View Full Version : Medicaid and childbirth - a startling statistic - at least to me
I went to a talk on women's health initiatives yesterday and was shocked to learn that in my state, Texas, 56% of birth expenses are paid for by Medicaid. It is even higher in other states. I had no idea that so many are uninsured or unable to pay. On the one hand, it makes me mad that women so readily become pregnant knowing their expenses will be covered...I have mixed feelings. Perhaps we should be handing out birth control more readily to keep this from happening. It sounds like once again a very politicized thing. Thoughts?
Medical care costs in this country are obscene. Maybe women should go back to home births to avoid kicking off their new offspring's life with thousands in debt. That said, of course in a perfect world people would have only the children they could easily afford--which would surely be a good thing for our environment and overloaded freeways.
"Medicaid covers 56% of births in Texas, 46% of births in California, and a stunning 70% of births in Louisiana...." (from the CDC) and if you dig further you'll find that is mostly for unwed, unemployed, impoverished teenage mothers - some who often have more than one child aready. I think the current welfare system we have in place actually encourages young women to become preggers rather than deters them. Life long welfare funding and medical coverage in many states without any incentives (both positive and negative incentives) to better their lives and get out of poverty can perpetuate that coninued cycle of poverty and births. At my old job we sponsered what was basicly a home of unwed mothers - all teens. They were required to pool their welfare funds, share childcare and household chores, go to school and/or work full time. It really gave them not only a way to better themselves and provide for their kids while providing them a safe and secure place to live with childcare (divided amongst the other teen mothers) but also gave them the negative incentives to improve their lives because, unless they choose to live theire and abide by the rules to have a job or go to school. they would lose their welfare funding. It gave them alot of incentive to improve their lives, get an education or work experience and get off welfare and get their own apts once 18. Too bad those homes for unwed teen moms seems to be a thing of the past as it would be a better incentive to move forward (as well as an incentive NOT to get preggers again if that was were you had to go if you wanted govmingt funding) if they only way you could get welfare funding was to live in one. Now they can live on their own without needing to do anything to improve their situation for the future. Having more kids seems the way to go instead!
Not to mention that in these poor, red states particularly it's becoming nearly impossible to get an abortion thanks to a bunch of demagogue legislators with nothing better to do than meddle in women's reproductive lives.
ETA: These same legislators (and some religious leaders) are also doing everything they can to limit access to birth control for poor women, relentless in their flogging of the "fallen," I guess.
I think that several states also are trying to eliminate or reduce Medicaid spending for birth control too. I don't know what Medicaid covers now but I assume it's pretty much every type of birth control method - pills, IUD's or whatever - and think cutting the funding that would PREVENT pregnancy in the firat place would be crazy. Of course teaching absinance (maybe requireing classes) should go hand in hand with any free birth control or abortion IMHO.
There is no data that supports the claims that welfare encourages teen pregnancies.
There is also no clear evidence that teaching abstinence has any effect at all on teen pregnancies.
There is no data that supports the claims that welfare encourages teen pregnancies.
It's less than conclusive in teen pregnancies but seems to be a factor in non-marital pregnancies.
http://www.urban.org/publications/308015.html
When an unmarried teenager bears a child, society often foots the bill because the teenager is likely to go on welfare. Over three-quarters of all unmarried teenage mothers began receiving cash benefits from the Aid to Families with Dependent Children (AFDC) program within five years of the birth of their first child (Adams and Williams 1990). Indeed, 55 percent of all AFDC mothers were teenagers at the time of their first birth, and 44 percent of AFDC mothers were unmarried teenagers (Moore et al. 1993a; Zill 1996). The connection between welfare programs and childbearing by teens evolved because AFDC was generally targeted on families with only one able-bodied parent. Since teen mothers have usually been unmarried in recent years, they usually qualified for AFDC. Participation in AFDC qualified these families for food stamps and Medicaid as well.
Because the U.S. welfare system has historically been designed to serve single-parent families rather than two-parent families and childless couples, it has been suggested that AFDC provided incentives for young women to have children. The belief that the welfare system has encouraged teen childbearing, and especially nonmarital teen childbearing, clearly affected the 1996 welfare reform legislation, which includes several provisions designed to reduce both teenage and nonmarital childbearing. This belief cannot be examined in an experimental study, but a variety of less rigorous methods have been used to examine the topic.
A slight majority of the studies analyzing the effects of these incentives have found a statistically significant positive association between the generosity of the welfare system and nonmarital birth rates.1 (http://www.simplelivingforum.net/#n1) However, the estimated effects vary widely, tend to be smaller for younger women and black women, and fail to explain the rise in nonmarital fertility over the past 25 years. In short, "the uncertainty introduced by the disparities in the re search findings weakens the strength" of the conclusion that the generosity of the welfare system increases nonmarital fertility (Moffitt 1997).
This doesn't surprise me at all, and frankly, I am surprised the percentage isn't higher. Prenatal care is outrageously expensive. I am on my second baby in a two-year span, and DH and I are some of those people who cannot "easily afford" to have children. We have always worked, and we pay close to $400 a month for 80/20 health insurance. Even with that insurance, though, we still end up paying close to $5000 out of pocket each time we have a child. This is for healthy pregnancies and normal deliveries. If something were to go wrong, we would end up paying much, much more.
So while I would bet that a large number of the Medicaid-covered births included in the statistic cited above can be attributed to teen mothers, even many hard-working adults would have trouble paying the cost of healthcare associated with pregnancy and childbirth. We barely can but manage somehow.
There is no data that supports the claims that welfare encourages teen pregnancies. No, but teen pregnacies often encourage the use/need for welfare and medicaid. Finding a way to end teen pregnancies will go hand in hand with finding a way to reduce welfare and medicaid - at least in that specific group - as well as the continued need for it long term if the mother can not find a way (via education or job training and resources) to improve her circumstances. That's why I advocate for tax payer funded programs to help those in poverty to gain an education and job skills both to help them before they are adults, as well as a prerequisite to receiving welfare for teens and adults alike. I'd rather see a teen Mom getting a tax payer funded education for 2 years in a trade, and getting housing, food and childcare provided to them, in lieu of just receiving a check and food stamps each month.
