I read a comment on MY OB Said What?! today by a woman who was told repeatedly that a VBAC (vaginal birth after cesarean) “wasn’t possible.”  She finally got her OB to admit that this had nothing to do with physical reality; he simply would not be covered by malpractice insurance if he attended a VBAC.

This is yet another way that insurance distorts the health care market. Doctors must be free to think in terms of reality and evidence (such as that VBAC is quite possible for most women and safer as well); in other words, in terms of GOOD MEDICINE.  Instead, most can only think in terms of what they are “allowed” to do.  It is difficult for most of us to admit that we are constrained, not by what is correct or good, but by some external, arbitrary restriction; so many doctors brainwash themselves, in a way, into believing that it CAN’T be done rather than admitting that, while VBAC is safer, they must expose themselves to risk if they plan to act on that truth.

Dependence on insurance has done us all a disservice by letting us pretend that we are safe.  Rather than assessing their own risks in terms of their own priorities, doctors depend on malpractice insurers to make their risk assessments for them.  So rather than having multiple competing points of view, and the opportunity for each consumer to choose a doctor whose point of view fits her own needs and desires, we have a homogenized standard of risk assessment that doesn’t fit anyone. (Similarly, medical cartels such as the AMA, whose monopoly is enforced through licensing, homogenize medical practice in general and limit consumer choice.)  Insurance has its legitimate uses, but not as a substitute for a trust relationship with one’s clients, or for using one’s own mind to decide what is good, safe, kind medical practice.