on Spain

The New York Times had a piece yesterday about the most logical and yet astounding emerging trend in the bewilderingly inequitable American system of private health insurance: the denial of insurance to women who have had a C-section. WOW. As if the pain and immobilization, risk of infection or death were not enough for someone to deal with! This is exactly the type of thing we never foresee until it is too late, proof of the axiom that the more we know the more we know we don’t know, and another notch in the adjustable ward bedpost of medical progress as women’s regress.

Not that the C-section is anything terribly new- it’s at least of the Roman era- but there has been considerable progress it the quality and quantity of its use. I am reading a not-new-either book by Matt Cohen called The Spanish Doctor, a medieval tale of dodgy and heroic medicine in the context of serial Jewish genocide and ghettoization. It’s good, I recommend it. M-L-T’s sister is in Spain right now and Spain was on my brain, so I picked it up. In one of the first scenes, Haveli, the doctor, is called to the home of a wealthy, heirless Christian merchant whose wife is near-death from labouring a very crooked babe. The merchant makes it clear the life of the infant should come before that of his bride, but Haveli decides not to wait for her death to remove the baby from her womb: he drugs her with four cups of wine, and cuts.

After the medieval bedroom procedure Cohen describes, it’s certain she cannot conceive again. But now not only is C-section not counter-indicated with future pregnancy, vaginal birth after caesarean delivery is also possible. It’s pretty sleazy for insurance companies to automatically assume you will get pregnant again, require another C-section and cost them money, just because you did once before.

In Canada at the moment we do not face even a fraction of the peril Americans encounter when they need health care. But some things you do need insurance for, non-hospital-administered drugs especially. And we imperil our likelihood of qualifying for insurance by seeking out unnecessary health care. (Some C-sections are obviously needed! Just not as many as women are receiving!).

Last year when I studied genetic screening of infants we faced the unanswered question of how abnormal but not necessarily “positive” results would affect insurability. It is hard to worry about what infants will be asked by Blue Cross thirty years from now, so it didn’t weigh too heavily on me. But last week Women’s College in Toronto announced it is now offering genetic testing to all Jewish women to detect BRCA1 and 2 positivity- markers for breast and ovarian cancer risk. Jewish women appear to host the BRCA genes at far greater number than non-Jewish women; the Women’s College project may find justification for a more systematic screening program. Cancer drugs- including prophylactic tamoxifen- cost a lot of money. Are these volunteers jeopardizing insurability? Does it make economic sense to require insurance companies to turn a blind eye to voluntary genetic testing results? Hardly just for the genetic testing industry and the pharmaceutical industry to reap while the insurance industry pays. If anything these markers of medical progress provide increasing evidence of the need for a complete extraction of health care from the market, and complete socialization of the burden of treatments.