There is also no clear evidence that teaching abstinence has any effect at all on teen pregnancies.Then change how you teach absinence. Talk about the ramifications of having sex and getting pregnent - both the long term and short term ramifications on your lifestyle and finances. A "Just Say No" approach isn't going to work, you need to find the triggers that work with teens (both boys and girls). I have no ideas what those may be myself but I'm sure they are out there. And it can't hurt in any case to talk about absinence. Even if you get thru to only one person - that's one less teenager who gets pregnent and one less mother and child on government welfare.
"And it can't hurt in any case to talk about abstinence."
Agreed.
>>>>>back in the day, many moons ago, when we were young, the dark ages of the early 1980s. A few of my friends and myself started having babies. Many of us had no insurance. The one girl had two babies, $5,000 a piece and that was the bill to pay, they put it on payments I remember. I had no insurance in the first few months, I had to make payments. Only one couple were getting assitance. SO when and why did it happen that girls were not handed a bill so to say?
I guess they first go to clinics who then refer them to Medicaid options if they are not able to pay. I recall having to make payments too.
No, but teen pregnacies often encourage the use/need for welfare and medicaid. Finding a way to end teen pregnancies will go hand in hand with finding a way to reduce welfare and medicaid - at least in that specific group - as well as the continued need for it long term if the mother can not find a way (via education or job training and resources) to improve her circumstances. That's why I advocate for tax payer funded programs to help those in poverty to gain an education and job skills both to help them before they are adults, as well as a prerequisite to receiving welfare for teens and adults alike. I'd rather see a teen Mom getting a tax payer funded education for 2 years in a trade, and getting housing, food and childcare provided to them, in lieu of just receiving a check and food stamps each month.
The studies I have read are that teen pregnancy is tied directly to child sexual abuse, interestingly enough in this study, the abuse of males. The study I was most familiar with was back in my social work days, probably 20 years ago, so out of date. The linkage that the UW School of Social work did had a very direct link between the age of teen pregnancy & the age of onset of the assaults. As one girl said, "How could I know to say yes or no when I've always been forced?"
http://www.guttmacher.org/pubs/journals/3609804.html
Ending child sexual abuse would go a long way towards ending teen pregnancies, it seems. It is my belief that teaching kids self-agency from very early, as well as the correct terms for their body parts, how to recognize safe & unsafe touch, how reproductive & sexual health functions, starting in kindergarten, with age-appropriate information is needed.
Teens are smart. Educated teens make better choices.
Regarding that stunning figure that 70% of births in Louisiana are paid by medicaid...... I live in Louisiana and worked in the inner city schools of New Orleans. I was very surprised to see that 95% of my students certificates said "father legally omitted/unknown" in the place where the father's name should be. Yet I knew who many of the fathers were because the children were named after their fathers or had fathers in the home. It seems Louisiana will go after the father for child support or garnish wages if their child is on Medicaid so the mothers simply refuse to name the father so they can claim benefits.
Also, these mothers on welfare/medicaid can get FERTILITY TREATMENTS so they can have more kids. Yep, i had students whose moms were living in the projects, on welfare, didn't work, didn't have the father's name on any of her children's birth certificates (they all had different dads) but she was trying to have MORE children and the state was covering her fertility treatments so she could have more kids that would be supported by the gov't.
As a person who struggled to finance my own college education and decided to only have ONE child as I could only afford one child, it is disheartening to hear that some people feel they should have the right to have as many children as they please, all at the tax payer's expense.
Louisiana tried to promote/offer long term birth control such as norplant (which i used while in college) or depro provera shots to welfare/medicaid recipients and that idea was slapped down as being intrusive and insulting that the gov't would restrict welfare recipient rights to procreate as they please.
So a woman's right to have multiple children on welfare was deemed "none of the state's business" but ironically the same women feel they have a right to expect the state to pay for these children.
There are people who feel they have a right to have multiple children at the expense of the government and refuse to work. They don't see welfare and medicaid as help thru a temporary situation or crisis, they see it as a way of life and an entitlement. This is what is draining the system.
I dont mean to sound so cynical or against anyone. There were also many student who had parents who did work and were trying to better themselves and oddly, those people were looked down on by those who felt welfare and medicaid was the best way of life.
I'm all for helping teen moms get job training and life skills so they can become independent. I wish teens had more options with vo-tech schools and job training apprenticeships, etc. Not everyone is cut out for academics. Many are more gifted in hands on learning an their potential needs to be developed an nurtured.
I agree that the US should transition back to a midwifery model of care.
A midwife -- prenatals and birth included -- cost $3600 in PA in 2008 when I was pregnant. I know because I priced it out. Friends of mine across the US paid out of pocket for these births (insurance wouldn't cover) and the most anyone of us paid was $5k. It cost less to just go witht he midwife than go with a doctor/hospital, even in network with the co-pays and deductibles. I consider that a real PITA about the effing US insurance system. It's just a big money-sink that doesn't give back any of what it promises unless you are in dire straights, and even then, they are loathe to cover.
In most socialized systems in the western world, midwifery is also the standard of care. Women have every access here to the OB care that they may require, but honestly, it's not utilized that much -- only if mom or baby are in trouble, really. And, doctors here talk women out of utilizing them because it's very expensive on the system, and there are limited resources -- so they'd rather save it for the *real* emergencies.
But not the blessed US insurance system. No doggies. Spend spend spend and so on and so forth. Madness, really. Talk up tests, talk up having to go to a doctor. Talk up the c-section, and make sure she gets more.
And lets also talk about "affording" children.
In my case, having an unassisted birth and pregnancy -- which admittedly isn't for everyone -- that cost me $0. My friends and family basically provided all of our baby needs, which we estimate came in under $1k for the first year. it's amazing how little a baby needs. We didn't even need a new minivan or house with a larger bedroom or yard.
It turns out that the 1300 sq ft condo and prius with car-seat were more than enough for a 8 lbs baby.
it also turns out that when you move to NZ, you only need to take 8 bags of stuff with you, and one of those is the carseat that was purchased new for $350 before the kiddo was born and he's still using at age 4.5.
I clothe him for about $150/yr and that includes shoes.
His weekly costs are higher once he started eating food. Darn kids! I'll say he's 1/3 of our food budget per week -- so he eats $125 all by his lonesome.
He manages to squeeze himself and his toys into our 480 sw ft house. I don't really know how he manages, but, there you go. He also manages to fit that car seat into our super-flash (read: fancy) 1994 honda accord station wagon. It does cost us $80 in gas every two weeks since we are at something like $8/gallon right now so I really feel for you poor 'merican's who have to pay over $5/gal! the horrors.
