Back to Basics

A real case of government healthcare…

One of my daughters became pregnant and found to everyone’s surprise she was going to have identical twins.  The news came with mixed emotions as well as difficult decisions.  This was not her first child and she, like many in the family, believes in natural childbirth without medication.  Only her first child was born in a hospital while all the others were born at home with a midwife.

She initially started seeing her midwife for prenatal visits, but when they discovered she was expecting twins the reality of government interference took hold.  The state of Arizona does not allow midwives to knowingly delivery twins, so they had to find a doctor.  They are on the state insurance, which poses it’s own challenges.  However, trying to find a doctor that not only would accept the state insurance but would also deliver twins and accept a patient at 10 weeks became almost an impossible task.  It took her a month to even obtain the booklet of doctors she requested from the state to start her search.  She went through the book and was more often turned down because the doctors no longer accepted the state insurance.  With the help of her midwife and fortunately a state employee willing to help, she was able to obtain the services of a high-risk OB team.

Through the ultrasounds they discovered the babies were identical twins, had separate bags of water but shared one placenta.  This put her in a higher risk category.  At one point during the pregnancy they determined she was experiencing twin-to-twin transfer and was then referred to a specialist.  Because of this the doctors wanted to see her 3 times a week and she underwent regular ultrasounds and non-stress tests.  During her third trimester an ultrasound indicated she actually had two placentas; that there was a division in the placenta that had not previously been noticed; the twins may not be identical.  At that time it was also revealed that she had not actual experienced twin-to-twin transfer, it was only borderline.  With only 4 weeks remaining until her due date the doctor told her she needed to find another doctor because she was now no longer considered high risk!

She took childbirth classes at the hospital she was to deliver at.  She is also a childbirth instructor so these classes were quite unnecessary from a childbirth aspect, but with this unusual pregnancy she wanted to be informed about the hospital, their procedures, as well as the special considerations in delivering twins.

During her regular doctor visits they discussed the expectations of delivery.  This resulted in a difference of opinion from the doctors and expectant parents.  The doctors believed in a medicated birth with a likely outcome of an induced labor as well as a cesarean delivery.  The parents believed in an unmedicated birth, as natural as possible, and only in an emergency to save the mother and/or babies did they want a cesarean.  They created their birth plan and the doctors made their modifications.  They were able to “negotiate” delaying an induction until 38 weeks.

She went in to labor naturally and the first baby came quickly.  They never made it to the hospital.  Labor never stopped and what seemed like a very short time later the second baby was delivered; he was a breech delivery.  Both babies were well and of good size, especially for twins (7 lbs. 14 oz. and 6 lbs. 9 oz.) with the mother and father cooperating during delivery; no one else was present.  This was a Sunday and at this point they did not want to go to the hospital because there was no need.  So they contacted one of their midwifes who came over to make sure mother and babies were okay – everyone was fine.  It also turns out the twins are identical, sharing only one placenta – the latest ultrasounds were wrong!

On Monday morning they contacted the OB doctors and told them the babies were delivered.  The parents asked if they should come in to be seen by the doctors and were told by the doctor’s office that they should come in 2 weeks.  The parents questioned this and the doctors decided they should make an appointment for that Thursday.  Everything seemed fine.

However, the parents received a call from the referring midwife indicating the doctor had issued a 911 call and told her to see the mother and babies immediately.  This second midwife came over Monday and checked everyone out – everyone was fine.

They kept their appointment on Thursday with the doctors, and again everyone was fine – or so they thought.  They expected to return to the doctor for her 6-week visit.

Under the title of Public Health & Workforce Development are a number of grants, scholarships and other programs, providing training, services and a whole new array of studies relating to health care – a lot of money being spent to support the expansion of government, special interests, illegal immigrants and labor unions, but little to help solve the health care issues.

The first expansion is the establishment of the Public Health Investment Fund, which requires deposits from the revenues of the Treasury in the amount of $88,700,000,000 over 10 years. This money is authorized to be appropriated by the Committee on Appropriations of the House and Senate for carrying out the activities under the designated public health provisions. These areas include Community Health Centers, National Health Service Corps Program, National Health Service Corps Scholarship and Loan Repayment Programs, Primary Care Loan Funds, Primary Care Education Programs, Nursing Workforce Development, The National Center for Health Statistics and the Agency For Healthcare Research and Quality.

