Rearrange the spectrum, a turnaround, and sell it to the wireless companies. More of what is happening in todays cable industry from todays cable show on the communicators. Next, a discussion about childbirth costs in the u. S. With elizabeth rosenthal. This is from todays washington journal. It is about 40 minutes. Host now joining us Elisabeth Rosenthal, correspondent for the New York Times, looking at American Health care system and its expenses. This past week, american way of birth, the costliest in the world. Itsok at childbirth and expense. Thank you so much for joining us, Elisabeth Rosenthal. Guest thank you for having me here. Host why did the New York Times have Truven Health analytics look at the cost of giving birth in america . What value going on this topic . Guest a group called truven analytics to the report of commission by three healthcare groups this year to look at the changes in childbirth costs. The numbers were really eye popping to me. I wanted to know a little bit more about how that had changed over time because i think we have all seen Health Care Cost escalates. We really wanted to find why is this happening. Host why look at birth . You talk about how this is one of the most fundamental things that women, families, go through an experience, so why look at this in particular . Guest when i initially laid out this series, i was not going to include childbirth. It had not even occurred to me. When we sorted talking about at the time, i found out that i older colleagues were energized by things like hip replacements and colonoscopies, but my younger colleagues were all complaining about how expensive childbirth had become. These are people with insurance, so then when i started asking around, i discovered that there were many people whose insurance is not even cover them for childbirth anymore. I think to me, childbirth is one of those kind of iconic moments. It is a healthcare intervention, but it is the one that perpetuates our country and our species, so if insurance is not covering that, that is not a good sign. Host the New York Times look at the average 2012 amount paid by country by rate. Commercial delivery, 9700. Cesarean birth, over 15,000. That is usually above other developed nations. Why the huge price cap . Guest that number for the u. S. Actually lays out a number of things because that probably would not include the anesthesiologist fee, a radiologist fee for scan, and that talks to why it is so expensive because most countries consider childbirth a kind of package, it is very hard to childbirth without a scan. We tend to what we call unbundle. We charge for every little piece as if you are going through a supermarket and have celery and roast beef for dinner tonight. We charge item by item by item, and the costs really add up. That is one of the reasons. Another reason is that hospital excesses tend to be more. Our doctors fees tend to be more. We do more tests in part because people make money from everything we do. Host looking at other countries in the extensive report, you can see switzerland at 4000 compared to america, over 9,000. France, 3500. Even a cesarean session coming in significantly lower. Do these countries offer less highquality care than the United States . How does the care for a mother and child differ for those countries in the u. S. , or does it . Guest there are some differences, but i should point out that in response to our article, we got a number of comments from people who said i was living in switzerland or in france or in denmark, and it was heaven to have a child there. And then i came back to the u. S. And had a child, and it was you know, the services are fine. They do not like the bills when they compared i think that is the big difference is. I should point out that some of these countries have a National Health system, others have fees for Service Medicines like ours, they just cost it differently. So i do not think there is any difference to the kind of services. We tend to do more of things that cost more. Like cesarean sections. We might say, get ultrasounds every week or twice a week for the last trimester. That may be appropriate in some cases. But they also do the things that patients who do not need it. We also do not use midwifery much compared to other countries. Host Elisabeth Rosenthal writes in her recent New York Times story studies show that their citizens do not have less access to care or to high tech care during pregnancy than americans. She also writes that payments and incentives for providers mean that american women with normal pregnancies tend to get more of everything, necessary or not, from blood tests to ultrasound scans. And then finally, they financially suffer the consequence. Elisabeth rosenthal, tell us about some of the families that you talked to as they prepared to had babies to have babies. Were they able to keep track of very sensitive than what the bill would ultimately be . Guest the telling thing for me was the main family i focus on, a young couple, renee martin and her husband, mark willits, in new hampshire. Theyre the most responsible kids i have met in a long time. They tried to do everything right. Get they wanted to pregnant, these are two young adults who have always had Health Insurance. They tried to get Health Insurance for their pregnancy, but discovered, and this is a catch i did not even know about, and many states at this moment in time, you have to buy a pregnancy rider if you or your Health Insurance to cover pregnancy. And what that means, and their case, they researched it, they discovered that to get covered for pregnancy, they would have to pay 800 a month a month to have coverage for pregnancy, and the catch22 is that they would have to buy the coverage before they got pregnant, right, so you could pay 10,000, 15,000 a year to have coverage for pregnancy, not