Micro premies: Care and costs

[Witsec7]

I absolutely agree.

My issue (highly personalised, I know), is with the care becoming routine and being given even against the express wishes of the family and the individual involved.

I totally agree with you, if the family has a DNR on record it should be honored. I've got 4 pages of very specific advanced directives.

[Miggy]

I think it is a bit sad that those of us living in developed countries even count the cost of medical treatment. I believe we all have the right to good health care and good education and I will pay whatever is needed in taxes so that can occur. Decisions about medical treatment should be made on the needs of the patient, not the cost. (I'll get off my soapbox now.)

[rhianna]

I think it is a bit sad that those of us living in developed countries even count the cost of medical treatment. I believe we all have the right to good health care and good education and I will pay whatever is needed in taxes so that can occur. Decisions about medical treatment should be made on the needs of the patient, not the cost. (I'll get off my soapbox now.)

This is how I see it . . . healthcare, like everything else, must needs be scarce in a world of scarcity. We have to cut costs somewhere. Right now in America we seem to sacrifice preventative care for the sake of heroic measures and defensive medicine, and it is really expensive. And if you think everyone should get tip-top treatment, the bill can be astronomical. We could easily get ct scans for everyone who has a cough and MRIs for everyone who has headaches. Similarly, using your example of "good education," we could insist that every child have a macbook pro and professors with phds for middle school classes. The cost ceiling when you want to provide people with state of the art medical care and education is truly limitless.

You say that you would be willing to pay whatever is needed in taxes. I will take your word for it; however, I imagine that many, if not most people, would not be willing to pay 70% of their income in federal taxes for other people's healthcare and education.

Now my examples are extreme, I admit, but I was using them to illustrate my general principle: that healthcare must be rationed somehow. However, having done the research I have, I will actually retract my statement about not liking public funds being used for NICU stays. I truly did not realize how small a percentage of our health budget is used by NICUs. In addition, I think the principle of spending a lot of money on a micropreemie as opposed to a very old person makes sense, as the interventions are more likely to increase quality of life for a micropreemie. However, I do think it would be reasonable to find out why we have so many more preterm births and costlier NICU stays in the US than other developed countries.

Finally, I also am in favor of reducing drastic interventions in the elderly. I work in healthcare and this is an area I am more familiar with than neonatology. We definitely need to focus more on quality of life as the optimal outcome. I also think that the decision-makers should be patients and families; however, I also think that health care providers should make it very clear how likely they think any given intervention would be to actually increase quality of life as opposed to simply prolonging it.

[lilith]

I agree. You can always spend more on healthcare. It's like education. More funds are always going to get better outcomes and happier recipients.

But it has to be budgeted and prioritised, even in the wealthy world. We could spend the whole budget in healthcare if we wanted to, and there would still be improvements that could be made.

I also find it immoral to have western countries pouring ever more dollars into both healthcare and education and claiming that it's the only humane way and that their citizens are entitled to it, while there are countries where only the very rich can access any healthcare or education at all.

This is from someone who lives in a country with public healthcare and education and supports that for everyone. You still need to prioritise funds to ensure that all of everyone's actual needs are met before you can move on to wants.

[Turtle]

This is how I see it . . . healthcare, like everything else, must needs be scarce in a world of scarcity. We have to cut costs somewhere. Right now in America we seem to sacrifice preventative care for the sake of heroic measures and defensive medicine, and it is really expensive. And if you think everyone should get tip-top treatment, the bill can be astronomical. We could easily get ct scans for everyone who has a cough and MRIs for everyone who has headaches. Similarly, using your example of "good education," we could insist that every child have a macbook pro and professors with phds for middle school classes. The cost ceiling when you want to provide people with state of the art medical care and education is truly limitless.

You say that you would be willing to pay whatever is needed in taxes. I will take your word for it; however, I imagine that many, if not most people, would not be willing to pay 70% of their income in federal taxes for other people's healthcare and education.