So, lets say that he's one-third of the biweekly transportation bill, even though he really isn't, and we'll include the parking in that and he's like, totally costing us $121 every two weeks in his dastardly transportation requirements!
Oh, and he gets hair cuts every-other month because we actually can't do it ourselves (unless we shaved his head and his hair is so pretty and I want him to look like a surfer not an aryan skin head). That costs me $15 every two weeks because the damn stuff keeps growing.
We don't buy him presents. Go ahead, call us bad parents. My parents and my ILs do, and they also pay for extras. Like, my parents bought him a bow and arrows, they also pay for his lessons. That's his on-going birthday gift from them. If he didn't have that, we'd do thigns casually as we could, or trade, or figure it out.
And, we travel with him. That's where he becomes really damn pricey. to go to nelson for me to work, you know, he costs the whole price of a seat on the airplane. Or ferry. W ealways take the plane. LOL I can't boat for 5 hrs. It's awful. So, he costs about $150 for that when we do it. And one time, we took him to hobbiton and that cost us $30!
He's so terribly expensive.
I think people just have ridiculous ideas about how much kids cost. That goes for poor people in the US. I know lots of poor people who are frugal as can be and guess what? 7 kids and wholly independent and not having to use government support. 5 kids and fine. There are people the world over who raise children in ways that aren't nearly as "needy" or expensive as people in the US think kids are expensive.
My parents were very poor and managed to afford both my sister and I (it took a long time before they got into the middle class -- i think we were in jr high/high school). So. . . what are folks talking about when they talk about 'affording children?'
now I'm just ranting.
I probably am hormonal and want another baby or something.
ApatheticNoMore
3-8-13, 3:06am
The World Health Organization says "15% of pregnancies and childbirths need emergency obstetric care because of risks that are difficult to predict." So that midwife might be enough for most people (85%) but 15% of women with complications is not a small number. Modern medicine isn't all bad, the death rate for women in pregnancy prior to the 20th century was 1 in 100. Now the rate is more like 11 in 100,000 in the U.S. Oh the modern world such a terrible thing! Of course things like c-sections are now overprescribed leading to slight increases in death in childbirth. So all these procedures are like a bell curve or any such curve that has a point of optimization with less optimal results from too little and too much, and current medicine definitely errs toward too much. But I don't particularly like the arument that because the health care system is such a giant cluster@#$# that somehow we're all unworthy of any medical care. Why have the human race progress in medicine at all in that case? Much of the progress is illusionary, but 1 in 100 women used to die in childbirth.
Miss Cellane
3-8-13, 9:32am
I agree that the US should transition back to a midwifery model of care.
In most socialized systems in the western world, midwifery is also the standard of care. Women have every access here to the OB care that they may require, but honestly, it's not utilized that much -- only if mom or baby are in trouble, really. And, doctors here talk women out of utilizing them because it's very expensive on the system, and there are limited resources -- so they'd rather save it for the *real* emergencies.
But not the blessed US insurance system. No doggies. Spend spend spend and so on and so forth. Madness, really. Talk up tests, talk up having to go to a doctor. Talk up the c-section, and make sure she gets more.
In partial defense of the doctors, there's a very real threat of malpractice suits if they don't do every last little test that they can on every single baby. Obstetricians carry crippling levels of malpractice insurance, and a lot have left the field because of the threat of lawsuits. Parents who have a baby that has a birth defect are understandably upset, and many are looking for someone to blame. Or someone to help fund the extra expenses that a special needs child will incur for the rest of his/her life. Not everyone understands that medical science, despite the advances made even in the last few decades, cannot spot every single birth defect before birth and can't predict how a baby will be affected by said defect even if they can diagnose it before birth.
Even if a baby's birth defect is considered to be something that is genetic and there is nothing medical science could have done to fix it, then parents sue because the doctor should have been able to detect it and give them the choice to continue the pregnancy or not.
So you end up with obstetricians who prescribe every test imaginable at the slightest hint of trouble, because skipping one little thing could mean a lawsuit down the road.
Louisiana tried to promote/offer long term birth control
As we speak, Texas and other states are trying to pass legislation that will further quell birth control options including abortion. I might be imagining it, but it always seems to be mostly males pushing that agenda. As I told a young grad student after the talk, it feels like we are going backwards on this.
Teens are smart. Educated teens make better choices.
+1+1+1+1
Re: The welfare system. It strikes me that while welfare may not encourage young women to get pregnant it is designed to suck them into the system with very little chance of escaping it. What other choices/options/opportunities are available? Our welfare system just looks like so much social quicksand to me.
I wish I still had the article link - Texas cut millions that was going to fund planned family kind of stuff. Then they sat down and did the math and a study showed that they'd see an explosion in costs for the number of additional births that would occur and be paid for by Medicaid (it was like $70 million in cuts they did that would cost them $270 million in additional births).
They were trying to put the funding back, but I don't know the outcome of that.
Many of these teen mothers come from communities that are underserved and in which poverty is endemic. Their access to education is poor and their chances of getting jobs other than janitorial or other low-status, minimum-wage, vanishingly low. Even the minimum wage jobs are not usually abundant! The culture within such communities usually does not recognize a woman's right to determine her own life or manage her own fertility. A woman's status may well be entirely dependent on being attached to a man and her economic survival on welfare payments, or prostitution, especially in populations where grinding poverty and malnutrition are multigenerational. The men, on the other hand, often derive status from producing multiple children by multiple women, and they are not engaged in those children's lives either emotionally or financially. It's a lose-lose situation for these women. It's been shown over and over again that when women are empowered to take control of their fertility, especially through societal acceptance of their RIGHT to do so, and have access to contraceptive measures, and when they are empowered financially through access to employment, that the average age of first birth rises and the total number of children born per woman drops precipitously. If all you know is what your grandmother and mother and sisters do, and its the cultural norm, especially if you have only a couple of years of high school education and no access to a job, well, you use the economic strategy that you know...
Help for these young women is multipronged. Trying to indoctrinate them into abstinence is going to fail - flying in the face of their cultural indoctrination, making them into green monkeys, essentially. Then there's the unpleasant fact that for many of them, sex is their only source of affection or affirmation from a man, and that's a biological drive. They're usually raised with absentee fathers, so again this knock-em-up-and-move-on situation is the norm for them. Societally, they get lots of comfort and support from other women while they are pregnant and raising babies.
