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Americans pay far more for maternity care and delivery than our peers in the developed world, as described in a lengthy article The New York Times published yesterday. But while the stories of the women in the piece end with delivered babies and enormous bills, the costs of having a child in this country continue after the hospital. All along the way, this country has made the cost of having children nearly prohibitive.
The costs of pregnancy have spiraled out of control in the United States. Charges for delivery have nearly tripled since 1996. Out-of-pocket costs have risen fourfold. The total price tag for a pregnancy and newborn care with a vaginal delivery is about $30,000, while it comes to $50,000 for a C-section. Women with insurance pay an average of $3,400 out of pocket, a large sum as it is. Yet over 60 percent of women with private plans that aren’t through their employers lack maternity coverage. Not to mention that nearly one in five women between the ages of 18 and 64 are uninsured. As one woman paying for private insurance told the Times, “I know that a C-section could ruin us financially.”
Two decades ago, the article points out, women didn’t usually pay anything except a small fee if they wanted extras like a private room or television. That’s more in line with what women in developed countries across the pond pay. Ireland guarantees free maternity care at public hospitals with the option to pay a fee for private deliveries. The average price for a vaginal delivery comes to about $4,000 in Switzerland, France and the Netherlands, but mothers are on the hook for little of that. Yet American women and European women have access to about the same care. One of the bigger contrasts? That more babies die in the United States in their first day of life than in sixty-eight other countries. The US ranks at number fifty in the world for maternal mortality.
The real difference driving costs is our healthcare system. Here at home, we pay for each individual test, procedure and medication, including a $20 splash of disinfectant on the umbilical cord, a bottle of which goes for $2.59 at Walgreens. In most other developed countries, by contrast, hospitals and doctors receive a flat fee for caring for a pregnant woman.
Unfortunately, the sky-high costs of giving birth to a new child don’t end when a woman leaves the hospital and pays the bill. As I reported last year, the lack of paid maternity leave in this country means dire financial straits for many new mothers. Workers are guaranteed only twelve weeks of unpaid leave under the Family Medical Leave Act to take time off for a new child or to care for a sick family member, and while some get paid leave through their employers, more than 40 percent of new mothers only have access to unpaid leave. Even worse, less than half of private sector workers are even covered by the FMLA because of restrictions in the law.
The financial choices are very challenging for those who take unpaid leave. The Department of Labor came out with a new report on the FMLA and found that among those who received partial pay or no pay at all, 30 percent had to borrow money to get by, 35 percent dipped into savings meant for something else, the same percentage put off paying bills and nearly 85 percent had to limit their spending. 15 percent had to go on public assistance, and in fact, a quarter of all “poverty spells”—when someone falls into poverty for two months or more at a time—begin with the birth of a child. This struggle can also lead to bankruptcy: a 2006 study found that 7 percent of those filing cited the birth of a child as the cause.
Of course, the costs don’t even end there. Thanks to our lack of universal preschool and the little help we extend to parents who struggle to pay for childcare, finding a quality, affordable place to leave children when parents go off to work is nearly impossible for many families. And the cost of childcare here is pretty outrageous: full-time center care for an infant can reach as much as $15,000 a year. The cost for an infant and a 4-year-old is more than annual median rent in all fifty states.
Our developed peers again best us when it comes to paid leave and childcare. The United States is actually an extreme outlier when it comes to paid maternity leave: we are one of just three countries out of a total 178 that doesn’t guarantee paid time off. Fifty countries offer paid paternity leave. Meanwhile, twenty-one other countries increased spending on childcare faster than the US over the past two decades, from .35 percent of GDP on average to .47 percent, while we’ve fallen far behind, just spending .11 percent today.
The rest of the developed world has figured out how to make having a child a reasonable expense. They control medical costs and have nationalized healthcare. They guarantee paid family leave. And they find ways to make quality childcare within reach for most families. By failing on all of these fronts, the US is putting an enormous financial burden on new families.
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