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Right to Bear Children: What’s Our Obligation to Provide Health Care?

Elizabeth Rosenthal as been burning up the pages of the New York Times with her series on the high cost of health care in the United States. I mentioned her July 1 article on the high cost of childbirth in the U.S. a couple weeks ago.

Rosenthal discussed health care costs on Fresh Air Wednesday. Her response to Terry Gross's question about the cost of childbirth in Europe included one fascinating and unfamiliar phrase:

...most European countries - I mean it's almost hard to even do an economic comparison because most countries feel that childbirth is a right, it's vital for perpetuating your citizenry and your country, and so there really shouldn't be a cost disincentive for having a child. So even though you could - you can come up with a cost for childbirth in other countries, patients almost always aren't actually paying it. It's the cost to the system. So the cost to the system - or the cost if you were coming from outside and for some reason were to have your baby in France or Great Britain, so anyway, the cost in other countries tends to be in the $5,000 range, often much lower - as opposed to, here, 20,000 [emphasis mine; Elisabeth Rosenthal, interviewed by Terry Gross, "'Paying Till it Hurts': Why American Health Care Is So Pricey," NPR: Fresh Air, 2013.08.07].

Childbirth is a right—I don't think we hear that phrase much in our discussions of women, reproduction, and health care in South Dakota or the U.S. We raise great legislation and fuss about the right to life. We pay rhetorical attention to the product of reproduction, but not so much to the reproducer. We seem more inclined to view childbirth as an obligation; when places like Texas and South Dakota restrict abortion to practical impossibility while rejecting plans to make health care affordable, we seem more bent on enforcing an obligation than in facilitating the exercise of a right.

Does our lingering puritanism about sex prevent us from understanding moral aspects of childbirth that Europeans get more easily? Do we South Dakotans believe women have a right to bear children? If we do, why do we allow the cost disincentives to childbirth that Rosenthal reports to persist?


  1. Owen Reitzel 2013.08.09

    Which again points out the hypocrisy of the Republican Party. They are pro-life up to the point that the baby is born.

    Overall the question that needs to be asked and answered by the Republicans is "Is healthcare a right?"

  2. Douglas Wiken 2013.08.09

    White working people may not have a right to childbirth because of the incredible costs, but Native Americans do and we pay for childcare from before birth and on.

    Expand Medicare/Medicaid to all and do away with the rest of government health including that for congress critters and do away with employment-related insurance as well.

  3. MC 2013.08.10

    Healthcare is not a right. At least it wasn't until Obamacare.

    This might sound kind of strange, but you can't give someone something without first taking it from someone else.

    People were giving birth long before Obamacare, long before the government was here, and some time before there was even medical care. Medical care costs time, talent and materials. It seems fair that a patient should reimburse the doctor, nurse, lab technicians and all the working parts of the system, for the time, energy and materials used on that patient.

    What if the patient can't pay? Do you take (steal) from others? It is a common fact that preventive medicine is much cheaper than reactive care. Does the government have the right force preventive care on to us? Procreation is natural part of life, and childbirth a natural event. Does the government have the right to force pre-natal care, or even delivery care? If so, who pays for that care if the patient can't afford it?

  4. caheidelberger Post author | 2013.08.10

    Quick logic check: I can give X to A without taking X from B. We can subsidize health insurance by taxing other items. And if we go to the extreme, we could provide everyone with single-payer coverage with a portion of the money we currently burn up on the overwhelming bureaucracy and profit-grubbing of our current inefficient system. Would can give everyone health insurance and save money.

  5. Barry Smith 2013.08.10

    MC - When Ronald Reagan signed the EMTALA into law in 1985, health care became a right in the United States. Now the objective should be how to make that right the most cost effective.

  6. Erin 2013.08.10

    MC: "Healthcare is not a right."

    Fine, then voting isn't a right either. Elections require tax support, and that means someone who is not paying taxes gets to vote while utilizing services that my taxes have paid for.

    How do you expect patients to pay for healthcare when they can't work because they have health problems for which they can't get healthcare, because they can't work? And children? Will we be sending them to the assembly line to pay for all their healthcare? Maybe we should garnish their wages when they hit adulthood to pay for all that healthcare they mooched off of us for 18 years.