What's needed is, of course, education and jobs. A young woman who is barely literate or numerate is not only limited in her chances of getting employment, even where jobs are plentiful, but is crippled in her daily life. How can you do price comparisons on food when you don't know numbers or how to work with fractions? How can you fill in job applications when you can't really understand them, or read nutritional labels on foodstuffs and make good decisions? Above all, what these women need is to be shown, gently and kindly, that there are other ways to live, and given hope and tools to achieve them. Spartana spoke of homes for teen mothers - that's a good system, and it's a pity it fell apart, but the girls in them had already had a child. Wouldn't it be better to reach the girls before they got pregnant for the first time?
Suzanne, you said it perfectly. And today, International Women's Day, is a good day to advocate for young women!
domestic goddess
3-8-13, 12:37pm
It just never fails to amaze me how our legislators will cut funding for birth control and/or abortions, and then don't seem to see how this impacts the number of babies being born. Let's deny birth control, and then deny payment for the births of the resulting babies. Do these people really not understand how babies get here?
And let's insist that every baby be born. No exceptions. I have finally accepted that my experiences color my opinions on this issue, and that my experiences are not those of everyone, something that a lot of people don't understand. I have held a newborn's brain in my hands, because the baby was born without a skull to cover and protect the brain, which is just covered by a thin membrane. Eventually, this membrane will start to break down, and the baby will die of infection, having seizures frequently, as a result. But let's spend hundreds of thousands of dollars in nursing care, while we wait for the inevitable to happen. I have taken care of babies with anencephaly, which means they are born with only minimal brain structures, and most of what they have is abnormal. But we pay for them to be in hospital until they finally die. But let's be sure we don't terminate those pregnancies where conditions exist that are incompatible with life.
I got in a huge debate with some members of dsil's family during the election over this very issue. I was called "Hitler", and they apparently think I am capable of just about anything. Now one of dsil's older sisters has found out that the baby she is expecting has Down Syndrome and a heart defect. I'm sure they think that I think that this baby should have been aborted, which is absolutely not true. But I also think this family has no insurance, and this child will need quite a bit of care, at least for a time, and various therapies for several years. While I have no problem with my tax dollars going to this use, this is a rather exceptional case, and not the usual one of a teen mother and her baby. This is an intact family, though poor, with 5 other children. They are staunchly Catholic, and don't believe in birth control, but here is a family with 5 children who are already struggling having a special needs child, who is always going to need some kind of govenment assistance. Where to draw the line between who should/can or shouldn't/can't have a child? Which children are worth saving? Which ones will cost too much to keep alive? Why spend so much to care for the ones who will not be able to survive anyway? Who gets to decide the answers to these questions?
I understand there are families waiting to adopt babies born with Down Syndrome, if your relatives are willing to consider that option, given their financial situation.
The studies I have read are that teen pregnancy is tied directly to child sexual abuse, interestingly enough in this study, the abuse of males. The study I was most familiar with was back in my social work days, probably 20 years ago, so out of date. The linkage that the UW School of Social work did had a very direct link between the age of teen pregnancy & the age of onset of the assaults. As one girl said, "How could I know to say yes or no when I've always been forced?"
http://www.guttmacher.org/pubs/journals/3609804.html
Ending child sexual abuse would go a long way towards ending teen pregnancies, it seems. It is my belief that teaching kids self-agency from very early, as well as the correct terms for their body parts, how to recognize safe & unsafe touch, how reproductive & sexual health functions, starting in kindergarten, with age-appropriate information is needed.
Teens are smart. Educated teens make better choices. I agree. I think child abuse and an unstable home life both are big factors in teen pregnancies. That coupled with raging teenage hormones along with the rebellion against parents and society that often occurs at that age and teens general lack of maturity to understand the long term consequenses of their actions, coupled with media influences that glorify sexual behavior at an early age as well as glorifies the life of single impoverished parents -teen or otherwise.
poetry_writer
3-8-13, 3:28pm
As we speak, Texas and other states are trying to pass legislation that will further quell birth control options including abortion. I might be imagining it, but it always seems to be mostly males pushing that agenda. As I told a young grad student after the talk, it feels like we are going backwards on this.You can get birth control very easily now. Every drug store sells condoms or you can get them free at some places....obviously that isnt the answer (in my opinion). Its out there, available, often free and they still dont use it. I live in Texas and I knew what a condom was at an early age. Whatever happened to personal responsibility........
domestic goddess
3-9-13, 10:58am
JaneV2.0, I'm sure they would not consider adoption; this is a wanted baby, and the heart problem is one for which the surgery is quite successful and the mortality rate is pretty low. Dsil's family is very child-oriented; one brother and his wilfe raised two children who were the grandchildren of their father's second wilfe. DD and dsil have decided that this will be their last one, and that will make theirs one of the smaller nuclear units in this family. One brother has 6 kids and this sister will be having her sixth. Now the younger generation is starting to have children, too. I'm sure this little boy will be showered with love, and other family units will pool their money together to be sure he will get what he needs.
Thank you for bringing up a good point, though. Through the years I have known people who adopted special needs children. These wonderful people are out there, and they are a blessing to those children who need a home and family so desperately. I have such respect for them and for what they do; much more than I have for those people who insist that every child be born, but fail to step up to the plate and do a single thing to help those children who may need homes due to biiological mothers who know they can't raise them.
flowerseverywhere
3-9-13, 11:51am
Keeping women poor and powerless is part of the agenda of some religions, political groups and individuals. the old Women are whores or asked for it while men are sowing their wild oats is an alive and active attitude in many cultures.
You can get birth control very easily now. Every drug store sells condoms or you can get them free at some places....obviously that isnt the answer (in my opinion). Its out there, available, often free and they still dont use it. I live in Texas and I knew what a condom was at an early age. Whatever happened to personal responsibility........
It's easier said than done - I expect there are plenty of homes where the kids would rather be caught with cigarettes or booze than with condoms. Although minors can purchase condoms they can run into issues doing so. Having it available is another - wallets are not a good place to keep one.
Agreed personal responsibility is often lacking - but there are reasons we (mostly) don't hold minors to the same level of accountability as adults.
To the already excellent posts that express what I've been thinking for a long time, I'll add a story I've seen multiple times:
Young woman is advised she's pregnant. She is a student and/or works low-paying job, and has no insurance. Boyfriend, with whom she's in a committed relationship, has good job, makes good money, with insurance. Suggestion: maybe it's time to get married now?
