Tsung-Mei Cheng is a health policy research analyst at Princeton University. Uwe Reinhardt is James Madison professor of economics and public affairs at Princeton University.
Last week, during a committee hearing on the Republicans’ health-care plan, Rep. Mike Doyle (D-Pa.) asked Rep. John Shimkus (R-Ill.) to name a mandated benefit in the Affordable Care Act to which he objected. Shimkus replied: “What about men having to purchase prenatal care?”
Shimkus is probably not the only member in Congress who believes that forcing men to purchase health insurance that includes maternal care is unfair; it represents what some have characterized as a war on men, as several conservative health-policy wonks also have argued. (See, for example, Linda Gorman’s “Obamacare’s War on Men.”)
As a matter of moral values, people are entitled to different views on this issue. But we must wonder whether Shimkus and like-minded men are at all aware of the flourishing scientific literature showing that the in-utero experience of a fetus, especially the mother’s nutrition and health behavior, significantly shapes the health status, mental health and cognitive ability of offspring in early life and in adulthood. The in-utero experience of female babies, in particular, has been shown to affect not only their health through to adulthood, but also the quality of their ova (eggs), which means that it is likely to affect the health status of future generations.
Nobel laureate James Heckman has devoted much of his research to this issue. A few years ago, the British medical journal the Lancet devoted an entire issue to this phenomenon. There is little doubt among the experts that good maternity care could improve the in-utero experience of many fetuses.
So the truth is not “self-evident, that all men (and women) are created equal,” as the Declaration of Independence would have it. Depending on their in-utero experience, some babies are born with a long-term mortgage on their future health and cognitive prowess while others are favored by a good in-utero experience.
Shimkus himself has co-sponsored pro-life bills in Congress, showing great love and concern for the well-being of fetuses. One would think he would do everything a legislator could to make sure all American fetuses have the best in-utero experience a nation could bestow on them to maximize the overall health status and cognitive ability of future generations. On that thought, his attitude on maternal health care is truly puzzling.
Ultimately, this issue turns on a simple question: “What is a child?” Should we view a child as a national treasure who will one day run our country — in which case all Americans should be willing to invest in a health system that maximizes the health status and cognitive ability of that child? Or should we view children as a parent’s private consumption good — a pet, so to speak — for which its owners are solely financially responsible?
Here we should note that the total cost of a normal delivery in the United States is about twice as high or higher as it is in most other developed countries. In fact, developed countries throughout Europe and Asia routinely mandate that all citizens acquire health insurance for standard, comprehensive benefit packages that include maternity care. Having attended many health-care conferences around the world, we cannot recall ever hearing men abroad lament that this constitutes a war on men. Nor would it be common to hear American men with employment-based health insurance complain that they are forced to subsidize maternity care with their premium contributions.
Most men seem to recognize the extraordinary contribution mothers make to their nation’s future. Does anyone really need to be reminded that women provide the hard labor of carrying a child to term, of giving usually painful birth to that child and of nurturing the child along to adulthood? Most men seem to realize that helping finance maternity care is the least they can do to thank women for their awesome contribution to the nation’s future.
But some seem unaware of the research and linkage between maternal care and child health and merely consider it unjust on moral and libertarian grounds that men should help pay for maternity care. We must accept this as a personal moral preference. In terms of economics and U.S. national interest, investing in maternal health care strikes us as the much wiser path. The health status and cognitive ability of future generations of Americans is easily as important as a strong national defense.