SEND 14 OF 21

The prevention is a rounding error

The prevention is a rounding error next to the catastrophe.

DR. YAMICIA CONNOR, MD, PHD, MPH

Which leaves one way to explain why we don't do it.

People have never actually seen the bill — never had it laid out, never been walked through why the cheap thing prevents the expensive one. That is most people. That is not a flaw in their character; it is a gap in what they have been shown. And it is fixable. It is the entire reason I write these.

Start with what we already spend, because that is the part people miss: we are spending it either way.

A baby born at twenty-four weeks runs a median of about two hundred sixteen thousand dollars and ninety-two days in intensive care before it ever goes home. A baby born at term runs about six hundred dollars and two days. Same medicine, same country, same insurer — the entire difference is how early the pregnancy ended. And that first hospitalization is only the down payment. Across a lifetime, the added societal cost of a single infant born before twenty-eight weeks comes to roughly three hundred forty-four thousand dollars — about twelve times what a moderately early birth costs. Those earliest babies are seven percent of the preterm group and more than a third of the entire tab. Nationally, preterm birth costs the United States on the order of twenty-five billion dollars a year.

And it is not only the smallest babies. Among healthy, full-term, single babies, NICU admissions rose from 3.84 per hundred births to 4.50 in eight years — a seventeen percent rise. That does not mean more babies were harmed; it means more care was delivered. Care delivered is still a bill, and it is the expensive door, opening more often, for babies who did nothing to deserve the visit.

We are not deciding whether to spend that money. We already spent it. We are only deciding when — and therefore how much.

We already spent it. We are only deciding when.

Download to share →

Because here is the fact that should end the conversation: delaying a delivery that would have come before twenty-six weeks until the pregnancy reaches term saves more than two hundred thousand dollars in a single case. The prevention is not costly relative to the catastrophe. The prevention is a rounding error next to the catastrophe.

Now, I know the objection, because I have it too. Maybe all of this is just poverty wearing a medical costume — poor women have worse pregnancies and poor children have harder lives, and maybe the birth in the middle is a symptom, not a cause. It is the right question. It is the one honest thing the other side has going. And the research answers it.

When economists compared twins — same mother, same house, same genes, same bank account, differing only in birth weight — the smaller twin still grew up to earn less and go less far in school. When they tracked hundreds of thousands of siblings through Florida's birth and school records, poorer newborn health predicted worse cognitive development years down the line, and — this is the sentence that matters — the effect held "across a wide range of family backgrounds." It did not wash out when they accounted for how poor the family was. And when the government ran an actual experiment, randomly handing some families in high-poverty projects a voucher to move somewhere better, the children who moved young went on to earn, by the researchers' estimate, about three hundred thousand dollars more across their lives than the children who stayed. Hold those three studies together, because they are doing something a correlation cannot: they are the reason I can tell you that a carried pregnancy and a stable address do not merely travel alongside a better life. Where we have been able to measure it cleanly, they produce one.

The voucher experiment

This is the randomized experiment I mean, run on a different budget line. The government did not have to guess whether stability changes an outcome. It ran the trial, and the savings moved the same direction the twin studies do.

A randomized trial of HUD Family Unification Program vouchers found lower homelessness and fewer out-of-home placements than services as usual, and every $20 million in vouchers saves well over $100 million in foster-care costs.

Read →

Prevention is the cheapest care available

And here is the part that makes the timing worse than bad luck: the cheap thing is not merely underfunded. It is the specific line item cut first, on purpose, whenever a budget tightens.

Which is exactly why it's the first thing cut. Title X, the family-planning floor, went first.

Download to share →

Read →

WHAT YOU ARE A PART OF · 15

We Still Don't Understand the Basics

The medical field does not understand how a woman's body works. That isn't rhetoric.

We don't know what triggers labor. We can't reliably diagnose endometriosis, even though it affects roughly one in ten women — and the average delay from first symptom to diagnosis is years long. Most of our disease models are built on male biology, because until 2016 even animal studies routinely excluded female subjects on the grounds that estrous cycles were too noisy to bother with. Our understanding of how hormones and the immune system interact — the systems that shape everything from autoimmune disease to perinatal mood disorders — is rudimentary.

Meanwhile, the conditions that disproportionately affect women — autoimmune disease, chronic pain syndromes, PCOS, perinatal depression, postpartum hemorrhage, severe maternal morbidity — are routinely misdiagnosed, under-researched, or dismissed.

This is not a knowledge gap. A gap implies the work is in progress. This is a structural choice — which questions get asked, which patients get studied, which deaths get audited. The choice has been made, decade after decade, against women.

NEXT

Next: the bill nobody opens, and what compounds inside it while we don't.

Thank you for being here. Forward this to one person who needs the spine.

— YC
Dr. Yamicia Connor, MD, PhD, MPH · Founder & CEO, Diosa Ara | Creator & Editor-in-Chief, The Labora Collective

A Labora Collective Publication — part of the Diosa Ara ecosystem