The Supreme Court decision on Dobbs v. Jackson Women’s Health Organization will not only personally affect every woman of childbearing age but will have profound and unintended consequences on our healthcare system and economy.
Much has been written about the effect the Dobbs decision will have on a woman’s right of privacy and control over her own body, but we should also be mindful of the negative impact Dobbs will have on our already inadequate healthcare system.
According to multiple sources, the United States has the worst healthcare of any industrialized nation. The three areas where our healthcare system fails us the most are: the cost is beyond the reach of over 33% of the country, it does little to promote preventive care such as prenatal care, and our infant mortality rate ranks us below several third world nations. By allowing individual states to ban abortions, those three areas are about to get worse.
Setting aside the humane aspect for just a moment, consider the economics of the Dobbs decision. Many states will now be replacing a relatively low-cost gynecological procedure with more intense and very expensive obstetrical surgeries that have a higher chance of fatal outcomes to the mother and or the fetus. Most of those high-risk surgeries are greater than 10 times more expensive than a therapeutic abortion procedure. For all those intense, high-risk obstetrical surgeries that inevitably fail, the financial burden falls on the remaining parent (in a two-parent family) and/or on the hospital system itself. But even when those high-risk surgeries are successful, the parent(s) will be left with enormous medical bills that could force them to default into bankruptcy.
Other financial factors to consider are the birthing outcomes themselves. Abortion bans will result in more babies born with severe medical malformations, some of whom will die within hours of birth while others will need a lifetime of intense medical treatment and often lifetime institutionalization. Parents dealing with the loss or disability of their newborn will find their medical bills equally devastating.
Babies born to women with a substance use disorder, often a result of sex-for-drugs, may have behavior disorders requiring special considerations in education and community law enforcement. But even healthy babies born into the increasing number of poor families and single mothers will require additional resources from our communities and states which are already stretched financially. The states pushing the most restrictive abortion bans provide the fewest resources to address those needs, but even states like New Hampshire aren’t prepared to handle the increased demands we’re likely to see.
Health insurers will likely raise their premium rates, set limits on coverage for pregnancies or discontinue coverage of pregnancies altogether. This will leave families and hospitals “on-the-hook” for most of those expensive obstetrical procedures and for infants needing life support.
There are a host of other reasons for the cost of healthcare to rise. For example, outlawing a medical procedure will cause malpractice premiums to increase for doctors and hospitals who treat women of childbearing age. Those costs will be passed on to all patients, not just women.
If the financial consequences of abortion bans are not bad enough, the humanitarian fallout is much worse. Our healthcare system does little to promote health, only to provide “insurance” for when we get sick. This “sick care” system is antithetical to women seeking healthy outcomes of their pregnancies. As the cost of healthcare rises, fewer women will be able to afford preventive health such as prenatal and early childhood care. This explains our high infant mortality rate, which will only increase as more women are forced to carry unintended and medically unsupported pregnancies to term.
Women who be forced to carry pregnancies that are the result of rape and incest will be further victimized by a lifetime of PTSD and depression. Mental health care is yet another area inadequately covered by the for-profit insurance industry. And with the increase in birthing mortality to both mother and baby, we will see more single fathers and orphans struggling to survive in our country which is rich in resources, but poor in its ability to distribute those resources to the people who need them the most.
Healthcare is a “zero-sum” entity. What happens to one group affects us all, both medically and financially. The pandemic showed us that any group that didn’t take precautions against COVID became hotspots for spreading the disease. Similarly, with a ban on abortions in some states, healthcare will become more complicated and more expensive for everyone in all states. What affects one group of Americans reverberates to affect us all, albeit unevenly.
We can offset much of the financial hardship as well as some of the inhumanity that will beset young families and young women of child-bearing age by taking the profiteering out of our healthcare system and making care universally available to everyone. Universal healthcare means less paperwork, more choices of physicians and other healthcare providers (everyone would be “in the plan”), a huge reduction in administrators and associated administrative costs, and more emphasis on preventive care which would reduce the need for expensive procedures. A healthcare system that covers 100% of Americans is more “pro-life” and “pro-choice” than the system we have now. It enables more women to have safer pregnancies and healthier babies. It also means that more families will be able to afford the children they have.
As we debate over women’s reproductive rights, including abortion, we can all agree that we need a healthcare system that works for everyone. This needs to be done now to minimize the fallout that is inevitably going to ensue from criminalizing a vital medical procedure. A universal healthcare system is a necessity regardless of which side of the abortion debate you agree with.
We are a stronger nation when we give everyone access to preventive healthcare that is affordable, effective, and universal. Healthcare is essential. Now with the Dobbs decision, we should make it universal.
James Fieseher, MD, of Dover, is a recently retired family physician.