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California wants to pay doulas more. Really?
Paying the doctor versus paying the coach
Let me start by giving a warning. I’m about to climb onto my soapbox and shout at the wind about something that I think is insane. Another warning, if you are a doula this is probably going to anger you.
There is a debate going on in the state of California about providing doula services for pregnant women covered by Medicaid to assist them with their delivery. For those of you not familiar with doulas, let me fill you in. They are not clinically trained and are unregulated. They don’t deliver babies but rather provide resources to navigate the health care system, information on sleep and nutrition, and lactation support. They also support mothers during birth to make sure their wishes are being respected by the hospital.
Let me pause here and just say that I don’t have anything against doulas, and I am sure they do a wonderful job and help many women during childbirth. The rant that is about to begin has nothing to do with doulas but rather the insanity around covering these “services” with stretched public funds under Medicaid programs.
Ok, now that we have all the disclaimers and caveats out of the way, ARE YOU FREAKING KIDDING ME?!
The debate in California is now centered around how much they are going to pay for this service. The state suggested $450 per delivery. The doulas think that is not nearly enough and would like $1000 per delivery. Other states who already cover doulas pay anywhere between $350 to as much as $1500 per delivery.
In Oregon, the state that pays $350 per delivery, the Medicaid system received claims on about one percent of deliveries. Advocates for doulas say that the reason they are not used more is that the reimbursement is so low that they can’t attract doulas who want to work with Medicaid patients.
Ok, for the sake of argument, let’s say that this is true. Let’s say Oregon increase its reimbursement to $1000 per delivery and that increased the utilization to 50% of the Medicaid deliveries. If that were to happen Oregon would have just added $40 million to its state budget. If California sets a price at $1,000 and 50% of the women used the benefit, they would have just added $134 billion dollars of expense to Medicaid every year. I was unaware that California had an extra $134 billion dollars laying around.
Remember that is $134 billion dollars being paid to unlicensed, unregulated, non-clinical “birth coaches.” Seriously, does no one else see the problem with this?
Quite frankly, as bad as that math is, it isn’t even the worst part. The worst part is that even after paying that money, you still must pay someone to deliver the baby. You know, like an actual doctor. Someone who went to school for about fifteen years, is licensed, regulated, and has malpractice insurance. You remember doctors, don’t you?
Many states have a hard time attracting Obstetricians to care for Medicaid deliveries. The reason is a combination of the fact these are difficult patients and low reimbursement by Medicaid. In North Carolina, a vaginal delivery with postpartum care pays the doctor $800. The doctor is getting paid less in North Carolina to deliver the baby than what the doulas want to get paid in California to provide “support”.
Ok breath, in and out (as a doula might tell me). To be clear, in California they want to start taking taxpayer money to cover birth coaches and potentially pay them more than what doctors get paid to do the delivery? To borrow one of the best quotes from the movie Forest Gump: “are you crazy or just plain stupid?”
We have some very serious problems with health care and how we are going to finance it. These problems are going to force us to make some very difficult decisions. Like many things in life, we will be looking at what we want versus what we can afford. Can we at least start by all agreeing that in a world of limited resources, covering doula services with taxpayer dollars is not something we should do?