knowing if you are going to get pregnant. So where they were in life, they decided to just get regular insurance. Got got pregnant when they pregnant. They were not particularly trying. And then they had to approach it as a shopping trip. So they went to the hospital and said what is this going to cost us. At first the hospital said we dont know, and the next response that i was oh, between 4000 and 45,000 dollars. These are Young Professionals trying to be response will and plan out their finances, and if you got an estimate like that for a car or kitchen remodel, you could not go forward. Host Elisabeth Rosenthal has a doctorate degree, she studied history and biology at stanford. She has been with the New York Times since 1993. She is working on a yearlong series right now looking at Health Care Costs and the United States. If youd like to join the conversation, we have socialized if youre insured, you can call it that 202 5853880. If you are uninsured, call us at 202 5853881. And if you are a Healthcare Provider, you can call us at 202 5853882. What is a difference between those who have insurance and those who do not have insurance . Birth in terms of their experience, they both will suffer financially. People who dont have insurance have to start from square one and see if theyre qualified for medicaid or a state program, which might subsidize insurance, or look for a hospital because of some do now offer a package rates. But you have to be really careful to ask what is included in that package because there are often additional fees. People who have insurance are often blindsided because they think oh, well as many of my colleagues at the New York Times did, i have insurance, this will cover me. And then the whole pregnancy, or at the very end of pregnancy, they are hit with bills in the 4000 to 6,000 range. It is a lot of money. This can really add up. Ofecially if youre in one the highcost urban areas for medical care. Host lets go to the phone, next call is from nick in maryland. Calling on our insured line. Caller good morning. My understanding is the cost of medical care in the u. S. Is also related to Cost Shifting based upon those who do have insurance having to pay an additional premium, an additional amount, to cover the cost of those who do not have insurance. And therefore is a person is in a situation where they do not have insurance, or the insurance is not going to cover particular received your, then the rate that such a patient is charged is the inflated rate. That sounds terribly unfair to me. Guest yes, i think often the uninsured face the highest rates because they face the rack rates. Theres also this issue of Cost Shifting him a but i dont, and i know it is often given as a reason for why our rates are so high, but i would point out that even our medicaid rates pregnancy are much higher than those in other countries eared so i dont think Cost Shifting really explains the very high rates of pregnancy. There arent a lot of uncompensated deliveries going on now. Poor people who cant afford delivery tends to be eligible for medicaid or some of the low Income Assistance programs for pregnancy. The people with more means, like renee martin in the series, she basically will try very hard to pay those bills. Host columbus, ohio, gerald is uninsured. Go ahead. Caller im calling in to make a comment. The cost of insurance or the cost of medical period i already came to the same conclusion that they can do at the end of the article. It costs so much because they charge whatever they want. What it is costing to have it done is how much they want to charge. They have no morality when it comes to that. Guest yes, i think we price medical care the way we have priced almost any other good. Aw much does it cost to make smart phone . Certainly not 400, 500. You can sell a smart phone for 400 because that is what people are willing to pay, and that is what happens in medical, too. Hospital pay is getting x amount of money, we will get that too. We would like to say that our healthcare is market driven, it is not a functional market. Thee is not a vision, as Time Magazine article pointed out. How hospitals charge would they want. That is what we find out again and again in this series. Patients do not know the right theyre paying. Thedoctors do not know price the delivery costs. So how can you choose wisely . Host Elisabeth Rosenthal wrote a piece for the New York Times last month, it looks specifically at colonoscopies, the cost differences based on region and hospitals. You can also see other procedures and how much they cost and he United States. The average u. S. Price up here, and the average price in other countries, things like a hip placement costs on average 40,000 in the u. S. , they cost 7,700 in spain. The drug lipitor costs 124 in the u. S. And 6 in new zealand. Lets go to a Healthcare Provider in washington, d. C. Caller as ive been driving home, i would just like to comment on some of the issues on bundling or unbundling, i should say. You have to be clear of how we have been compensated when they look at the entire fee. We have been set on global fees for the delivery and postpartum for quite a while. So i think there is a misperception out there that somehow at least the obstetrician or the physician is being compensated for ordering extra test or for doing a cesarean section versus a vaginal delivery. The process has always been one great bundle. So i think we are on the forefront of what a lot of other specialists are probably going to be headed at. I think talking about the cost of delivery between, i think you had the range of 4000 to 45,000. A small part of that is the obstetrician, which has been controlled for a long while. It is all of the other components are those are my comments. Guest yes, i think the obstetricians have been on the forefront of