NO
MORE MILLION DOLLAR BABIES
SYNOPSIS:
In America, babies born prematurely are routinely
given intensive care.
But thousands of other pregnant women receive no prenatal
care at all.
If we want to create the greatest good for the greatest number,
we will discontinue treating babies that are going to cost $1 million
before they leave the hospital
and reallocate the money now used in our neonatal intensive care units
so that all pregnant women
receive the prenatal care
that will prevent
them from giving birth prematurely.
As passionately as we care about individual babies,
if our society has one million dollars to spend
would we prefer to have 1,000
healthy babies or one
very expensive baby?
OUTLINE:
1.
THE MOST COST-EFFECTIVE WAYS
TO USE
HEALTH-CARE DOLLARS FOR BABIES.
2. IN THE PAST, PREMATURE INFANTS COULD NOT BE SAVED.
3.
IN COUNTRIES WITH LIMITED HEALTH-CARE MONEY,
PREMATURE
INFANTS ROUTINELY DO NOT SURVIVE.
4.
CREATE NO MORE NEONATAL INTENSIVE CARE UNITS
UNTIL ALL
PREGNANT WOMEN HAVE PRENATAL CARE.
5. NON-POLITICAL ALLOCATION OF HEALTH-CARE DOLLARS.
No
More Million Dollar Babies
by
James Leonard Park
1. THE MOST COST-EFFECTIVE WAYS
TO USE
HEALTH-CARE DOLLARS FOR
BABIES.
Caring for a premature baby in an incubator
in
the Neonatal Intensive Care Unit (NICU) can cost $10,000 per day.
Thus, 100 days in the NICU costs about a million dollars.
And if the premature infant needs surgery or other specialized
treatments,
the costs can easily mount to more than a million dollars.
Instead of treating one premature infant to a
million dollars of health-care,
it might be wiser to spent $1,000 each on 1,000 other babies,
giving their mothers prenatal care
so that these babies will
not need
intensive care after birth.
If the individual family had to pay the costs
themselves,
how many would impoverish
the whole family to save one premature
infant?
Is there a family that has sold everything they own
—house,
car, jewelry, stocks—
to
provide intensive care for an infant born too soon?
Instead of spending all of these assets to save one
newborn,
most families would probably allow nature to take its course,
resulting in the death of an infant that had little chance of
surviving.
They would grieve deeply for this loss.
But our present system of medical care automatically
assumes
that each premature infant should be saved no matter what the costs.
How can we shift the money available for premature
babies
so that there will be fewer
of them?
Preventing premature births
is much more cost-effective
than giving intensive care to babies born at very low birth-weight.
Insurance companies routinely pay for infants born
with problems.
And even mothers who have no health insurance
have their premature infants routinely placed in the NICU.
Emotionally it is difficult to let an individual
baby go,
especially when we have the technical capacity to save that
baby.
But health-care costs do matter.
Would it do more good
to use that money for 1,000 other babies?
Frequently, inexpensive health-care can make a dramatic difference.
More healthy babies will result if we discover how
to say "yes"
to health-care for the one thousand expectant mothers
who will have routine births and "no" to that one in a thousand
who will give birth to a fetus so early in its gestation
that there is no way to save it from death
without spending one million dollars.
In another essay,
I have set a limit for my
own life-time medical care.
I choose not to absorb more than one million dollars
of the money available for my health-care:
"Voluntary Rationing of Health-Care":
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-VRAT.html
And since I have set such a limit for my whole life,
it makes sense to set a similar limit for any newborn infant
for whom I might have to decide.
It will always be difficult to decline medical care for economic
reasons.
But if we know that other
patients will receive
routine (and less expensive) health-care as a result,
then we might be willing to refuse medical care
that is known in advance to
cost too much.
2. IN THE PAST, PREMATURE
INFANTS
COULD NOT BE SAVED.
This is the history of the human race
for the first
seven million years of our existence:
If the baby born prematurely could not survive on its own,
then it would die a natural death within a few hours after birth.
Only in the 20th century did neonatal intensive
care emerge.
And most of the mothers of the world do not have access to NICUs.
So the fate of their premature babies is the same
as in all those millions of years up to the present.
The human race has thrived without
neonatal intensive care.
It would not be catastrophic to return to the patterns of years past:
Strong and healthy babies will survive without specialized care.
And those who were born too early in their gestation will not survive.
3. IN COUNTRIES WITH LIMITED
HEALTH-CARE MONEY,
PREMATURE
INFANTS ROUTINELY DO NOT SURVIVE.
Most of the countries of the world
do not have enough money to pay $1,000,000 to save one premature infant.
So they do, in fact, ration their money for medical care.
They give what prenatal care they can
to insure that most babies
are
born without complications.
But they do not routinely give huge amounts of money
to an infant who cannot survive without an incubator
for several weeks.
When medical care must be paid by the family,
the family also knows ahead of time that they cannot afford
to pay more than it costs to keep the whole family alive for ten years
just to insure that this new baby will survive.