  7. Jenny 2013.08.10

    In a compassionate society, healthcare is a right. Too bad there's not more compassionate conservatives.

  8. Jenny 2013.08.10

    But welfare subsidies for wealthy farmers are a right, but healthcare is not. Only in America.....

  9. MC 2013.08.10

    You can not give X to person A without first having X to give.

    Governments by their nature do produce anything. Their only form of income is to tax. In order for a government to acquire X to give to person A they have to take (tax) someone who produces something (person B)

    Why should person B help support person A? If person B takes care of himself, and only see the doctor for a check up, and person A is obese, because they can't stop eating, smokes, drinks too much, takes illegal drugs, etc.?

    Is our system flawed, it is need of serious reform. But what is coming down pipe makes the cure worse than the cause. We need honest tort reform. We need to let doctors practice medicine without having to practice law at the same time.

    I say this again.

    Health Care IS NOT a right! It it were a right, EVERYBODY would have immediate access to a doctor regardless where they live. That means the people in New York has the same access to a doctor and medicine as person in Wells, Nevada, and the same for Pumpkin Center, Colorado. If it were a right, no one would be charged, not the patient, not the government nor the public they are supposed to be serving.

    I already can hear the cries that republican hate the poor and they want the poor to suffer even more, and republicans have no compassion and they are of full of hate and are the spawn of Satin himself. This is not the case at all. I have found republicans to be most generous with their giving to charities. They will also help individual families in need. What they don't like is being forced to give, and taxed to support those who are unwilling to help themselves. They also do not believe this is not the proper role for our government.

  10. interested party 2013.08.10

    The 9th Amendment guarantees natural rights not enumerated by the Constitution but has been kicked aside by the body of law. Why should states interpret the 10th to have the power to supersede individual rights?

  11. Jenny 2013.08.10

    Was going to war with Iraq when it was not paid for a right then, MC? I don't like having my hard-earned tax dollars and my children and future generations being forced to pay taxes for a war that was not necessary.

  12. Barry Smith 2013.08.10

    If a person is sick and the law says that the hospital must treat them, is that not a right ordained by law. What is it about health care as a right that you don't get MC? Your argument about access makes no sense , otherwise voting would also not be right. It is much easier to vote in NYC than on the reservations of South Dakota. You have the right to bear arms why are you charged for the gun? Your arguments make no sense.

  13. MC 2013.08.10

    If there are barriers to voting on the reservation then why isn't the tribes and the counties addressing the issue? (not a third party) You have the right to keep and bear arms, doesn't mean you will be handed rifle & box of ammo once you turn 18. I'm on the fence about mandatory military service for 2 years.

  14. Ken Santema 2013.08.10

    I don't see how healthcare being a "right" means it should be taxpayer subsidized? Here are couple examples:

    Person X has decided to purchase a gun to protect his family from intruders. Since bearing arms is a right should Person X get taxpayer dollars to pay for the purchase of that gun?

    Person Y has a blog where she speaks about many political issues that are considered unpopular or extreme. She pays money to have this blog hosted. Should taxpayer dollars pay for the blog run by Person Y to exercise her right to free speech?

    I think anyone can agree that healthcare is a right that everyone has. However being a right does not mean the government should provide taxpayer dollars for the exercise of that right. Taxpayer dollars should only be spent to protect rights, not enforce certain political views of how a right should be exercised.

  15. Deb Geelsdottir 2013.08.10

    A question seems to be about why some tax payers should allow their tax money to go for someone else's needs.

    Because we are one nation, and that's what nations do - work together. We are not simply a geographic space inhabited by several million different people. We are a unified, recognized, legal entity together. Not separate little kingdoms. So we pay taxes to the various entities for the benefit of all.

    We, the U.S.A., survive and thrive exactly due to our nationhood. As a nation we share responsibilities, costs, goals, aspirations. We help those in need to build the whole. A Nation.

    Why should tax money go to help someone who can't afford a life-saving surgery? Because she is another American, just like you.

  16. Owen Reitzel 2013.08.10

    I look at healthcare Ken from the view of the 6th Amendment where you are entitled to defense counsel and if you can't afford one it will be provided for you.
    We have the best healthcare in the world and fewer and fewer people can afford it.