To make these programs even more appealing is the stipulation that “Amounts appropriated under this section, and outlays flowing from such appropriations, shall not be taken into account for purposes of any budget enforcement procedures including allocations under section 302(a) and (b) of the Balanced Budget and Emergency Deficit Control Act and budget solutions for fiscal years during which appropriations are made from the fund.” More spending without any concern for balancing the budget or controlling the country’s deficit. We don’t have it, but let’s spend it!

The first program – Community Health Centers – will obtain increased funding in the amount of $38,800,000,000.

The National Health Service Corps is being amended allowing the Secretary to issue waivers to individuals who enter into a contract for obligated service to pay for their education. It further raises the loan repayment amount from $35,000 to $50,000 and will be adjusted thereafter to reflect inflation. Additional appropriated funds for this program are $796,000,000 over the next 10 years. Additional funding is authorized in the amount of $3,171,000,000 over 10 years to cover the National Health Corps Scholarship and Loan Repayment Programs.

The Frontline Health Providers Loan Repayment Program will be established to address unmet health care needs in certain areas, populations, or facilities as designated by the Secretary. Individuals participating in this program must agree to serve for a period of 2 years in a health professional needs area specified in the program. This program has a clause that if there are an insufficient number of applicants for the program, then all excess funds from the program will be transferred to the National Health Service Corps to recruit more people to take advantage of this fund.

The Secretary shall establish a primary care training and capacity building program consisting of grants and contracts to plan, develop, operate or participate in accredited professional training in the field of family medicine, general internal medicine, general pediatrics or geriatrics. Funds for this program are from the Public Health Investment Fund in the amount of $3,023,000,000 for 10 years and will include the following:

• Capacity Building in Primary Care – grants to specialties of family medicine, general internal medicine, general pediatrics or geriatrics, with preference given to entities that train individuals who are from underrepresented minority groups or disadvantaged backgrounds.
• Training of Medical Residents in Community-Based Setting – a program established for the training of medical residents in community-based settings, with preferences given to entities that support teaching programs addressing the health care needs of vulnerable populations or are a Federally qualified health center or rural health clinic, as well as preference to those training individuals from underrepresented minority groups or disadvantaged background.

• Training for General, Pediatric or Public Health Dentists and Dental Hygienists – grants and contracts to plan, develop, operate or participate in an accredited professional training program or oral health professionals, with preference given to individuals who are from underrepresented minority groups or disadvantaged backgrounds.

Grants for Health Professionals Education – Advanced Education Nursing Grants is being amended, including increases in dollar amounts for the Nurse Faculty Loan Program. Funding for this program is $1, 450,000,000 over 10 years.

The Public Health Workforce Corps is being amended and expanded by the following: Creating the Public Health Workforce Scholarship Program, Public Health Workforce Loan Repayment Program, Enhancing the Public Health Workforce, and Preventive Medicine and Public Health Training Grant Program. Appropriations for these programs total $642,000,000 over 10 years. The Enhancing the Public Health Workforce even includes provisions for veterinary medicine! I’m not sure how veterinarians will provide quality health care to people or decrease health care costs, but it’s nice to see even our animals will be included in the grant programs.

Under the Subtitle “Adapting Workforce to Evolving Health System Needs” there are a number of grants and programs including:

• Health Professionals Training for Diversity, which includes scholarships for disadvantaged students, loan repayments and fellowships regarding faculty positions, and educational assistant in health professions regarding individuals from disadvantaged background.

• The Nursing Workforce Diversity Grants is being amended and adding the Coordination of Diversity and Cultural Competency Programs.

• The Secretary will establish a cultural and linguistic competency training program for health care professionals, including nurses, consisting of grants and contracts to develop and implement models of cultural and linguistic competency training. Preference will be given to entities that address cultural and linguistic needs of the population and health disparities, and placing health professionals in regions experiencing significant changes in the cultural and linguistic demographics of populations, including communities along the United States-Mexico border. Obviously this program will benefit all the illegal immigrants coming from Mexico to obtain free health care.

Appropriations for these programs total $1,138,000,000 over 10 years.

Grants and contracts are given to develop training programs to promote the delivery of health services through interdisciplinary and team-based models, with preferences given to entities that demonstrated training to the greatest number of health professionals who serve in underserved communities.