Now my examples are extreme, I admit, but I was using them to illustrate my general principle: that healthcare must be rationed somehow. However, having done the research I have, I will actually retract my statement about not liking public funds being used for NICU stays. I truly did not realize how small a percentage of our health budget is used by NICUs. In addition, I think the principle of spending a lot of money on a micropreemie as opposed to a very old person makes sense, as the interventions are more likely to increase quality of life for a micropreemie. However, I do think it would be reasonable to find out why we have so many more preterm births and costlier NICU stays in the US than other developed countries.

Finally, I also am in favor of reducing drastic interventions in the elderly. I work in healthcare and this is an area I am more familiar with than neonatology. We definitely need to focus more on quality of life as the optimal outcome. I also think that the decision-makers should be patients and families; however, I also think that health care providers should make it very clear how likely they think any given intervention would be to actually increase quality of life as opposed to simply prolonging it.

I think we have so many babies in NICUs in the U. S. because we also put a lot of money and effort into helping women conceive and stay pregnant who would not be able to do so without medical intervention. The journalist might be a good example of that. Or twins/triplets conceived through fertility treatments. Plus, doctors will stop preterm labor before viability that would have otherwise resulted in a miscarriage.

[meda]

I think we have so many babies in NICUs in the U. S. because we also put a lot of money and effort into helping women conceive and stay pregnant who would not be able to do so without medical intervention. The journalist might be a good example of that. Or twins/triplets conceived through fertility treatments. Plus, doctors will stop preterm labor before viability that would have otherwise resulted in a miscarriage

I think that's partially true, but the demographics on premature labor do not back that up entirely. Age is a factor, so as more older women have babies that can result in preterm labor. but you are far more likely to go into preterm labor if you are a minority, have completed 13 years or less of school, and live in certain areas of the country, which points to poverty and a lack of access to decent prenatal care as crucial factors . I think in the side bar to the premie article the were stats that broke down preterm labor risk by demographic. The highest risk were not middle class to affluent white women in their 30's and 40s, who are most likely to use fertility treatments.

[fundifugee]

Interesting discussion and one I confront daily in my line of work. It never ceases to amaze me how reluctant people are to consider advanced directives/Do Not Resuscitate/Allow Natural Death orders. I have one and I am 40 and healthy. I don't believe in these interventions that basically prolong death, not life. But I am forced to do them because people somehow believe it goes like on TV, a few chest compressions, some beeping and terse commands, and wow! they come right back with all their marbles and physical faculties. Nobody seems to want to think about death and what they would want for the end of their lives, they leave it to their families who are absolutely burdened by the guilt of being asked whether to let their relative die.

On another note, I found it interesting in the article how she repeatedly expressed thanks to the inexperienced nurse who realized her baby's abdomen was a little more distended, the doctor who "ordered" surgery and the surgeon who did it even though she didn't want to. But the surgery was an open-and-shut, no intervention possible, and the kid ended up healing herself. It is shocking how often people (doctors and patients) accept and appreciate these torturous methods without realizing that it probably was completely unnecessary and did more harm than good.

[CynicMom]

I haven't cried like that in a long time.

[Turtle]

I think we have so many babies in NICUs in the U. S. because we also put a lot of money and effort into helping women conceive and stay pregnant who would not be able to do so without medical intervention. The journalist might be a good example of that. Or twins/triplets conceived through fertility treatments. Plus, doctors will stop preterm labor before viability that would have otherwise resulted in a miscarriage

I think that's partially true, but the demographics on premature labor do not back that up entirely. Age is a factor, so as more older women have babies that can result in preterm labor. but you are far more likely to go into preterm labor if you are a minority, have completed 13 years or less of school, and live in certain areas of the country, which points to poverty and a lack of access to decent prenatal care as crucial factors . I think in the side bar to the premie article the were stats that broke down preterm labor risk by demographic. The highest risk were not middle class to affluent white women in their 30's and 40s, who are most likely to use fertility treatments.

Very good point. The lack of access to decent prenatal care is a problem for so many women in this country and no doubt contributes to the problem. Adequate prenatal care would probably be cheaper than dealing with the massive NICU and long term disability bills I'm sure.