  17. Ken Santema 2013.08.10

    I agree healthcare is getting to a point where fewer and fewer can afford it. But I question if government intervention with taxpayer dollars is the correct method to use. Increased interventions over time have caused the prices of medical practice and insurance to rise (especially in the last 30 years). Obamacare does nothing to reduce the costs already added by regulations. Obamacare will in fact increase the overall cost of healthcare as a nation. The fact it may reduce the healthcare costs for some does not make a good case for raising the overall cost to the country.

    Somehow the words "right" and "entitlement" have been intertwined over the years. I would think anyone that makes the moral case for healthcare as a "right" would also be working in their local communities to find solutions for helping the poor. Outsourcing morality to the government may make people feel good, but it has a poor track record of actually helping anyone except politically connect special interest groups.

  18. Jana 2013.08.10

    How well history recalls the barriers set up for blacks to vote in the South. The Supreme Court...not so much.

    If there's a problem with coming up with legislation that serves your business interests, why get a lobby or rely on ALEX to write your bills? If you have no power on your own, why hire an attorney?

    If they won't let you run your foreign pipeline full of toxic sludge through a state, why hire the state GOP chair to be your voice?

  19. Barry Smith 2013.08.10

    Owen brings up an interesting point. The Founding Fathers saw fit for the Government to provide for legal services as a right for those who could not afford it, at a time when affording legal services was a problem for many of the poor. All things considered one has to wonder if they today would see fit to provide medical services as a right. It is only speculation since medicine of the time consisted of mostly sticking leeches on people, but it is interesting.

  20. Barry Smith 2013.08.10

    MC can scream all day long that "Health Care IS NOT a right! but it is akin to screaming The state bird IS NOT the pheasant. There are laws on the books that make the state bird the pheasant just like there are laws on books that make health care a right.

  21. MC 2013.08.10

    Maybe a better defination of what I believe health care is may help.

    Healthcare includes visits to the doctor, lab work, tests, medicines (short term and long term) procedures in clinc/ hostipal and rehab.

    The ER is not a health care plan. Yes you have to be treated if presentented to an ER. Who eats those costs? The state, the clinc or hosiptal? Almost all of us knows prevention and early detection is cheapest versus an ER visit.

  22. Owen Reitzel 2013.08.10

    I agree MC that prevention and early detection is cheaper then an ER visit but for some the ER is the only thing they can do. It's not right but that's the only choice they have. And they sure can't afford tests (like mammograms) to prevent diseases.

  23. Barry Smith 2013.08.10

    MC if you have to be treated at the ER, which by law is a right, Why are you against a law that makes prevention and early detection a right? By your own admission it is cheaper. Where is your conservative fiscal responsibility?

  24. Deb Geelsdottir 2013.08.10

    Ken, I know it is conventional wisdom that health care programs have contributed greatly to increasing costs, but I wonder how true that is? Are there links to credible sources? One of the reasons I'm asking is that overhead for Medicare is very low. Medication expenses for the VA are quite low. (Nope, I don't have links. I'm not very good at knowing how to find stuff like that on the web. Anyone else?)

    I know that the Republican-led Congress of the GWB years forbade negotiating with drug companies for a government program.

    So part of my wondering is if there were not special deals for private health care businesses, could a government program be more efficient without the profit push in the private sector. Are the cost comparisons truly apples to apples?

  25. Ken Santema 2013.08.10

    I have links, but not sure if you would count them as credible. There have been many studies over the years trying to show the cost of regulation on varying industries, with mixed results. I usually refer to this 2004 Policy Analysis because it looks at the good and bad effects of regulation.

    The key findings in this study is that regulations cost the average american household an extra $1,500 per year. The majority of the difference from a cost/benefit viewpoint is from the Medical Tort System. However regulations steming from the FDA and placed upon medical facilities were also large contributors to the cost. Ironically the Health Insurance industry showed the most beneficial cost/benefit ratio for regulations; but that is what Obamacare aimed to fix?

