When Julie Bryant found out she was pregnant, she immediately called her best friend Laura Davis, who was a brand-new mom herself. Having a child was one more life adventure the two women would get to share, after both growing up in eastern Canada, attending the same college, moving to America to attend the same medical school, becoming physicians, and getting married. Yet geography now kept them apart: After medical school, Bryant, 35, had settled in New York City, while Davis, 34, had returned to Canada.
On the phone that day, Davis pressed her: “Will you come home to have the baby?”
Despite the lure of her friends and family there, Bryant’s answer was firm. “No,” she said, “I’ll get better care if I stay in the U.S. because I can pay for it.” Was she right? A New York Times story today says that in the U.S. many pregnant women face “sticker shock” because charges for delivering a baby have tripled since 1996, making them the highest in the world. The story also posits that the increased costs don’t translate into more or better services. But that’s not exactly the experience of these two friends.
In Newfoundland, the province both women are from, the health care system is 100 percent public. Everyone gets the same access and the same care for free. You literally can’t pay for service because there are no private doctors. You also must be referred to see a specialist by your family doctor; you can’t contract with one directly for an appointment.
When Davis discovered that she was 10 weeks pregnant, she went to her regular doctor to get a referral to an OB-GYN. She was a healthy woman with a normal pregnancy, so her specialist visit was not prioritized by the system. It was so low a priority, in fact, that the first available OB-GYN appointment was when she was eight months pregnant. This is the norm, according to Davis. Until you’re a few months away from your due date, you’re seen by only your general practitioner. A study conducted in 2012 by the Fraser Institute, a leading Canadian public policy think tank, found that the median wait time in Newfoundland across all specialties from a patient’s initial visit with a general practitioner to treatment by a specialist is 26.8 weeks. “The problem is wait times,” Davis says. “Even if you have money, you can’t buy a faster appointment. If you have a high-risk pregnancy, you would get in a lot quicker, but for a normal one, you probably wouldn’t get in until your last trimester.”
Davis managed to work the system, but only because she is a doctor herself. She was able to “make a few calls” and get in to see an OB whom she knew, after only a few weeks of waiting. It also likely helped that she developed some minor health issues that needed to be addressed, bumping her up on the wait list. The average woman could potentially work the system if she was insistent enough, but Davis had the advantage of being able to personally call the physician’s secretary to secure her appointment.
For the duration of her pregnancy, Davis visited her OB every few weeks. Each time, she would spend about an hour in the waiting room for a 10-minute visit. If she had concerns or questions between visits, she could either call the doctor’s secretary or go to the walk-in case room of the local hospital, a triage area set up like an emergency room for pregnant women who need to see a doctor. There, she could see a nurse until the resident doctor on call was available, which would take about an hour. To see an attending physician at all, she would have to be in actual labor or have a serious issue, and the wait would be several hours. Still, she was one of the lucky ones.
Meanwhile, on the other side of border, Bryant found herself navigating a very different health care system. Bryant, then 34, initially chose to see a practitioner at a clinic that accepted her insurance. “But she never remembered anything about me from visit to visit,” Bryant recalls. “She spent no more than three minutes during our appointments.”
The lack of attention became more than a mere nuisance when Bryant began throwing up so profusely that she couldn’t keep down water. After repeated attempts to reach the doctor through her answering service, Bryant finally got a call from a different doctor “who sounded like she was at a nightclub.” This new doctor told her that she was sick because she was pregnant.
Bryant decided it was time to pay out of pocket to see a better doctor—and since she lives in the U.S., she could. So she found a blog on which New York women leave comments about their experiences with different OB-GYNs, and then made an appointment with Dr. Janice Marks for the very next day. Dr. Marks’ practice is completely private; the reason she doesn’t take insurance, according to Bryant, is that she doesn’t have to. Marks initially spent an hour and a half talking to Bryant about the plan for her care, asking her preferences, and reassuring her. During the following months, which included a scare involving early contractions around 22 weeks, Bryant was always able to reach Marks personally within minutes through her answering service. Marks even called her unprompted during a vacation in Colorado just to check up on her. The total cost out-of-pocket to Marks for all of Bryant’s visits? $12,500.
“You get what you pay for,” says Bryant. “There’s this shame we’re supposed to feel for being … rich, but that’s not fair, is it? I wasn’t born rich. I worked really hard. You should be able to buy what you want with your money.”
To her, the American attitude toward medical care comes as a dose of welcome reality. “The message in the Canadian system is that we’re all alike, and there’s something nice about that when you’re not sick,” she says, “but if you actually have medical problems, and you’re in a system that’s designed to treat the most people and save money, and not to do absolutely everything that’s possible, then that’s when it becomes an issue. If I were dying of cancer, I’d rather live here.”
When she went into labor in September 2012, Marks was waiting and ready at Lenox Hill Hospital. From 10 a.m. until the birth of Bryant’s daughter at 4 p.m., Marks was there virtually the entire time. She performed a successful C-section when it became clear that Bryant’s pelvis was too narrow to let the baby’s head pass.
Back in Newfoundland, when Davis went into labor with her daughter, she went straight to the case room of the local hospital and waited to be seen by whoever was on call. She didn’t have control over who her doctor would be. “I wish I could have had a doctor who was following my pregnancy and knew me,” she says, “but it ended up fine.”
After she delivered a healthy girl, she shelled out $300 for a private room, rather than share a ward with three other women. The money was the only amount she spent in medical costs during her whole pregnancy and labor, unless you include the annual 45 percent of her income she pays in taxes partly to help cover the cost of MCP, the health care plan for her province.*
Davis says she would have paid for more attentive care if she could have, “just for the reassurance alone. It would have been nice how [Bryant] could call up her private doctor with any concerns, and I didn’t have that. If I had questions, I had to wait, or take a trip to the emergency room. It was a little inconvenient.” If she were in the States, she says she wouldn’t have hesitated to pay the $12,500.
So under which system does each prefer her daughter to grow up? Bryant’s response is unequivocal—she wants medical care that can be bought—but Davis hedges. “It’s tricky,” she admits. “Within Canada, she’ll have access to care, but if there was anything complicated or specialized, I wouldn’t hesitate to go to the States.” And if, after many years of health care reform, the U.S. becomes even more like the province of Newfoundland, abandoning private care altogether, then where would the women go?
Bryant pauses. “I don’t know,” she finally says. “Where else is there to go?”
*Names have been changed to protect the women’s privacy.
Correction, July 3, 2013: This article originally misidentified the MCP as the Canadian national health care plan. It is the provincial health care plan for the province of Newfoundland. (Return to the corrected sentence.)