[Mama Mia]

I think it's important to keep in mind that "good" pre-natal and birth care is often something that is not readily available, at least in my area. My daughter who at the time faced the triple challenge of being very young, a minority, and poor - had an absolutely horrific birth because the "health care providers" were blatantly ageist, racist and classist and dismissed everything she said and performed ridiculously unneeded interventions - while delaying needed care. This resulted in her near death, and her baby having to stay in the NICU. She had a situation similar to the thread where the woman died at home due to an infection during labor - but she was actually IN the hospital, with the so-called doctor saying " well she's probably just not wanting to get up and see the baby, you know how these teens are " - when she was in fact on the verge of death !

[Irishy]

Healthcare should be universal. Picking and choosing who meets what criteria is what's wrong with American healthcare. My tax dollar for other people's problems etc etc. I hope that in the future, there will be no need for any health insurance policy for every American citizen. The ethics of fertility doctors are another kettle of fish. Hello Octomom.

[Ramona]

. I can however begin to understand the attachment a parent has to a child once it over the age of 1 or so. .

Are you saying that you don't understand how (or that) a parent an be "attached" to a baby less than a year old? ?

[Ramona]

As a Canadian, I'm perfectly fine with my tax dollars going to NICU stays. I know babies who were born very, very early, and I'm grateful that their families were not put in a position of having to face bankruptcy in order to save their lives. That's what universal government-funded healthcare is all about.

[another Canadian here who agrees!]

[Irishy]

I am going to disagree with the general sentiment here and say I found in glurgy in the style of christian email-forwards. The most interesting part to me was the discussion of the financial costs. I am in favor of universal healthcare, but I will be honest and stay that I wouldn't be pleased with taxpayer money going towards multimillion dollar NICU stays for micropreemies.

I will also say that I am childless and happily so, and I truly do not even understand a little the pain/heartbreak associated with infertility, difficult pregnancies, miscarriage and other situations relating to fetuses/infants. I can however begin to understand the attachment a parent has to a child once it over the age of 1 or so. As children get older, I can conceptualize the feeling parents have for them better and better. I fully realize that most people are not like me, and public opinion will always be in favor of drastic interventions for preemies. Probably it is a good thing.

Yes, before my babies reached their first birthday, we had no feelings for them. In fact, we kept them in the boot of the car. Once they turned one, we grudgingly admitted that they were somewhat amusing and began to interact with them. As for when they were foetuses? Total ambivalence. If they had been stillborn at full term, I would just have gone and got my nails done.

[slickcat79]

My friend gave me this article to read a few years back because it was assigned to her med school class: The Cost Conundrum. I thought it was a really interesting read, and it touched on a lot of the issues that go into the cost of medicine and the sometimes unconventional reasons and solutions for them.

While I'm not in favor of the for-profit system in the US, I think it's worth noting that even countries with socialized medicine have guidelines re: the costs associated with various treatments. Perhaps they have better systems for administering palliative care and are more realistic about when it's needed, but it's not like people in Canada and Europe never die because their medical care is too expensive.

The US has really poor outcomes in general for the money it spends, but really high comparative survival rates for things like advanced cancers. One of the reasons for that is the amount of money spent on treatment. As with so many things in this country, it really highlights the massive gap between have and have-not. If you have enough money or your insurance is good enough, you can survive stage 4 breast cancer with a good prognosis, but if you're uninsured you might die from a simple dental infection.

[Sobeknofret]

Yes, before my babies reached their first birthday, we had no feelings for them. In fact, we kept them in the boot of the car. Once they turned one, we grudgingly admitted that they were somewhat amusing and began to interact with them. As for when they were foetuses? Total ambivalence. If they had been stillborn at full term, I would just have gone and got my nails done.

As the mom of a micropreemie, I'm kind of nauseated by the whole convo frankly.

[Irishy]

Sobeknofret I am too. I've been reading this thread for a couple of days and have had my jaw on the floor.

[treemom]

Sobeknofret I am too. I've been reading this thread for a couple of days and have had my jaw on the floor.

me three.