    I'm not at my work computer so I can't find the link... But. The overhead cost of Medicare (I think according to the CBO) is about 2%, with most private insurers being between 11%-15%. The problem is the Medicare overhead costs don't count federal services originating or shared with other federal agencies (infrastructure, IT, accounting, etc..). There are also differences between what is counted as "administrative" in the Medicare world and the private insurance world (even in the private insurance world this word has been found to have varying meanings between companies). It had also been found that companies with higher overhead generally had lower premiums for their customers. This was in part believed to be because those companies spend more time on preventative healthcare services and educating their customers about healthy living (I don't remember if they had proof of this, I think it was just speculation about the results).

    Now having said all that I don't think it can truly be an apples to apples comparison. And the Republicans have made things worse by trying to use terms like "free market" and "personal responsibility", which unfortunately they don't understand so they ruin it for those of us that do.

    As a libertarian I would probably be opposed to any government intervention. However, I think a program aimed directly at actually helping poor people get direct medical attention would have been better than a system that further complicates the medical insurance industry and potentially hurts more Americans than it helps. That would be the lesser bad situation compared to what Obamacare will potentially do to the medical industry.

  26. caheidelberger Post author | 2013.08.12

    Permit me to go back to the original rights comparison. Here in the U.S., we speak frequently of the "right to life." Europe speaks of the "right to bear children." The two rights, if they are indeed rights, are not mutually exclusive. I'm very curious: why in America do we hear a lot about the former right but almost nothing about the latter?

    Subsidizing the exercise of rights: MC raises and Ken expands on the point that they don't like paying for other people's exercise of their rights. I'll agree that saying people have a right to X does not mean we have an obligation to raise taxes and hand out X to everybody. I have a right to property, but that right does not oblige you to surrender your property to me.

    But look what Owen and Barry bring up: if charged with a crime, we have a right to a speedy and public trial and legal counsel. That right is important enough to us that we pay for the court that conducts that trial and the defense lawyer if the accused can't afford one. So the 6th Amendment gives us a right that we think entails an entitlement, an obligation on our part to provide for others services without which that right could not be exercises effectively.

    Now we apparently don't feel the same way about the right to bear arms. We haven't created a Gun Stamps program. On the Second Amendment, we mostly focus on avoiding laws that create undue burdens on individuals' exercise of that right.

    Ken's blog example on the right to speak is reasonable. We don't subsidize blogs (but you're all welcome to ring my tip jar above!). As with guns, we focus on removing excessive restrictions to free speech.

    But notice we do subsidize education. We use our taxes to create schools that are open to all citizens, under the notion that education is essential to exercising the right to speak and all other democratic rights. (But we don't provide free gun training in the public schools. Hmmm....)

    So there's a spectrum here: some rights we say, "Do what you want; call us if someone tries to take that right away." Other rights we say, "This right is important enough that we're going to give you stuff to help you exercise this right."

    Where does the right to life fall in that spectrum? The fetuses to whom that right is most frequently applied cannot survive without taking something from someone else. Does not "right to life" then necessarily entail an entitlement to handouts from someone else?

    Suppose a baby is born with serious ailments that require heroic medical intervention. Mom and Dad look at their other five kids and decide they just can't afford the treatment for this sickly child. They tell the doctors to end treatment. Does that baby have a right to life? If so, what are our obligations in this situation to ensure that child can exercise that right?

    Likewise, where does the European right to bear children fall on this spectrum? I'm ready to grant that a woman can't walk into a clinic and demand in vitro fertilization, then demand a free stay in Sanford's cushiest maternity suite.

    But as noted by Rosenthal, childbirth is a pretty fundamental human activity. We have a very practical interest in making sure it keeps happening. Is childbirth important enough to us that we will subsidize pre-natal care and delivery the way Europe does, in order to remove the unavoidable economic barriers to exercising that right?

    Put it this way: if we'll pay for an accused criminal's lawyer, should we pay for an expectant mother's midwife or ob-gyn?

  27. Ken Santema 2013.08.12

    Getting ready for the fair, so not time for a proper response. Bookmarking so I can potentially do a future post on it. Its a debate worth having.

  28. caheidelberger Post author | 2013.08.12

    No worries—I do not impose time limits in the comment section.

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