By Jessica Brown

The recent Orrin J. H. Johnson commentary misses reality.

The efficacy of the United States’ health-care system is embarrassing. In addition to harming individual Americans, it undercuts our position as the economic powerhouse around the globe.

Consider American health care’s spectacular failures in maternal and infant care. We spend more than $111 billion a year on maternal and newborn care – more than any other country in the world – yet we have the highest rates of maternal and infant mortality of any wealthy country. This happens when you have no system.  Maternal health care in the United States is a shambolic series of piecemeal services with unnecessary services driven by conflicted payment structures. Insurance companies now pay for discrete tests and procedures. Unnecessary procedures generate revenue for doctors and increase iatrogenic risk—the risk that comes from every medical intervention. In reality, our system harms us.

Assess the system by looking at objective, measurable outcomes. America ranks sixtieth in the world for maternal mortality deaths. Europe’s heavily regulated health-care markets deliver better results.In 2015, the Netherlands had a 0.007 percent maternal mortality rate per 1,000 live births. The U.S. rate for same year was double that of the Netherlands at 0.014 percent. The infant mortality rate in the Netherlands was 0.0032 percent while the U.S. had a significantly higher at of 0.0056 percent per 1,000 live births. So America's maternal mortality rate is double that of the Netherlands, and we have an infant mortality rate that is significantly higher than that of the Netherlands.

We also suffer from expensive over-treatment. For example, obstetricians attend 98.64 percent of America’s four million annual births. In the Netherlands, women often opt for a midwife attendant over a doctor for uneventful pregnancies. About 46 percent of Dutch women choose to have a midwife.

Americans often believe things that are not true—like the misplaced belief that we have the best health-care system in the world. Objective measures show this is pure folly.  Medical organizations, drug companies, and medical device companies spend billions convincing Americans that we need to spend lots of money to fix ourselves. This, of course, is highly lucrative for them.

The American method of birthing showcases this problem. In other nations where best outcomes for patients are sought after more than profits, inductions and unnecessary c-sections are rare. But the U.S. has too many needless inductions and far too much knifing—researchers estimate that half of American c-sections are performed unnecessarily. In fact, a woman’s chance of having a cesarean section may increase depending on the hospital in which she chooses to give birth rather than the nature of her labor.

Consumer Reports investigated 1,200 hospitals in the United States and found that “C-section rates for low-risk deliveries among U.S. hospitals vary dramatically, even in the same communities and among similar institutions, and that in most hospitals the rates are above national targets.” The U.S. is home to 221 hospitals with c-section rates above 33.3 percent for low-risk pregnancies.

The overuse of c-sections results in poor health outcomes for mothers. Unnecessary c-sections may drive as many as 20,000 complications a year, including sepsis and hemorrhage. While mothers catch complications, hospitals pad their bottom lines.  C-sections are also more lucrative for hospitals and doctors than vaginal births. One economic study found that obstetricians perform more cesarean sections when there are financial incentives to do so. In deciding their own treatment, female doctors were 10 percent less likely to get c-sections themselves, suggesting that obstetricians may treat physicians differently than other patients, or physicians who are patients rightly balk at unnecessary procedures.

Overall, our health-care system is far from the greatest in the world. Childbirth is an industry in the United States and profits for hospitals, doctors, pharmaceutical companies, and insurance companies reign supreme to the detriment of women and babies.

In contrast, nations with health-care systems allowing for greater individual autonomy in care deliver far better outcomes overall. Elsewhere doctors and hospitals reap rewards for improving conditions for mothers and babies. Allowing the U.S. health-care system to continue to run amok will only worsen conditions for women and infants here. Republicans and Democrats in Congress are right to look at single-payer systems, and other systems that work better than ours does.  

That’s not hyperbole. It makes moral and economic sense.

Jessica Brown received her J.D. from the William S. Boyd School of Law. She is the author of the forthcoming article “The Fight For Birth: The Economic Competition That Determines Birth Options In The United States” that will be published in the University of San Francisco Law Review.