The Washington PostDemocracy Dies in Darkness

Opinion Bernie Sanders says it’s better to give birth in Finland than the U.S. He’s right.


A few years ago, personal finance writer Ester Bloom, faced with a four-figure health-insurance deductible and a narrow network of doctors to choose from, attempted to price out how much giving birth to her younger child would cost her. It turned out to be an all but impossible task.

I thought about Bloom on Wednesday, when reviewing a Twitter dispute between Bernie Sanders and former Trump administration official Nikki Haley over the high cost of giving birth in the United States. The argument originated earlier this month, when Sanders tweeted, “In the United States it costs, on average, $12,000 to have a baby. In Finland it costs $60. We’ve got to end the disgrace of our profit-driven health care system and pass Medicare for all.” Haley didn’t respond until Wednesday, when she suddenly replied, “Alright @BernieSanders, you’re not the woman having the baby so I wouldn’t be out there talking about skimping on a woman when it comes to childbirth. Trust me! Nice try though.” She added, “Health care costs are too high that is true but comparing us to Finland is ridiculous. Ask them how their health care is. You won’t like their answer.”

Au contraire. I’m a woman, and I know what country I would rather give birth in, and, no, it’s not the United States. All that money Americans spend isn’t buying us much at all. If Finland’s health-care system is what we get for “skimping” on women, sign me up.

Finland beats the United States when it comes to childbirth on almost every measure. Its maternal death rate is among the lowest in the world, while the United States, at 14 deaths per 100,000 live births, ranks a lowly 46th, firmly in the lowest tier of developed countries. Our infant mortality rate is triple that of Finland. Almost one-third of babies in the United States are delivered by Caesarean section vs. 1 in 6 in Finland. Conditions in even top-notch U.S. teaching hospitals can be challenged, with women laboring in hallways and waiting rooms because there are no rooms available for them.

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Americans pay lots of money for these dismal results. Yes, most people are not responsible for the $12,000 average bill for a typical vaginal birth. (A C-section runs just under $17,000.) But we are still usually out a four-figure sum. More than half of all those with employer-based insurance plans have a deductible of more than $1,000, so families find themselves on the hook for hefty chunk of that money. The average out-of-pocket cost to a mom from the beginning to the end of a pregnancy is just over $1,600 for a vaginal birth and almost $2,000 for a C-section.

As a result, posts on how to save money on giving birth are something of a personal-finance website staple, though the advice is usually limited to the useful information such as reminders that forgoing the epidural can save a new mom more than a thousand dollars and helpful reminders that “you’ll need to study your plan in-depth to understand your out-of-pocket costs.” I’ve had two children, and I assure you parsing my health-insurance policy is just about the last thing I wanted to do while experiencing morning sickness or chasing after a toddler while eight-months pregnant. (I also don’t recommend forgoing the epidural — I attempted that too.)

That’s not to say Finland’s heath-care system is problem-free. A comprehensive health-care reform undertaken to cut costs as the population ages is causing no small amount of political controversy. But most Finns remain happy with their system. And why wouldn’t they? There’s no question that Finland gets better results for much less money spent. The day before Sanders’s tweet, a “CBS This Morning” segment on the subject found it cost a mother less than $60 to have a baby in Finland, so long as she is covered by the country’s health-care system. No one is billed separately for a minimum number of ultrasounds or doctor visits. And did I mention the free baby sleep box with a mattress the Finnish government tosses in, which also includes clothes, toys, bath towels, mittens and a snowsuit?

All of this is separate from the fact that the United States does not mandate paid family leave for new parents; 25 percent of mothers of newborns are back on the job within two weeks. The cost of child care exceeds the cost of sending a child to a public university in a majority of states. In Finland, on the other hand, new mothers receive about 16 weeks off from work, while dads are granted about two months. Child care is subsidized too. Little wonder that a survey released Wednesday found Finland is the world’s happiest country. They value the health and welfare of their citizens. The United States? Not so much.

Read more:

Katrina vanden Heuvel: Let’s fight for universal child care

Meghan Kruger: Good day care is hard to find. Elizabeth Warren’s plan might make it harder.

Katy B. Kozhimannil and Austin Frakt: Rural America’s disappearing maternity care

Elizabeth Bruenig: The United States could have Nordic-style welfare programs, too