John Goodman is indispensable on the topic of health care economics. In this instance, he points to a study of a hospital that delivers babies of at-risk mothers with good results at low cost.

So why not replicate Parkland’s baby delivery system all over the country? One thing standing in the way is government. If all of Parkland’s 16,000 expectant mothers were enrolled in Medicaid or had private insurance, for example, much of what Parkland does might not be possible

The cost of having a baby in this country has skrocketed over the years. We just presume that you need lots of doctor visits and ultrasounds, that you will sue your ob-gyn for a zillion dollars if the baby is not perfect, etc.

We could spend way less money near the beginning of life and near the end of life with little overall impact on our health statistics. But it would require big changes in institutions and cultural norms.

I personally am not on a crusade to change our culture around health care. I don’t want to tell other people how much to spend on pre-natal care or end-of-life care. I just want them to be making decisions more on the basis of spending their own money, rather than someone else’s.