Family/friends discuss, and they decide NOT to marry, since single woman without ins. will qualify for Medicaid (zero bill)and this is better financial decision for them than co-pay on his insurance (larger bill). It happens all the time.
Like the situation in Louisiana with moms stating the father is unknown, the system is broken so that it actually rewards poor choices and lack of responsibility. I have no solutions. I'm just agreeing it's a sorry situation. And, actually, I'm surprised the percentage isn't upwards of 70% everywhere.
The World Health Organization says "15% of pregnancies and childbirths need emergency obstetric care because of risks that are difficult to predict." So that midwife might be enough for most people (85%) but 15% of women with complications is not a small number. Modern medicine isn't all bad
Never said otherwise.
The way that midwifery care works here is that your midwife is your primary care provider who provides the same prenatal care as a low-risk woman going to an OB in the US is (ie, the 85%).
Therefore, the 15% who are risked out receive obstetric care. There's nothing in this model that says that people who do not need obstetric care shouldn't get it, nor that it shouldn't be accessible. Rather, it asserts that in a finite resource such as "medical care" it should be provided to those who need it most, and those who do not need it should work within another model of care.
it might also be noted that midwives are very highly trained medical professionals. Thus, they are providing medical care. It's just less costly to the system over all -- and just as effective -- than the way things are done in the US.
And for examples, look to France, NZ, Australia, Canada, the UK, etc etc etc. Most countries that have some form of socialized medicine use midwifery as their foundational model of care here. It is medical care, and if a person needs obstetrics, it's available to them.
But I don't particularly like the arument that because the health care system is such a giant cluster@#$# that somehow we're all unworthy of any medical care. Why have the human race progress in medicine at all in that case? Much of the progress is illusionary, but 1 in 100 women used to die in childbirth.
Except that no one made this argument.
The reality is that medical care is a finite resource. What happens when we over-prescribe certain treatment pathways is that those who really need it but can't afford it don't have access to it. Those who don't need it are receiving something that they don't need. It's a burden and a waste on the system.
If the *insurance* system in the US would transition to a midwifery model of care, it would mean *massive* savings (and bigger profits) for clients and insurance companies. But, it would change the income streams of hospitals.
In terms of standard of care/malpractice insurance, this is all tangled up with the insurance culture -- not necessarily legal culture per se (though that's tangled up too). And, standard of care varies. It's basically what is culturally "done" in a given environment.
Malpractice exists here, and the requisite law suits, etc -- but it is a difficult standard to reach, and the way it's managed is through 'reasonable medical practice.' Reasonable is based on evidence-based practice combined with the culturally common practices. It's the same in the US.
The problem is, the US's standard of practice isn't often based on evidence (ie, much of obstetrics is non-evidence based care -- such as once a c-section, always a c-section -- the evidence doesn't bear out, and it's NOT standard practice to do that in other nations), and is often based on culture and the almighty dollar. That is to say that because the insurance companies, hospitals, and so on are bloating the prices for things (becuase they can -- it's sort of a weird monopoly game), they design policy from their various policy organizations in order to reflect that which will increase the cash flow.
And that's warped.
No where does this argument say "abandon all medical care!" it says, instead, that this medical care process needs serious reform, and there are many ways to get there -- from a socialized system to cutting insurance from employment benefits to single-payer plans, etc.
In partial defense of the doctors, there's a very real threat of malpractice suits if they don't do every last little test that they can on every single baby. <snip>
Even if a baby's birth defect is considered to be something that is genetic and there is nothing medical science could have done to fix it, then parents sue because the doctor should have been able to detect it and give them the choice to continue the pregnancy or not.
So you end up with obstetricians who prescribe every test imaginable at the slightest hint of trouble, because skipping one little thing could mean a lawsuit down the road.
Again, part of this is cultural.
Historically, the legal standard for malpractice is whether a reasonable practitioner in the same situation would behave similarly. This standard hasn't changed in terms of malpractice law overall. It is basically the same and has been for a while.
But what we have is a rising of two different elements one-after-the-other which have significance as to how the US ended up as it did. There are probably several others, but I'm going to focus on two.
If we go back to the mid-1800s, we have the advent of obstetrics. It didn't really exist before then, and to be honest, it's quite terrifying the origin of the science -- most of it was non-consentual, no-pain-medication practice on female slaves and their babies. It was not ethical, it was not double blind, and much of wasn't evidence based. Many of the practices that are still in use today find their history there. It's just "common practice" now -- but it may not be evidence based (some practices have had zero double-blind studies, for example).
In the late 1800s, as medicine was taking hold as an alternative to folk medicine -- and germ theory was also starting to develop -- you have the rise of sanitation as part of the equation, and the development of the idea of public health (spear-headed, btw, by female doctors of the era). At the same time, you have the development of professional organizations, whose primary job was to promote medicine in the public sphere. They also set professional standards (education, apprenticeships, and professional standards).
Medicine, much like midwifery, during this era was a largely "this is what we do" culture as opposed to an evidence-based process, and these organizations were extremely aggressive in terms of trying to capture the cultural mind that doctors were safer, more effective, etc, than folk medicine. Of course, many doctors also sold snake oil and did all kinds of nutsy things (like today), but because they were part of this organization, they did great. Basically, by the 1920s or so, ACOG ran a massive smear campaign against midwifery -- which they continue to this day -- which essentially casts midwifery as "not medical care" and "unsafe for babies."
And it is true that there are no double-blind tests of midwifery care. This is largely because running such tests would be unethical, and it's difficult enough to manage the ethics on obstetrical double-blinds (which is also why so much of their stuff is cultural as well). But where there is evidence *both* midwives and doctors follow those practices, and of course there have been many medical advancements that are part of the midwifery tradition and practice that extends far, far beyond what was a folk practice in the late 1800s.
We then need to jump forward a few years when insurance was offered as a benefit of employment. At this point, insurance companies started to really blow the market in terms of how things worked in the medical world. Prior to this era, people either bought insurance on their own or they went to the doctors and they paid what they could -- and often the doctors themselves needed to be competitive. That is to say, they had to provide the best medical care at the best price.
What happened then was that the insurance companies created networks which had deals around which clients would go where, what care they could get for the money that the provider would then bill them for, and this would often be less than what they would get on an open market because it was negotiated. Out of this, adding in tests or other elements in order to make up this deficit became the norm, and therefore became the "standard of practice" which was then passed up the line to the organization, where it was then codified and handed down/over to anyone new.
