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The Patient Protection and Affordable Health Care Act

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The Patient Protection and Affordable Health Care Act

The Devil's in the Details - Infant mortality

One side argues for healthcare reform by pointing to the high infant mortality rate in the U.S. (6.8 per 1,000 compared to 2.4 in Sweden and 3.9 in Germany, for example). The other says that infant mortality is counted differently in the U.S. than it is in other developed countries, and therefore the claim is false. There the argument seems to have stopped, with each side choosing to believe that the other is distorting the facts or lying. But who is right? I decided to find out about this devilish detail.

The Centers for Disease Control says infant mortality is indeed counted differently in the U.S. and 14 of 19 European countries. They report all live births of any gestational age. Four countries only report live births after 22 weeks or weighing more than 500 grams. Their mortality rate looks lower because they exclude some of the deaths the U.S. counts.

But “when births at less than 22 weeks were excluded, the U.S... rate dropped... to 5.8... .” So both sides are right: the U.S. rate is considerably higher than in other developed countries and infant mortality is counted differently in the U.S., so the U.S. rate is inflated. Both sides distort the facts to fit their own agenda. Or, more probably, they just stopped with the facts they liked. Good news: they’re probably not just lying.

When the discussion stops, everybody goes away mad and distrusting of the other side. Continued discussion might lead to solutions. A closer look shows that the U.S. rate for premature births is actually lower than other countries’ up until 37 weeks of gestation. After 37 weeks the U.S. rate is 12.4, while the rest of Europe (except one) is between 5.5 and 8.9.

One of the major causes of premature birth is the health care system and how it handles prenatal and birthing care. This is addressed in the Affordable Health Care Act at: SEC. 2301. COVERAGE FOR FREESTANDING BIRTH CENTER SERVICES and other places in the bill. Was it being addressed before the act was passed? I don’t know, though the percentage of pre-term births in the United States has risen 36 percent since 1984, and, after decades of decline, the rate did not decline significantly from 2000-2005.

Can we address this problem with the kind of regulation of private insurance contained in the Affordable Care Act? We’ll see.

Since it took me four hours to get this far, I continue to believe that the health care question has gotten too complicated for most people to understand. Worse, I doubt that most politicians understand or pursue these details. (Some may, since the Act addresses this issue. But they may just have been following party lines.) I reckon most vote the way they’re used to voting, and skip the devilish details. We continue to exacerbate our differences, while we should be looking for the common ground we need to solve these problems.

If you would like me to continue this series, have a question, a research topic, or a suggestion for me, or would like to contribute your own devilish detail, please contact me at: 208-304-9066 or docnangee(at)yahoo.com. 

You can read the CDC briefing at http://tinyurl.com/yj33qhn.

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Nancy Gerth is a freelance writer

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health care, Patient Protection and Affordable Care Act, health insurance, reform, infant mortality, statistics

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