If they definitely want another child,
it makes more sense to start over with a new pregnancy
rather than spending more
than they have to save a premature infant.
These are harsh facts of reality.
But these facts are easier to accept when the family knows in advance
that no expensive neonatal care will be available.
4. CREATE NO MORE NEONATAL
INTENSIVE
CARE
UNITS
UNTIL ALL
PREGNANT WOMEN HAVE PRENATAL CARE.
In the United States, direct health-care costs
are usually outside of the budget of the individual family.
They are not asked individually to approve
either spending thousands of dollars to save one infant
or spending the same money to maintain the rest of the family.
But we do have systems in place to approve
building more health-care facilities or rejecting such expenditures.
Our collective policy about allocation of health-care dollars
can devote those dollars to the prenatal care of all pregnant
women
instead of spending it for intensive care of a few unfortunate infants.
It is much more cost-effective to give prenatal care
to all
than to try to correct
problems that arise for some infants after
birth.
It is conceivable that in some future time,
prenatal care will be easily available to all pregnant women.
Routine prenatal care can
prevent many premature births.
If the pregnant woman receives good medical care,
the pregnancy will continue until the baby is ready to be born.
Universal prenatal care should have a higher
priority
than building new intensive care units for premature babies.
And even when we have both universal prenatal care
and good intensive care for infants born with medical problems,
we should still have some reasonable ways of deciding
which newborns to
treat and which to
allow to die.
How will we draw this line?
On one side we will put those babies we can afford to try to save.
And on the other side of that line,
we will put those babies who will cost $10 million to save.
And even with intensive care,
some premature infants will die despite our best efforts to save them.
5. NON-POLITICAL
ALLOCATION
OF HEALTH-CARE DOLLARS.
Such decisions about the allocation of limited
health-care dollars
should be kept out of the political realm.
Politicians, who usually must worry about re-election,
do not want to attract attention as killers of newborn infants
who would be far too expensive to treat
and who would have a poor quality of life
even if the treatments were successful in preventing immediate death.
Whenever such issues get into the mass media,
the pressure builds to use the public funds to keep someone
alive.
This response arises because so many people
regard the U.S. Treasury as a limitless pot of money.
Because the numbers are incomprehensibly large,
we just think there will always be more money
to devote to any particular case we hear about.
Elected officials must face the voters.
Political challengers will take advantage of any controversial
decisions.
This pushes politicians toward safe choices rather than
the best choices.
What politician could stand for re-election on the basis
that he or she cut funding for neonatal intensive care units?
Even if thousands of pregnant women receive prenatal care as a result,
the political opposition will exploit that vote against expensive care.
Therefore, it might be wise to let decisions about
health-care
be handled by a commission that is not directly elected by the
people.
This would be similar to the base-closing commission in the USA.
Because a politician can only lose
local votes
by supporting the
closing of a local military base,
this decision had to be placed under the jurisdiction
of an independent
group of people.
These commission-members consider all military bases
in the USA,
deciding in the national
interest instead of supporting
local decisions,
which is almost always to keep the local base open
because of its economic benefits to that community.
If we as a nation are going to control health-care
costs,
we need some non-political
way of making over-all cost decisions,
even when some of these decisions will hurt the local economy
and even tho some individuals will not get the care they desire
simply because the same health-care dollars
can be spent more effectively to treat several other people.
Such a commission allocating health-care dollars
should never make health-care decisions for any individual
patient.
Rather, those who must allocate local dollars
will have to learn to operate within their pre-determined budgets.
The principles for such allocation will be set forth in abstract
statements.
Then the doctors and hospitals will apply the standards.
This is the way decisions are made in almost all developed countries.
Most patients receive the treatments they need and desire.
But some cases are beyond the capacities of the health-care system.
Created
September 4, 2009; Revised 3-11-2010; 11-4-2010; 6-5-2011; 10-26-2011;
5-16-2012; 5-19-2012; 5-24-2012; 10-11-2013; 10-13-2013;
8-5-2014; 1-24-2015; 8-5-2015; 9-24-2015;
12-22-2016; 1-31-2019; 5-9-2020;
Has this essay changed your mind?
Did you believe before you began to read
that all premature infants should get maximum medical care?
Do you now believe that putting the same money
into prenatal care would do more good for more families?
Do you agree that universal prenatal care
should come ahead of constructing more neo-natal intensive care units?
AUTHOR:
James Park is an independent writer
with deep interests in medical ethics.
Four other essays on controlling health-care costs are linked below.
Much more will be discovered about him on his website:
James
Leonard Park—Free
Library
You
might be most
interested in the wing devoted to Medical Ethics.
Here are some other ways to change our health-care
system:
There
is No Free Health Care:
Tax-Supported Medical Care
Nine
Ways to Reduce Health-Care Costs
Voluntary
Rationing of Health-Care
Medical
Futility Monitor:
Avoiding the Million-Dollar Death