Act, Sen. Booker (D-NJ), Extend Medicaid coverage to a year following childbirth; pilot Maternity Care Homes, a model that provides coordinated, comprehensive, and culturally appropriate services and care; and assess and recommend strategies to expand Medicaid coverage of doula care.

What You Can Do

See resources below for your senator/representative

You can call or email your Senators and Representative and say

My name is _________, I am a constituent and live in zipcode ________.

We can all agree that we need better healthcare and this goes for mothers and children especially.

We have a crisis of maternal mortality in the US where 20 maternal deaths occur for every 100000 live births and even worse for black women 50 die. This can’t continue.

I want you to sign on as a cosponsor and actively support passage of the Momnibus package of bills currently in the Congress. This includes:

· H.R.1551 – Quality Care for Moms and Babies Act, Rep. Engel (D-NY); Rep. Stivers (R-OH)

· S.116 – MOMS Act (Modernizing Obstetric Medicine Standards), Sen. Gillibrand (D-NY) reduce maternal mortality

· H.R. 1897 / S. 916 – MOMMA’s Act, Rep. Kelly (D-IL), Sen. Durbin (D-IL) – Extend Medicaid for a year post birth, expand maternity care quality improvements

· MOMMIES Act, Sen. Booker (D-NJ) – Extend Medicaid for a year post birth

Background

The history of universal healthcare is a rather long subject. In each of these letters I will describe some of it so that over time you will see how we arrived where we are today.

Most of the industrialized world has some type of universal healthcare covering most if not all residents. The systems employed to accomplish this vary because the values that each country cherishes vary from each other.

Countries with universal healthcare chose to ask the question “How can everyone have healthcare?”. If you don’t ask the question you never get to the answer.

So far we have discussed the Bismarck model of nonprofit insurance funds paid for with insurance premiums. We also discussed the English Beveridge model where the government is the single payer insurance fund manager. Today we will discuss the National Health Insurance Model which is a hybrid of those two.

In the National Health Insurance Model there is a single payer insurance fund run by the government as a nonprofit . The insurance is purchased by employees and employers, and is not funded by a tax. As in the Bismarck model, the majority of healthcare providers are private, not government employees.

South Korea uses this model as several other countries. One of the complaints often heard about universal care is that there are significant wait times to see a specialist. Recent analyses indicate that in the top 35 industrial countries wait times are fairly similar, including the United States.

As we discuss how other countries provide universal healthcare it is important to note that all the different systems represent important cultural values. Remember that economies have a better shot at being healthy when workers and their families have healthcare.