Neal Kaufman is director of the Pediatric Ambulatory Care Clinic at Cedars-Sinai Medical Center, which serves about 3,000 children from low-income families. He is also on the board of directors of the March of Dimes, a senior consultant to the Child Health System of L.A. County’s Department of Children and Family Services and an advisor on child health services to the L.A. Free Clinic and Venice Family Clinic.
He was interviewed by TRIN YARBOROUGH about the consequences of proposed cuts in government-funded health care, particularly state funding for prenatal care of illegal immigrant women.
When I look at the proposed cuts in prenatal care for immigrants, I can’t understand how anyone could think that eliminating those nine-month costs would save money. To me it’s clear that, humanitarian considerations aside, the increased costs to taxpayers will be enormous. It means a serious waste of taxpayer dollars.
Every day I see what happens when women don’t receive prenatal care. Some of the children suffer from mental retardation, chronic breathing and digestive problems, physical deformities, minor brain damage that can cause learning disabilities, and other conditions that could have been prevented through prenatal care. For example, during prenatal visits women can be taught to take a simple vitamin called folic acid. Without it a baby is more likely to be born with an opening of the spine that prevents it from ever walking or maintaining bowel or bladder control.
Prenatal visits can also easily detect and control two common complications during pregnancy, diabetes and high blood pressure in the mother. Her diabetes can cause such severe defects in her baby as an open spine or malformed heart. Her high blood pressure can cut the blood supply to the fetus and cause her baby to be born severely malnourished, with a small brain and permanently stunted growth.
Under federal law, care in an emergency--which legally includes every delivery--must be provided to everyone, including illegal immigrants, if necessary at taxpayer expense. Prenatal care can prevent minor pregnancy problems from becoming major emergencies, which are always more costly.
The cost of taking care of babies born prematurely or with birth defects is enormous, even with lesser defects like breathing difficulties. And some conditions need care for a lifetime, when with prenatal prevention they would never have happened. Since every baby born in the United States is automatically a citizen, no matter the status of its parents, this could be a taxpayer expense too.
Not all birth defects are preventable. But a significant amount are. During each of the three-month-long trimesters of pregnancy, different things can occur to harm the baby and also the mother.
One in 33 babies born in California is born with a birth defect, and the lifetime cost to California for 18 common birth defects, most of them preventable with prenatal care, has been estimated at $1.8 billion.
The basic problem is that too many working people don’t have health insurance. Of the uninsured, 70% to 80% are working people or their dependents.
When the health care crisis hit L.A. County about a year and a half ago, and the entire county health care system was on the brink of financial collapse, Cedars-Sinai loaned me to work half time as the senior advisor on health with the office of the county health crisis manager, Burt Margolin.
One thing we did was desperately look for other funding sources, and we explored such private sources as foundations. There was an extraordinarily good response. When the federal government bailed out the county at the last minute, these groups backed off for the time being, but there was a lot of consciousness raising.
Poverty itself causes health problems. Since 1990, when Aid to Families with Dependent Children was beginning to be cut, the number of kids in Los Angeles County placed under Child Protective Services because of abuse or neglect has almost doubled.
By law, the health care, clothing, food and shelter of all these children are funded by our taxes. Protective services is still an entitlement, and it’s uncapped. That means that legally there cannot be a limit placed on the number of kids in its care, many of whom face special health risks because when they are moved to various foster homes no single caretaker keeps track of things like their innoculations or treatment of such life-threatening but common conditions as asthma.
And the costs to taxpayers are not just medical costs. For example, children born with minor brain damage leading to learning disabilities--much of which could be prevented with proper prenatal care--may need years of expensive special education support. Children who can’t get proper education and training won’t be able to work and will require some taxpayer support or perhaps even end up in jail, once again at taxpayer expense.
The way a society cares for its frailest, most helpless members reflects on that society. But if you don’t believe in providing prenatal care from a humanitarian standpoint and just want to save tax dollars, then cutting prenatal care is simply stupid.
It’s an irresponsible waste of taxpayer money.