When the Invisible Hand Wields a Scalpel: Maternity Care in the Market Economy

I. DEEPLY SIGNIFICANT, HIGHLY CONTESTED: INTRODUCTION TO BIRTH IN THE UNITED STATES . . . . . . 200 R A. Overview of Cesarean Surgery . . . . . . . . . . . . . . . . . . . . 201 R B. Overview of VBAC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 R II. BEYOND RISKS AND BENEFITS: FORCES IMPACTING AUTONOMY IN MEDICAL DECISION-MAKING . . . . . . . . . . . . . 208 R A. The Best Care for the Highest Bidder: Health Care as a Commodity . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 R B. The Myth of the Free Market . . . . . . . . . . . . . . . . . . . . 210 R C. The Two-Patient Problem . . . . . . . . . . . . . . . . . . . . . . . . 213 R III. ILLUSTRATIVE EXAMPLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 R A. Between a Rock and a Hard Place: Maternity Service Closures and VBAC Refusal Policies . . . . . . 216 R B. Holding Your Uterus for Ransom: Economic Threats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218 R C. The Medically Unnecessary Vagina: Health Insurance Denials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220 R D. Defensive Medicine Goes On The Offense: Threats And Intimidation . . . . . . . . . . . . . . . . . . . . . . . . 222 R IV. FINDING SOLUTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225 R A. Market-based Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . 225 R B. Administrative Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . 226 R C. Policy Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 R V. CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228 R