[Minerva]

Sobeknofret I am too. I've been reading this thread for a couple of days and have had my jaw on the floor.

I haven't got any kids, and don't expect to have any, but same here.

I wonder if all the Canadian pro-lifers who moan that their tax dollars shouldn't be spent on abortion care are aware that the same argument is being made about the death-delaying treatments their religion requires.

[Katiebug]

Yes, before my babies reached their first birthday, we had no feelings for them. In fact, we kept them in the boot of the car. Once they turned one, we grudgingly admitted that they were somewhat amusing and began to interact with them. As for when they were foetuses? Total ambivalence. If they had been stillborn at full term, I would just have gone and got my nails done.

I'm not a mom to a preemie (our daughter was induced at 39 weeks for medical reasons) but have been pretty horrified by that expression since I read it and was wondering if anyone else felt the same.

[meda]

I'm not a mom to a preemie (our daughter was induced at 39 weeks for medical reasons) but have been pretty horrified by that expression since I read it and was wondering if anyone else felt the same.

Honestly, it came across as one of those for shock value statements from a certain type of the militantly child free. They are more evolved beings, so they do not feel sadness over miscarriage or infertility like the rest of us silly emotional women with too much free time. Plus, you know, infants are icky and stuff.

(Not a shot at all child free people, there is just a certain type of militant, not unlike militant atheists, that tend to go there)

[J'ean Skirt]

Honestly, it came across as one of those for shock value statements from a certain type of the militantly child free. They are more evolved beings, so they do not feel sadness over miscarriage or infertility like the rest of us silly emotional women with too much free time. Plus, you know, infants are icky and stuff.

(Not a shot at all child free people, there is just a certain type of militant, not unlike militant atheists, that tend to go there)

I'm childfree (although I hate admitting it because there are a lot of the angry childfree out there). I've never quite understood the deep, visceral need to reproduce that other people seem to have. Even when I was young-ish and watching my parents friends go through fertility treatments and adoptions I didn't quite get what would drive someone to spend all that money and time and emotional energy. As I've gotten older I've decided I'm mostly "broken" in that I don't feel it. But I do understand that some people (men and women) feel having kids is extremely important to them. And even if I don't understand the feelings or the drivers that doesn't mean they're not there or that they're somehow wrong or flawed or worthy of ridicule.

IOW, the statement made by the other childfree person shocked me, too. And is exactly why I don't normally associate as childfree.

[meda]

I'm childfree (although I hate admitting it because there are a lot of the angry childfree out there). I've never quite understood the deep, visceral need to reproduce that other people seem to have. Even when I was young-ish and watching my parents friends go through fertility treatments and adoptions I didn't quite get what would drive someone to spend all that money and time and emotional energy. As I've gotten older I've decided I'm mostly "broken" in that I don't feel it. But I do understand that some people (men and women) feel having kids is extremely important to them. And even if I don't understand the feelings or the drivers that doesn't mean they're not there or that they're somehow wrong or flawed or worthy of ridicule.

IOW, the statement made by the other childfree person shocked me, too. And is exactly why I don't normally associate as childfree.

That's why I tried to qualify my statement, and for the record I certainly don't think you're "broken" for not feeling the desire or need for children. I didn't want children for most of my 20's, I still don't understand why someone would want children when they are themselves quite young, but it's their choice, not mine, so there is no need for me to be an asshole about it. Also, I get why some child free folks are pissy, having people tell you that you are selfish or will change your mind has got to be annoying. There is just a certain subset of child free who seem to think there decision to not have kids makes them more special and enlightened, and feel the need to explain their superiority at great length.

[Irishy]

Please tell me you know my comment about keeping my babies in the boot of the car is complete and utter sarcasm! Just cos its been quoted out of context y'know.. I'm a mum of 4 (very much adored) babies!

[OkToBeTakei]

Please tell me you know my comment about keeping my babies in the boot of the car is complete and utter sarcasm! Just cos its been quoted out of context y'know.. I'm a mum of 4 (very much adored) babies!

I swear to whatever deity you please, nobody here would be that stupid? There again.