Got sliced? No health insurance for you

Another way the American birth system and the you’re-on-your-ownership economy rip women off: The New York Times reported this weekend that some insurers are denying health coverage or raising rates on women who’ve had C-sections. With more than 30 percent of all births in the U.S. now ending in C-section—and rising—and more and more people self-employed or freelance and therefore looking for individual health coverage rather than the group coverage sponsored by employers, this potentially affects a huge number of women.

These insurers are being entirely rational. C-sections are hugely expensive compared to vaginal births, and when you’ve had one C-section you’re nearly guaranteed having them in subsequent births. Ninety percent of women with a previous C-section now have repeat C-sections, thanks largely to guidelines issued in 1999 by the American College of Obstetricians and Gynecologists that strongly discouraged vaginal birth after caesarean, So a woman who has had a C-section does represent a risk of heightened medical costs. Insurers, like the rational capitalists they are, seek to off-load that risk, just as employers seek to offload risk to workers by hiring them on a freelance basis, without offering health coverage.

The insurers may be acting rationally, but the larger medical system is crazy. If capitalism worked the way it’s supposed to work, “the market” in its infinite wisdom would push C-sections to a minimum, perhaps lower than the WHO recommended maximum of 15 percent. Instead, the C-section rate keeps rising.

Despite mythology about women who are “too posh to push,” this rate is not driven by women asking for C-sections. A 2005 survey by Childbirth Connection found that only one woman among the 1600 polled said that she’d had a C-section at her own request for no medical reason. On the other hand, one quarter of those polled reported feeling pressured by a medical professional to have a C-section. And then they pay for it, in a high rate of infection of the incision, extended recovery and pain in comparison to vaginal birth, risks of injury to the baby, greater difficulty initiating breastfeeding, and greater risks of breathing problems in the baby—and finally in a loss of insurance coverage.

Ponder market insanities like this when presidential candidate John McCain advocates pushing our medical system even further into the 'free' market (you can go to his site if you're willing to translate the rhetoric into English, but Elizabeth Edwards' explanation of his plan is a whole lot more direct).