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It’s unfortunate that some opponents of federal government-directed health care jumped on the ‘Death Panel’ metaphor instead of the substance of the proposed legislation. Whether the federal legislation intends it or not, a government-directed plan necessarily requires bureaucrats to make life and death decisions that are more far-reaching and more complex than the hyperbolic ‘pulling the plug on grandma.’

No matter how wealthy we are as a nation, the government will never be able to provide health care for all AND provide all of the health care everyone would want. Trade-offs are inevitable; if universal access is a given, then the amount and quality of delivered medical treatment must necessarily be negotiable.

To understand the complexity and God-like power the feds are proposing to invest in some poor civil servants, let’s allow grandma to peacefully nap and consider the other end of the life spectrum, infant mortality. Imagine yourself charged with managing the cost of care for newborn infants under the government program. Here’s the situation you would face.

The U.S. has an infant mortality rate of approximately 7 deaths per 1,000 live births, compared with 5 deaths in other developed countries; in Norway, infant mortality is a mere 4.1. Race, geography, income and education all factor into those numbers, but irrespective of its genesis, low birth weight is a primary factor in infant mortality.

Low birth weight occurs in about 7 percent to 8 percent of all live births, but 40 percent to 70 percent of all infant deaths can be attributed to low birth weight (depending on how one defines “low”). When compared to normal weight infants (more than 5.5 lbs), infants with “moderate” (less than 5.5 lbs), “very low” (less than 3.3 lbs) and “extremely low” (less than 2.2 lbs) birth weights have 40, 200 and 600 times greater risk than normal weight infants, respectively.

According to the journal “Pediatrics,” 8 percent of 4.6 million infant hospital stays (2001 data) included a preterm/low-birth-weight diagnosis, accounting for 47 percent of the costs for all hospitalizations ($5.8 billion) and 27 percent of all pediatric stays. The average cost of the hospital stay (12.9 days) was $15,100 compared with $600 (1.9 days) for uncomplicated births. For infants less than 2.2 lbs, the average cost of hospitalization was $65,600.

Advances in medical technology have significantly improved the survival chances of infants with extremely low birth weights (without complications), but at a high cost. Complications, however, are common in infants with low birth weights, often requiring intensive, expensive care; still, the mortality rates remain relatively high.

What do you do? Here’s more data.

A study by the Rand Corporation found that 69 percent of infants who die during their initial hospital stay did so within one day of birth. Those infants were the least expensive to treat, an average of $6,310. For infants who died during the remainder of their initial hospitalization, average treatment was $58,800. Infants at “extremely low” birth weights, in aggregate, create the most costs; technology keeps them alive past the first day, but despite the extra effort and added cost, infants born weighing less than 2.2 lbs have the lowest initial hospitalization survival rate.

More data to consider: The aggregate annual incremental costs among low-birth-weight children ages birth to 15 have been estimated at $5.4 billion per year, not including long-term care, special services and special education often correlated with low-birth-weight children. All that said, remember, those are aggregate statistics; many low-birth-weight children grow into healthy, happy adults with no unusual health problems – you just don’t know who they will be.

So, were you tasked with managing the public newborn-care option, what would you do? Should the public health plan allow spending billions of tax dollars on technology and treatment attempting to save low-birth-weight infants when that practice has a high probability of complications yielding a relatively low survival rate with a high probability of ongoing medical and other expenses associated with survival?

Access, quality and cost — you cannot reduce costs if your promise is equal effort for every low-birth-weight child using whatever technology and treatment is available. In Switzerland, a country often cited for a lower infant mortality rate than the United States, infants weighing less than 2.2 lbs. at birth who die are designated stillborn, whether measures are taken to help them survive or not. Problem solved?

Infant mortality highlights the underlying question of the health care reform debate: How can individuals deal with unpredictable, unaffordable expenses? Neither the regulated, privately managed care approach we have today nor the government-run managed care proposals being debated in Congress provide an acceptable answer. A free market system where patients control the money, health care providers set prices for services, and private insurers are free to develop policies that convert unpredictable and unaffordable events into affordable and predictable premiums, could well be the best way to optimize (not perfect) health care resources.

Unfortunately, in the progressive rush to birth a government-run solution, the free-market solution is designated “stillborn.”

This commentary originally appeared in the St. Paul Pioneer Press, Friday August 28.

Photo Caption: Neonatalogist Jonathan Muraskas places his hand next to Rumaisa Rahman, known to be the smallest baby in the world to survive birth (8.6 ounces). Rumaisa was born at Loyola University Medical Centre in Chicago. Photo: Reuters