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Thursday, October 27, 2011

Money Driven

Apparently it's National Blog Post Writing Month. Seems pretty easy. And I, unlike the many lazy bloggers cluttering up the internet, will be finished well before November 30th. So here you go... Streimikes inspired by NBPWM. Perhaps you can look forward to another blog post next November!

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A few weeks ago I listened to an NPR story about kids from a Lakota reservation being taken by South Dakota state child welfare workers and placed in foster care. This was a common practice in the old days. Native kids would be restricted from practicing their religion, have their heads shaved, and were generally forced to assimilate. But things changed. The Indian Child Welfare Act was passed and there are federal regulations now about taking children from tribes. But this NPR reporter had dug up some profoundly disturbing things about what was happening in the Lakota Nation. In South Dakota, children were still being regularly taken away from the reservation. They weren't being placed with relatives or other Indian families. And there seemed to be very little communication or cooperation with the local tribal authorities about what was happening.

The journalist found out that the State of Dakota was getting millions of dollars every year from the federal government to help subsidize these placements. Federal matching funds are used to help pay for the very expensive foster care system. And every native kid was classified as "special needs" simply due to their race. That meant additional revenues for the state. The reporter also found former officials willing to testify that there was corruption. These officials went on record to say that South Dakota is a very poor state... and that the millions of dollars that were streaming in to pay for these programs meant valuable jobs for an industry-poor region.

The story went on to talk about one family's fight to get their children back, and about a plucky lawyer willing to fight the state government's unwritten policies. But mostly, it was just a sad story about what happens when money trumps humanity.

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Naturally, this made me think of dentists. I have been amazed by the pressure all dentists seem to exert regarding night guards. It's not that I think night guards are a bad idea. It just seems preposterous to pay $500 for one. People have argued that they have to cost this much because they are molded perfectly to your mouth. But the $5 athletic mouth guards that I wear playing softball are also form-fitted. I heat up the new mouth guard over steam until it's pliable, then put it into my mouth and bite down on the softened plastic. It cools and hardens in the exact shape my mouth requires. This amazing technology costs peanuts... and yet dentists push the $500 night guards on everyone. I have never heard a dentist suggest the $5 version to a low-income client... and I've overheard a lot of conversations between my dentists and the other patients sitting ten feet to my left or right.

Recently I got my first crown. I decided that I trusted the dentist's word. He said that I needed it to avoid a future root canal. But it really bothered me that between my insurance and me, I paid over $1200 for a procedure that took the dentist about an hour. To be fair, it also seemed to require about 50 cents worth of porcelain. Given the profitability of this procedure, what would stop dentists from prescribing crowns to almost every person that walked in... regardless of how necessary or helpful they would be? Why should I believe that money isn't trumping humanity here as well?

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This line of thinking made me want to call that NPR reporter... But not because I want him to investigate dentists and the corrupt night guard and crown manufacturing industries. I've decided that everyone knows dentists are evil. That would just be beating a dead horse.

The story I want cracked involves the strange rates of emergency c-sections being performed on immigrant and refugee women. C-sections are a legitimate procedure when natural child birth is not an option. And there can be all sorts of reasons for this... but being an immigrant is not one of them. In my job I see a great many women (women who have already successfully given birth many times!) ordered to get c-sections. There is usually no justification given to these clients... just a doctor's recommendation.

A quick bit of research found this study from the State of New Hampshire. Here's a money quote: "The rate of c-sections nationally has increased 53 percent between 1996 and 2007, to an average rate of 32 percent. There is no consensus about the short and long term benefits and risks to the mother and infant, and even though c-sections are performed routinely, many patients do not realize that the procedure involves major abdominal surgery and is associated with surgical complications and maternal readmissions. C-section provider charges and payments are often substantially higher than for vaginal deliveries, increasing medical care costs to the patient, the insurer, and they health care system in general."

Has the birthing process also succumbed to the same level of greed that child welfare and dentistry have?! And should I fight this? Should I be fighting this trend in my work as a social worker and advocate for vulnerable refugee women in south Seattle?

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