And from there, you have the response of the legal system. When a malpractice suit comes up, the first port of call is what the standard is from the professional organization and whether that standard is met. From there, both sides bring forth experts that talk about Reasonable standard of care. And, more often than not, the doctor wins -- but not before the insurance company had to pay the legal fees (that's what insurance companies do for malpractice insurance -- they provide legal representation to defend you).
Thus, now, Malpractice insurers are in the pie. They can dictate the scope of the doctor's prctice in order to provide coverage.
So, it goes like this. A low-risk woman is presenting normally in pregnancy in every way, and doesn't require any more than the basic care that a midwife would give. Yet, because of our professional organization and the insurance provider for the client, I must provide these other elements of care even though they are -- in my respected, educated Doctor-mind -- not necessary. If i do not provide them, I am A. not living up to the cultural standard of care of my professional organization, for which they can remove me from the organization which isn't good for my career; and B. I would no longer be one of the providers on the list for that insurer, and as such would have fewer clients. Add to this that in order to practice the doctor needs malpractice insurance, the insurer may have a standard that says -- beyond standard of practice of your organization, and beyond the standard of care from the insurance provider, you must also provide this medical care to demonstrate without a doubt that you did everythign you possibly could.
The reality is that in the current system, doctors are actually hamstrung from behaving in a rational, ethical way both financially AND in terms of the scope of their knowledge and expertise. And it sucks for them.
Yes, we might want to blame individuals who sue for malpractice. But, they aren't the *origin* of this situation. The *origin* are the insurance companies themselves, and that's a huge mess. Why should insurance companies decide what medical care people should get -- even unnecessary care? Why should malpractice insurers assert that people MUST get care that isn't necessary -- an expense to clients and insurance companies?
It doens't make any sense. ANd it's not medicine. And it's not sustainable.
Keeping women poor and powerless is part of the agenda of some religions, political groups and individuals. the old Women are whores or asked for it while men are sowing their wild oats is an alive and active attitude in many cultures.
So true...
1184
To be fair, oppression of women isn't limited to one country or religion:
http://t2.gstatic.com/images?q=tbn:ANd9GcRZ5SZk7dPWLqh3KdgC5TyWCvCg7BsxV 7p_cqQaee3WiieBf9iG2w
The link to the Texas debacle:
http://www.dailykos.com/story/2012/12/07/1168003/-Texas-Republicans-are-shocked-to-learn-that-birth-control-prevents-pregnancy
A summary: Last year Texas Republicans took $73 million away from family planning services. And now, projections are that poor women will deliver an estimated 23,760 more babies than they would have.
ADDITIONAL cost to taxpayers could be as much as $273 MILLION.
Contrast with this article on NY City: http://tv.msnbc.com/2013/02/05/with-sex-ed-contraception-and-plan-b-nyc-teen-pregnancy-rate-drops/
NYC public high school teen pregnancy rate dropped 27% over a decade, due in part to availability of free/low-cost contraception in schools.
A summary: Last year Texas Republicans took $73 million away from family planning services. And now, projections are that poor women will deliver an estimated 23,760 more babies than they would have.
ADDITIONAL cost to taxpayers could be as much as $273 MILLION.
We in the US are nothing if not short sighted.
poetry_writer
3-13-13, 3:50pm
The link to the Texas debacle:
http://www.dailykos.com/story/2012/12/07/1168003/-Texas-Republicans-are-shocked-to-learn-that-birth-control-prevents-pregnancy
A summary: Last year Texas Republicans took $73 million away from family planning services. And now, projections are that poor women will deliver an estimated 23,760 more babies than they would have.
ADDITIONAL cost to taxpayers could be as much as $273 MILLION.
Contrast with this article on NY City: http://tv.msnbc.com/2013/02/05/with-sex-ed-contraception-and-plan-b-nyc-teen-pregnancy-rate-drops/
NYC public high school teen pregnancy rate dropped 27% over a decade, due in part to availability of free/low-cost contraception in schools.
That implies that 23,760 women cant think for themselves and must have the govt tell them what to do, and how to use birth control. I'm not for the cuts in help to women, but again.....we have to assume some personal responsibility. Do we have to have the govt tell us how to put on a condom? Cant people go to a Wal Mart and buy a box? Cheaper than a baby. Obviously they can now, but they do not.
That implies that 23,760 women cant think for themselves and must have the govt tell them what to do, and how to use birth control. I'm not for the cuts in help to women, but again.....we have to assume some personal responsibility. Do we have to have the govt tell us how to put on a condom? Cant people go to a Wal Mart and buy a box? Cheaper than a baby. Obviously they can now, but they do not.
Actually it means women (women is stretching it, most of them are still kids) can think for themselves - when contraception is available the birthrate goes down. If it all it took was being told what to do by the government, all those abstinence programs and "just say no" stuff would have worked. It didn't.
poetry_writer
3-14-13, 12:01pm
Actually it means women (women is stretching it, most of them are still kids) can think for themselves - when contraception is available the birthrate goes down. If it all it took was being told what to do by the government, all those abstinence programs and "just say no" stuff would have worked. It didn't.
If they are old enough to have sex and refuse to take personal responsibility, i dont see that anything can help them. Govt programs, free birth control, whatever....unless one assume responsibility and uses birth control or abstinence (yes it is a choice).....there is little anyone can do. Birth control is available now for low cost at any drug store or Wal Mart. Do we honestly need the govt to tell us where to put a condom? And to hand us one? Sorry I get radical on this sometimes. Obviously we need to teach our kids, but as we all know, they dont always follow our advice. They themselves have to choose to be responsible.
If they are old enough to have sex and refuse to take personal responsibility, i dont see that anything can help them. Govt programs, free birth control, whatever....unless one assume responsibility and uses birth control or abstinence (yes it is a choice).....there is little anyone can do. Birth control is available now for low cost at any drug store or Wal Mart. Do we honestly need the govt to tell us where to put a condom? And to hand us one? Sorry I get radical on this sometimes. Obviously we need to teach our kids, but as we all know, they dont always follow our advice. They themselves have to choose to be responsible.
I agree on much of that. Unfortunately sometimes there is a difference between the way we want things to be - and what actually works. Not that it works well, but it appears those services help.
If they were the only ones affected, I'd lean further toward your outlook. But the resulting outcome of their actions (if they aren't aborted) often pay a huge cost as well. It's not something I would wish on anyone.
