Thursday, July 27, 2017

Maternal deaths and the elephant in the room

Below is a judicious article from a medical journal that addresses a problem that should not be happening.  Why is giving birth in the USA so often fatal?  The article runs through the range of possible causes and notes that it is mainly a black problem, but not entirely so. And the various potential causes do make sense.  So, as with many social phenomena, it is reasonable to conclude that a range of factors contribute to the final outcome.  There are many things you can die from.

But there is an elephant in the room that is only obliquely mentioned.  One that could very well contribute to the deaths:  Obamacare.  Many people cannot afford the much higher premiums now demanded and there are even more people who are only nominally insured.  They have insurance but their deductibles can easily reach $10,000 or more -- which in effect means that they are not insured at all.  A lot of routine medical costs are way below $10,000 so no help with such costs is available.  And even costs below $10,000 can be hard to meet for a big family or for people with many calls on their funds -- such as working single mothers who have to pay for childcare. And some people are just  not good at saving so the effective absence of insurance to help with medical costs simply means that medical care is simply not sought by them on many occasions.

So there can be little doubt that many precautionary visits to the doctor are not made and many possibly revealing scans are not carried out. So problems are missed until it is too late.  Early diagnosis is universally advantageous but is not practically available.  So Obamacare should be called DeniedCare.  Someone should tell the "rebel" GOP senators who are blocking reform that they are killing mothers

In 2005, 23 US mothers per 100 000 live births died from complications related to pregnancy or childbirth. In 2015, that number rose to 25. In the United Kingdom, the number was less than 9. In Canada, it was less than 7.

Very few wealthy countries saw increases over those years. Many poorer countries, including Iran and Romania, saw declines. But here in the United States, things got worse.

These numbers have been confirmed by independent research. Last year, a study published in Obstetrics and Gynecology found that the maternal mortality rate in the United States had increased by more than 25% from 2000 to 2014. This trend differed by state, however. Although California had shown some declines, Texas had seen significant increases.

Texas in particular has been the focus of much of the news on maternal mortality in the last few years. From 2011 to 2014, the rate doubled. Although we lack good data to tell us why, many have postulated that changes to family planning in the state coincided with this increase. In 2013, for example about half of the state’s clinics that provided abortion in addition to other reproductive health services were closed because of regulations passed against them. In 2011, the family-planning budget was slashed in an attempt to defund Planned Parenthood. Many clinics closed and more were forced to reduce their services.

Family planning matters. About 50% of pregnancies in the United States are unplanned and might lack preventive care that properly planned-for pregnancies might.

There’s more to this story than changes in regulations and family planning. Some of the increase is likely due to the growing prevalence of other chronic conditions. Obesity, diabetes, and heart disease likely contribute to maternal mortality, and trends for many conditions have been increasing over the last decade. Women are having children later in life than they used to, and some have more complex conditions. More women have caesarian deliveries, which can lead to complications. The opioid epidemic may contribute to maternal mortality, as well.

Disparities exist in maternal mortality as they do in other areas of health care. The increases we’ve seen are most noticeable in non-Hispanic black women. The number of deaths per 100 000 live births among black women is more than 3 times that among white women. In fact, for any state, the higher the percentage of black women in the delivery population, the higher its rates of maternal mortality. But racial disparities can only account for so much of the problem. Even if you look only at white women in the United States, the rates of mothers who die is greater than those in other developed countries.

The fragmented nature of the US health care system doesn’t help either. Too many people in the United States go without necessary care, because they lack access to care or avoid it because of cost. This is just as true of pregnant women as it is of everyone else. As many politicians argue that maternity care shouldn’t be considered essential benefits, some worry that coverage might get worse with reform.

It is possible that some of the increase in maternal mortality is due to better record keeping. States have been working to improve how they keep track of maternal deaths, as well as other causes of death, and better reporting would be reflected as increases in prevalence. It’s hard to imagine, however, that this increase in better records has been solely in the United States, and could account for all of the increases. There’s no reason to believe that all other countries would be keeping themselves in the dark. Moreover, the more universal and socialized health systems are less likely to have women, and their deaths, fall through the cracks and be missed.

Pregnancy and childbirth are risky. We don’t like to talk about it, but maternal mortality is the sixth most common cause of death among US women age 25 years to 34 years old. Proper maternal care helps to prevent morbidity and mortality, but that care is difficult when clinics close and insurance lapses. Medicaid can help to close the gap and often does with pregnant women, but even then, both physician services and mother’s finances are strained.

As with many things in health care, a rising tide would lift all boats. Efforts to improve the health of women in general would improve our rates of maternal mortality. Reducing levels of obesity, diabetes, and heart disease would achieve results. So would getting a handle on the opioid epidemic. But we’ve spent the last few years—if not more—focused on efforts to reduce infant mortality. Mothers may need a similar commitment.



The Truth About Capitalism

One of the chief objectives of globalism is to transfer wealth from rich nations to poor nations. To the equality-of-results crowd it sounds great, because they don’t understand that spreading the wealth actually makes everyone poorer.

