I’m delighted to announce my partner has been struck with a short-term disability. She is pregnant. Which, in the capitalist utopia that is the US, is pretty much the same thing. It’s the only developed country without mandated paid maternity leave; in some states, however, short-term disability insurance covers your income for a few weeks while you recover from the miracle of birth.
You know what is really a miracle? The fact that anyone gives birth in the US at all. (And, in fact, not many people do: the birthrate has plummeted.) It doesn’t just have the worst parental leave in the rich world, it is also the most expensive country in which to have a baby. It is hard to pin down exact costs because they vary wildly depending on your location and your health insurance. However, even with decent insurance, you can expect to pay a few thousand dollars out-of-pocket for an uncomplicated birth. Indeed, the cost of delivering a regular American baby is more than that of delivering a Royal baby in the UK.
Why is childbirth in the US so expensive? Do they cut the umbilical cord with diamond scissors? Do they feed you gold-coated grapes while you push? No, they do not. Although a friend did get a Chanel goodie bag from a Manhattan maternity ward. Which seems … unnecessary. But, while some hospitals might give you brand-sponsored gift bags, you are not getting better care than you would in the UK. You are getting massively marked-up care – along with the highest maternal mortality rate in the developed world.
Anyway, I am slightly stressed about going bankrupt before we even take the child home, so I have been talking through a birthing plan with my partner. If the hospital offers you a cup of tea, I have suggested asking how much it costs. If they ask if you want to hold the baby, ask how much it costs! (You can be charged $40 just for holding your newborn). If you want to go to the loo, ask how much it costs! My partner is not keen on this birthing plan and, to be fair, it has flaws. Namely, nobody in the US healthcare system can ever tell you how much anything costs. They just tell you to call your health insurance company, who tell you to call the hospital’s billing department, who put you on hold then tell you to call your insurance company. Three weeks later, you get a bill full of surprises. I read about someone who got an $11,000 “nursery fee” after giving birth because a nurse had taken her son out of the hospital room to check his hearing. This was purely “optional”, according to the person’s health insurance, so wasn’t covered.
Another thing you have to worry about? Even though your hospital is covered by your health insurance, one of the specialists who comes into contact with your newborn might not be. After having a caesarean section, a friend had a paediatrician quickly check her baby. Because the paediatrician was out of network – so not recognised by her insurance provider – she got a bill for several thousand dollars that she is still contesting. Which is precisely what you want to be doing while dealing with a newborn. Then there are the errors: it is estimated that up to 80% of medical bills contain errors. Weirdly, these always seem to be overcharging you rather than undercharging you. I dunno, but if you make mistakes that much it seems more like a business practice than an error to me.
I am trying to become a more positive person so I don’t turn my child into a curmudgeonly grinch. So here is something positive I would like to say: the NHS is wonderful. Seriously, if you are in the UK, don’t take it for granted. I almost had an aneurysm when I saw that an influential conservative thinktank had recently published a report saying there was “no reason to be grateful” for the NHS. Perhaps the report’s author should try reproducing in the US.
Arwa Mahdawi is a Guardian columnist