bundle fees when you look the total fee for pregnancy. The obstetricians charges have come at about a quarter or less, and obstetricians have their fees have not escalated the way the hospital fees and all the ancillary fees have increased. They do, in that sense, provide a model for what could be done for other doctors. I have to say obstetricians work incredibly hard. They are up all night. They are not the big money doctors in our society. That is absolutely true. It is really the system that is the problem, and the way we do things that leads to these high prices. Host the New York Times shows the cost of the childbirth in the u. S. , the average charge for medical care serenity birth of a child totaled more than 37,000 according to a study by Truven Health analytics. The charge is given here are the building charges. You can be broken down. Prenatal care, everything from radiology fees to pharmacy fees to lab fees, over 6,000. You see the delivery section, over 18,000. As our caller pointed out, doctors over 3800. You see the cost for postpartum care, also the care given to newborns. Any of these numbers really stand out to you, Elisabeth Rosenthal, as surprising . Guest the hospital care certainly stands out to me. Formve a very medicalized of birth. Which i think speaks to the fact that we dont allow midwives to be very participatory. I am not saying that midwives are the answer for everything. Some people cannot use midwives. Ie of the craziest things learned in doing this story is that we many insurance policies, specifically dont allow midwives. So the woman wants to choose the cheaper option, and if she is medically qualified and say to that, her insurance wont pay for it. That is nuts. Host john is insured. Caller good morning, ladies. Thank you for this interesting topic. I am active duty military, and i am enrolled under tricare. That is really at home as opposed to comparing healthcare cost and to europe, but we have actually a domestic, socialized Healthcare System, which treats a considerable amount of folks. I have not heard any numbers comparing the cost of childcare, and what is the cost to give a birth at walter reed hospital, for example, to a spouse or to a military member compared to what cuts in the private sector at a civilian hospital . Have you done any research to compare and contrast those two numbers . Guest im afraid i have not, but im going to now. That is a fascinating question because obviously if they can be done for a lot cheaper there, that suggests it could be on the outside. And it provides a model. Another part of the reason we pay so much for birth at right at hospitals or city state hospitals, is that there is no system. Every birth is negotiated one by one by one, whereas in a system like the military is using, you have a lot of our giving power, you have a lot of control over the entire system to control costs. So we are doing things one of the least efficient ways possible. I will look at this when i get to work this week. Host a lot of your reporting has looked at how procedure in denver can cost a different amount than a procedure in new york city. Guest yes, you do see big regional variations across the u. S. All of our numbers are higher than all of the numbers pretty much in any of the european countries. Rememberk we have to even the places that we think of as cheap would be hugely expensive compared to other countries. Regional is a lot of variation with respect to childbirth. I was somewhat chagrined to see that new york stands out like a sore thumb as being much higher than the rest of the country. It is not always the places that you would predict that are high cost. Some larger cities that have, probably in some cases more managed care, have relatively low cost. I think los angeles and San Francisco were not particularly high in the childbirth. So there is a lot of regional variations. It is very hard for consumers who are trying to be smart about this to know what is a reasonable cost in my city. Because obviously a reasonable cost for everything in new york city is going to be higher than a reasonable cost for everything in a small town someplace far away. Host Elisabeth Rosenthal, correspondent for the New York Times, here is our first input from a female viewer. Jan writes on twitter how much do necessary tests and malpractice insurance factor into these costs . Guest let me do the second part of the question first. I think malpractice is a big issue for obstetricians. They pay sometimes a couple hundred thousand dollars a year for malpractice. So it is a part of the problem, but the more i spoke to people, the more i thought it was not a huge part of the problem. Like i said, the obstetricians work for you hard. They have a very demanding job. They trained for years. And their fees are not the big part of the problem. So, yes, malpractice is there, but it is really not the issue. Necessaryf the testing, what you see is we do the necessary tests as other countries do the necessary tests, but we take those tests and do them more and more and more. I think there is a kind of sense with the Way Insurance in our country works that why not just get two scans a week, we will see how baby is, we will get a sense of how things are going. We have the sense that if you are insured, no one is paying, but of course we are all paying. There is no harm, but there is. Host cornelius, north carolina, jeff is insured. Go ahead, jeff. Caller my wife and i, this is relevant because we are pregnant right now. It will be in midjanuary. Something that has not been discussed, and ive been doing all of the the father reading, having a good time, but our postpartum, we are going to be paying a lot this year. 1231, we get to roll it over and it would all again next year. We will max out of pocket this year for all of the prestuff, we will have the baby nex