The main reason I’m against giving handouts to countries who destroy themselves through their socialist policies is that it sends the wrong message. We should not lie to such countries about the morality and merits of capitalism. The greatest gift we can offer is to help them understand that freedom is not about security or equality; it’s about insecurity and inequality.

We should teach them that the price of freedom is self-responsibility, and self-responsibility means that no one has a right to a house, a car, a job — no, not even healthcare. What everyone does have a right to is exactly what others are willing to pay him, free of government interference.

Those who think otherwise are responsible for our $20 trillion national debt and a federal budget deficit that is projected to be in the area of $500 billion and rising. Economic security is not a right, but it sure is a formula for disaster.

If we continue to subsidize bankrupt nations around the globe, we will be encouraging them to believe that capitalism is about security and equality. That, in turn, will cause them to be disillusioned when they find out the hard way that it is not. If instead we focus our efforts on educating them to understand that capitalism is about freedom of choice, self-responsibility, and risk, we will be doing them a great favor.

Unfortunately, progressives (as well as many phony conservatives) do not seem to understand this, especially wealthy faux liberals who are immune to the effects of socialist policies in Washington. I was reminded of this a couple weeks ago when a casual acquaintance of mine invited me to a social gathering at his home. In a moment of temporary insanity, and after being assured that no members of Black Lives Matter, the American Civil Liberties Union, or the Communist Party USA would be in attendance, I agreed to drop by.

I tend to be a target at limousine-liberal gatherings, and, sure enough, a middle-aged gentleman of means came up to me and, from out of the blue, sneered, “Capitalism is the most evil system ever invented.” He obviously was trying to get my goat.

Displaying my finest George Will deadpan expression, I asked how an intelligent, successful gentleman like him had managed to arrive at such a fascinating conclusion. To which he groused, “Under capitalism, the poor are exploited by the rich.” Yikes — it was the ghost of Vladimir Lenin!

Masochist that I am, I asked him to define the terms rich and poor for me, but he simply waived aside my question as though it were frivolous. My acquaintance’s wife then intervened and admonished us that political discussions were forbidden in her house, thus preventing a Sunday afternoon homicide.

Darn. I didn’t even get a chance to see the expression on his face had I been able to lay this one on him: The gap between the rich and the poor is supposed to increase under capitalism! That’s right, folks. Like it or not, it’s built into the system.

But hold on: Also built into the system is the fact that almost everyone is better off under capitalism. Why? Because trickle-down economics really does work! Try finding a Republican politician who will admit to that.

The U.S. government’s own Census Bureau’s statistics confirm this truth. Average-income figures clearly show that during the Reagan years, almost everyone’s income rose significantly, while during the Carter years, most people got poorer. Does anyone seriously believe that voters kicked Carter out of office and gave Reagan two landslide victories because they were better off under Carter and worse off under Reagan?

What was in play during the Reagan years was the so-called invisible hand of the marketplace. When people realize they can reap financial rewards by providing better goods and services to others, they work harder and longer hours to do so. As a result, the economy prospers and everyone is better off.

On the other hand, the more government interferes with this natural process, the worse off everyone is. How far mankind has advanced is not a reflection of his true potential; it is his true potential minus government interference. Those who believe that a strong central government is needed to manage a nation’s economy simply do not understand the awesome power of the invisible hand of the marketplace.

Which takes me back to the growing disparity between the rich and the poor (setting aside, for now, the important question of who has the omniscience and moral authority to decide who should be slotted into these two categories in the first place). In a mythical, totally free society, if everyone were to start with nothing, some people would become “rich” while others would become “poor.”

Now, stop and think about that for a moment. Wouldn’t natural forces assure that the most successful people would become even more successful over time and thus increase the gap between themselves and those who have not been as successful? After all, they would be using the same talents, efforts, and self-discipline that made them better off in the first place.

I’d love to see the Trump administration set aside childish notions and tell the truth about this “income inequality” garbage. Of course the gap between the rich and the poor increases under capitalism. But that, of and by itself, does not harm anyone. (Remember, the pie is not fixed.) The only problem is the one caused by venomous progressive thinkers who have unilaterally decided that such a gap is not “fair.” Which, of course, is merely their subjective opinion.

Personally, I don’t think of the increasing gap between the rich and the poor as fair or unfair. It’s simply reality. However, I do believe the fact that successful people tend to become even more successful is fair, provided they achieve their success on a non-coercive basis. Why shouldn’t a person be allowed to become as successful as his talents and hard work will take him?

That said, I believe the first step toward regaining our lost freedoms is to totally defeat progressive subjectivism. Go-along-to-get-along conservatives need to come to grips with the reality that compromise does not work, because it encourages a lie, and lies simply do not work.

Of course, the progressive is free to think whatever makes him feel good at any given moment. However, he should not be allowed to force others to give up their freedom to accommodate his arrogant notion of one of the most abstract ideas known to man: fairness. Fairness is a subjective word, right up there with “social justice.”

To paraphrase the great Milton Friedman, the only social justice that makes any sense is for everyone to keep what he earns in a totally free market.



For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated),  a Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

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