Should Insurance Companies Fund Fertility Treatments?
Back in graduate school, we paid a yearly fee to the graduate student union which funded a plethora of projects including the graduate student newspaper. Though I went to graduate school in Massachusetts, the front page article of the weekly newspaper was usually inexplicably about the Israeli-Palestinian conflict arguing in favour of Israelis moving out of the Middle East entirely. Week after week, while there were plenty of newsworthy things happening in the college town and on campus, these topics were eschewed for Middle East politics. And the whole thing made me beyond uncomfortable.
I made an appointment with the Dean of Graduate Students and she patiently listened to why I might feel uncomfortable with my graduate student dollars supporting a newspaper that advocated the extermination of...myself. And then she explained that she cannot control what the editor of the newspaper chooses to print, though the university did end up establishing an anti-Semitism task force to deal with the fallout from the articles.
I then expressed my Plan B, which was to stop paying my yearly fee to the graduate student union. It made perfect sense--I didn't want to support the newspaper, so I would pull my funding from the organization that supports the newspaper. Except that it didn't work that way. It turned out that out of the $100 fee, under a penny went to fund the newspaper and the rest of that fee went to support great programs such as rape/crisis hotline and financial aid. Pulling my penny wasn't going to sink the newspaper that included such scintillating headlines as "Death to Israel" but protesting our graduate student fee or refusing to pay it was going to affect a lot of other programs.
It was my first life lesson in the idea that simple solutions sometimes don't take into account all the facts.
With health care reform being a hot topic, the discussion of whether it is cost-effective for insurance companies to fund IVF is being debated within and outside the US.
According to Resolve, the National Infertility Association, "Some insurance companies and employers incorrectly believe that adding infertility coverage to a health benefit package leads to increased premiums. In fact, states that have passed laws requiring coverage of infertility treatment actually have reduced overall health care costs."
The reason being that those with insurance coverage tend to treat their infertility based on the best course of treatment rather than first trying procedures, surgeries, and medications covered by insurance. It saves money to bypass expensive attempts that have a lower success rate based on the reason for the person's infertility. Coverage of expensive procedures such as IVF, means that those utilizing the procedure can make sensible decisions such as transferring fewer embryos and therefore lowering costs on the back-end including the financial burden associated with premature birth (which is often the case with multiples). According to Resolve, "In states with full coverage for infertility treatment, multiple birth rates (twins, triplets, etc.) are lower than in states with no infertility coverage. (New England Journal of Medicine, August 2002)."
Think about it this way: would you rather have your insurance dollars going towards a $10,000 IVF cycle or a $150,000 hospital bill for a three week NICU stay for premature triplets?
Barb Collura, the executive director of Resolve says,
RESOLVE: The National Infertility Association has known for years that insurance coverage for IVF treatments is not only the right thing to do, but it will dramatically reduce and perhaps even eliminate higher order multiples as a result of IVF treatments. Study after study shows that when you take the cost issue of an IVF cycle out of the equation, patients make better decisions about the number of embryos to transfer, thereby reducing the risk of a multiple birth. A recent study by Shady Grove Fertility on eSET (elective Single Embryo Transfer) among their Shared Risk patients confirms this – patients make better decisions when they are not pressured with paying out of pocket for every IVF cycle. If you only have $10,000 to spend, as a patient you want to get the most for your money, which does not always lead to a healthy pregnancy, mom, or baby.
Yet even with these stark financial facts on the table, if you take the comments and blog posts popping up about insurance companies covering IVF, it appears as if the average, vocal, non-infertile man or woman would rather pay the astronomically high costs associated with premature birth rather than have a few pennies of their insurance premiums go towards IVF. Childfreedom posted two emails that she got from readers on this topic, with one stating:
Covered by insurance? It should be illegal. Nobody ever died from not having a baby...This is the thing I hate most about assisted reproduction: for some reason your body is not able to sustain an embryo or bear a child, but we can chemically torture it into doing what it shouldn't, all because society says you are a failure as a woman if you don't pursue every possible option to get a baby, no matter how impractical or expensive or detrimental to your health. Look what Science can do for you! Oh, so many beautiful babies! It's a miracle!
The Globe and Mail wrote about this topic in regards to Ontario and received 400 comments on the online article which states: "Life's unfair, and health care is a bottomless pit, and some of these procedures have wretched outcomes" to which many of her readers agree: "To the infertility zealots all infertile couples are angels. Dose of reality many are not, and some have indeed created this by their own making as well. Some should NOT have children, and if nature has assisted with that, maybe that is a good thing too."
Like It Is jumps off this article with her own thoughts: "it’s clear that it’s not just childfree people who object to being the purse strings for women who think having IVF is their right. The tax-paying public has a right to be alarmed."
The problem, of course, is that when insurance companies pick-and-choose what they cover without rhyme or reason, the general public is left to argue amongst themselves. Treatments for impotence are covered ("Within weeks of hitting the U.S. market in 1998, more than half of Viagra prescriptions received health insurance coverage.") but the drugs that help the body release an egg are not. Pregnancy and maternity benefits are well-covered, but abortion and fertility treatments (two sides of the same reproductive coin) are not. We pay a lot of lip service to family building and reproductive health, but then do not give people the means to help themselves or make sound personal decisions in regards to their body.
We can reduce people to caricatures and chalk up all problems to bad decision-making. Those who don't want insurance to cover gastric-bypass surgery reduce all people experiencing obesity as "lazy, irresponsible, sly and greedy folk." We can write off all children with ADHD as just needing to lower their sugar intake.
And even though the facts point to the contrary--according to a December 2005 report of the CDC’s National Survey on Family Growth (NSFG), the fastest-growing segment of U.S. women with impaired fecundity (the capacity to conceive and carry a child to term) is those under 25-- we can say that those who are experiencing infertility just waited too long to start building their family.
Returning to the lesson learned back in graduate school, simple solutions don't usually take into account all the facts. That simply writing off sections of the population and deeming certain diseases the fault of the person is reductive and lumps all the various causes for a disease down to a single factor. Instead of stating via insurance coverage that some diseases are worthy of treatment and others are not, let's aim to have policies that neither reward nor punish, but instead enable citizens to treat their health ailments.
So rather than discuss the people with the disease, let's discuss the disease itself and whether or not insurance companies should fund treatment based on the ideals and ethics we subscribe to within our respective countries.
As on July 2010, Quebec is the first place in North America to give government-funded IVF cycles. Couples will be able to get three IVF cycles for free.