But the resulting outcome of their actions (if they aren't aborted) often pay a huge cost as well. It's not something I would wish on anyone.
Agreed. The punishment doesn't fit the crime, so to speak. I'm as big an advocate of personal responsibility as anyone, but in large part we're talking about kids here. If you are 30-something I don't have a lot of sympathy, but 15 is an entirely different story. I was a relatively responsible 15 year old because I was lucky enough to have parents that placed a high value on teaching me how to be one. There are a lot of kids that don't have that advantage. It's not right and not fair to ignore that. There are plenty of other places we can put responsibility back in the hands of (adult) individuals before we go here. Besides, as a purely practical matter, if these young women 'pay the price' for irresponsible behavior it is all of us who actually end up paying.
If they are old enough to have sex and refuse to take personal responsibility, i dont see that anything can help them. Govt programs, free birth control, whatever....unless one assume responsibility and uses birth control or abstinence (yes it is a choice).....there is little anyone can do. Birth control is available now for low cost at any drug store or Wal Mart. Do we honestly need the govt to tell us where to put a condom? And to hand us one? Sorry I get radical on this sometimes. Obviously we need to teach our kids, but as we all know, they dont always follow our advice. They themselves have to choose to be responsible.
Yes, they do have to assume personal responsibility but I don't think that knowing the facts of life is enough to encourage acting responsibly.
Birth control is available FREE to everyone where I live, there are sex education programmes in schools and yet we still have one of the highest rates of teenage pregnancy in Europe.
Government programmes and whatnot can try their hardest, but they're merely touching on a SYMPTOM of a problem. There are far too many social issues at play, the largest of which seems to be deprivation - both financial and emotional (in terms of building solid family & social relationships that foster confidence, self-worth etc.). If all your friends are getting pregnant, why not join the club? If you feel like nobody cares about you, why not have a baby that will need and love you? And, not forgetting, you're not a man unless you sleep with a gazillion women...
jennipurrr
3-24-13, 11:26pm
This is sort of an aside to this conversation, but with all the talk of condoms...I really hate how condoms are touted as the be all end all in contraception, especially relating to teen pregnancy. They have a failure rate in real life (15%) that is getting into the territory of "pulling out" (27%) or the rhythm method (25%). I guess they are so championed because they help stop STD transmission and they are cheaply available anywhere. I think these young women would be much more empowered to avoid early pregnancy if society placed more emphasis on methods that are much more reliable. I live in a conservative state and the depo shot has been available for free at the Health Department for as long as I can remember, also many insurance plans cover the Mirena IUD for the cost of a co-pay and I believe it is free if one is on Medicaid. It lasts for 5 years and anyone (even those who haven't had a child) can use it.
http://en.wikipedia.org/wiki/Comparison_of_birth_control_methods
ApatheticNoMore
3-25-13, 2:08am
Because condoms don't have horrible side effects (the pill can be pretty aweful in terms of side effects at least for some).
I agree with ANM. There are pretty major side effects to hormonal birth control which most people overlook -- which includes the possiblity of long-term fertility problems.
Whereas, condoms are cheap, accessible, and do work -- and they also prevent disease (which depo et al doesn't).
jennipurrr
3-26-13, 2:46pm
I know the Pill does have side effects but in most of the world it is an over the counter drug (http://www.reuters.com/article/2013/01/02/us-birth-control-pill-idUSBRE9010FQ20130102). I feel like for teenage sexually active girls the risks of oral contraceptive/IUD use are incredibly low compared with the potential life effects of a child at that age. The I don't have children, but if I did and had a sexually active teenage daughter I would not want her to rely only on condoms. The failure rate (15% of sexually active couples relying on condoms result in pregnancy per year) is just far too high. I do understand the disease angle, but I believe many teens don't know the true stats.
I would like to see the pregnancy/contraceptive use stats broken down by demographics. I tried to google it and didn't have much luck. I have a gut feeling that poor teens aren't getting the same info that middle class and upper teens are with regard to the female based contraceptives. Using these could be a huge game changer for these girls who aren't trying intentionally (or subconsciously) to get pregnant. It seems from the middle class+ women I know, only rarely did someone have an unplanned pregnancy (of course you never know who had an abortion, but that issue aside) during high school or college and I think the fact a huge majority of the girls are on the pill is the main cause for that. Maybe I am minimizing culture and expectations though...but somehow the cycle has to be broken so that these poorer girls can go on to finish schooling if they so desire so they are not dependent on the state to take care of them.
I am of the stance that each of us DOES take personal responsibility to the degree we are capable of it at any given moment in our lives. Each of us has capacity relative to our own life experiences, educational opportunities, inner strength, outer resources, specific situations, etc. When my house burned down, my ability to "take personal responsibility" would have looked pretty limited to some.
The phrase "take personal responsibility" has always sounded like it was being said in accusation by a punitive & judgmental individual, finger wagging in the face of someone who simply needs compassion & assistance. Not helpful at all, nor in any way understanding of the life circumstances which we each run up against, especially when we need help. If my actions don't fit your definition of personal responsibility, that is your problem, not mine, and getting a lecture about it is incredibly uncharitable.
poetry_writer
3-26-13, 3:25pm
[QUOTE=redfox;135572]I am of the stance that each of us DOES take personal responsibility to the degree we are capable of it at any given moment in our lives. Each of us has capacity relative to our own life experiences, educational opportunities, inner strength, outer resources, specific situations, etc. When my house burned down, my ability to "take personal responsibility" would have looked pretty limited to some.
The phrase "take personal responsibility" has always sounded like it was being said in accusation by a punitive & judgmental individual, finger wagging in the face of someone who simply needs compassion & assistance. Not helpful at all, nor in any way understanding of the life circumstances which we each run up against, especially when we need help. If my actions don't fit your definition of personal responsibility, that is your problem, not mine, and getting a lecture about it is incredibly uncharitable.[/QUOTE
I mentioned taking personal responsibility. No way did I indicate a finger wagging put down of anyones actions or a judgemental attitude. It comes down to this: you choose to have unprotected sex, you may have to raise a baby and/or get an STD. Its how it is. Stating the truth isnt judgemental. Not at all sure what your house burning down (I am sorry it happened) has to do with the convo at hand. What do you suggest people do to help?
poetry_writer
3-26-13, 3:27pm
This is sort of an aside to this conversation, but with all the talk of condoms...I really hate how condoms are touted as the be all end all in contraception, especially relating to teen pregnancy. They have a failure rate in real life (15%) that is getting into the territory of "pulling out" (27%) or the rhythm method (25%). I guess they are so championed because they help stop STD transmission and they are cheaply available anywhere. I think these young women would be much more empowered to avoid early pregnancy if society placed more emphasis on methods that are much more reliable. I live in a conservative state and the depo shot has been available for free at the Health Department for as long as I can remember, also many insurance plans cover the Mirena IUD for the cost of a co-pay and I believe it is free if one is on Medicaid. It lasts for 5 years and anyone (even those who haven't had a child) can use it.
http://en.wikipedia.org/wiki/Comparison_of_birth_control_methods
Very true that condoms can and do fail. Someone I know had a terrible reaction to a Depo shot (hormones messed up, depressed etc)......So no method is without its problems. Better to use something than nothing, but I agree with your post.
