The Stupid Prize

You guys, I can't even believe it.

I was googling around today, looking for information for a talk I'm giving next week, and I discovered that the federal mandate requiring insurers to cover breast pumps gives them a boatload of latitude in defining the terms of that coverage.

They can say, "We will only pay for a manual pump."

They can say, "We will pay for an electric pump, but only from a specified vendor. Who may or may not carry the one you need."

They can even refuse to provide a hospital-grade pump for a medically fragile premie who is weeks away from direct breastfeeding.

That right there? Is some industrial-grade stupid. High-octane stupid. That's not even penny wise, pound foolish -- that's, like, drachma wise, pound foolish. (If the drachma still existed, there would be 408.5 of them to the pound. I think I need a smaller unit of currency to convey my disdain for this kind of stupid.)

The early days after a baby arrives are a sensitive window, in which a woman is calibrating her milk production for approximately the next six months. If her baby cannot move enough milk to send the appropriate message, it is critical that she have access to a hospital-grade pump.

Do you know how much this would cost an insurer? I'll tell you how much: $65 per month, or $2.17 per day. Do you know how the odds of developing necrotizing enterocolitis compare for breastfed premies versus formula-fed premies? I'll tell you how: formula-fed babies' odds are approximately eleven times higher. Eleven! Do you know how much it costs to treat a bout of NEC? I'll tell you how much: $74,000 if the baby doesn't need surgery, and $148,000 if surgery is required. 

But hey, that insurance company can totally save $2.17 per day by telling the mom to use a manual pump and be grateful for it.

When women don't produce enough milk for their babies, they may feel frustrated and defeated. Sometimes they blame themselves; sometimes they feel defective. But nobody can bring in a full milk supply with a manual breast pump. (I still remember how sore my arms were after one day of trying to use a manual pump for a baby who couldn't nurse.) It's not the mothers who should feel inadequate-- it's the bean-counters at the insurance companies who decided that a $2.17 daily savings trumped a potential $148,000 hospital bill (and that's on top of the substantial baseline costs of the baby's NICU stay).

There's ordinary stupid and then there's dumbfoundingly stupid. Unpredictable piecemeal coverage for equipment that ought to be the standard of care for premature babies-- that's so stupid it burns.