I mentioned taking personal responsibility. No way did I indicate a finger wagging put down of anyones actions or a judgemental attitude. It comes down to this: you choose to have unprotected sex, you may have to raise a baby and/or get an STD. Its how it is. Stating the truth isnt judgemental. Not at all sure what your house burning down (I am sorry it happened) has to do with the convo at hand. What do you suggest people do to help?
I used my house burning down as an example of how life deals all of us difficult blows. How can people help? By following up your truths that you stated, "raise a baby or get an STD" with offering assistance to those in need; financial, medical, housing, food, diapers, child care, a shoulder, etc. Compassionate responses that reflect an understanding that life deals all of us blows, and that as kind, good people, we assist those in need when we can, so that when we're in need, assistance will be something we can count on.
We are all in this together, deeply connected in our community. What affects you also impacts me, and my desire is for everyone the thrive. When we each do better, we all do better, and vice versa.
What does "take personal responsibility" mean to you?
I see "personal responsibility" used as a rhetorical club with which to batter the unfortunate among us, and I agree that bad things can happen and wipe out any of us financially and emotionally. My personal philosophy is that my mistakes shouldn't adversely affect anyone else in any meaningful way, but I've observed that a lot of people don't operate within that framework--or learn much from their experiences.
poetry_writer
3-26-13, 7:23pm
I used my house burning down as an example of how life deals all of us difficult blows. How can people help? By following up your truths that you stated, "raise a baby or get an STD" with offering assistance to those in need; financial, medical, housing, food, diapers, child care, a shoulder, etc. Compassionate responses that reflect an understanding that life deals all of us blows, and that as kind, good people, we assist those in need when we can, so that when we're in need, assistance will be something we can count on.
We are all in this together, deeply connected in our community. What affects you also impacts me, and my desire is for everyone the thrive. When we each do better, we all do better, and vice versa.
What does "take personal responsibility" mean to you?
Obviously I am not taking about walking up to some one and yelling BE RESPONSIBLE. We should help others. Personal responsiblity.... It means being responsible for myself. Personally....I alone have to live with the consequences of my decisions.
iris lily
3-27-13, 11:49pm
I am of the stance that each of us DOES take personal responsibility to the degree we are capable of it at any given moment in our lives. Each of us has capacity relative to our own life experiences, educational opportunities, inner strength, outer resources, specific situations, etc. When my house burned down, my ability to "take personal responsibility" would have looked pretty limited to some.
The phrase "take personal responsibility" has always sounded like it was being said in accusation by a punitive & judgmental individual, finger wagging in the face of someone who simply needs compassion & assistance. Not helpful at all, nor in any way understanding of the life circumstances which we each run up against, especially when we need help. If my actions don't fit your definition of personal responsibility, that is your problem, not mine, and getting a lecture about it is incredibly uncharitable.
Part of the problem is that many do not see out of wedlock babies born to teen or young mothers as a problem, 'specially the young mothers. Shaking a finger at them after the fact isn't a practical remedy for their fix. I personally don't think there is a remedy for that situation, much of that is about cultural values. And, I'm not interested in offering assistance but my tax dollars take care of any perceived obligation to help.
But I DO see social censure as a tool for establishing social norms, so a certain amount of tsk-tsking and finger wagging (done effectively) serves a useful purpose. Yes, making a judgement that a behavior is wrong seems reasonable to me! Isn't that what's going on in this thread, anyway? Seems like a lot of "judging" to me.
Let's take a topic less loaded with emotion to social do-gooders : dog breeding. An endless parade of homeless pets that end up in euthanasia chambers is a sad situation in this country. I think that 90% of dog breeders are irresponsible for putting more dogs on the ground, their motivation is $$$. Mine is a judgmental stance. So what, I am making a judgement about their values. Since I don't believe in gooberment meddling to shape social practices, I do not want more USDA laws (good luck in enforcing what there is already) but I think social censure is a tool to address this problem. I have friends who said they are going to breed their mutt. sigh. I told them "I will shun you" and I will, it's the tool that I have and in this neighborhood "someone not speaking to someone else" gets around, it has power.
The Puritan in me thinks, from time to time, that stocks weren't such a bad idea.
IL, in my view, finger wagging is best deployed by parents & loved ones, wherein a trusting relationship exists as a context within which the being-finger-wagged-at recipient can hear it. It's part of an overall I love you thing. Otherwise, most of us just shut down. I sure as hell do not take to anyone besides my spouse and maybeeee my Mom calling me on anything. Because I know they have my best interests at heart. Which is why I hear others saying it as being disrespectful.
And Jane, really?!? The stocks? Sheesh.
ApatheticNoMore
3-28-13, 2:34am
While most people may not listen to strangers who don't know them from Adam, I think they are even *less* likely to listen to family members! (yes I'm saying complete and utter strangers are only second to last, family members are dead last) You'll drive yourself crazy trying to make a difference with family, and learn some people unequivocably do not take responsibility for thier lives and frankly might never. And the fact that there is love and time and real connection there, frankly just complicates things.
flowerseverywhere
3-28-13, 6:46am
Where is the line between aiding the unfortunate and enabling irresponsible behavior? Who decides? Is having more than one child on Medicaid OK?
I see "personal responsibility" used as a rhetorical club with which to batter the unfortunate among us...
It is entirely possible to, at the same time, be compassionate and to hold someone responsible for their own actions. Our problem is that we, as a society, have failed to do either one.
I do think there's a place for peer pressure--and I also think it works--but it can be overused, misused, and misguided. And yes, stocks.
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