Thursday, April 28, 2005
Fertility Funding (UPDATED)
Susanna has an interesting post about one of the big problems with going over entirely to a government paid healthcare scheme: how do you allocate your available resources? And what do you do when fights break out about what should and shouldn’t be covered?
Thre’s a side issue here that’s interesting to me personally, as we see it play out even in existing insurance markets in the US, and that’s the coverage of fertility treatments. Susanna says, “Reproduction isn’t a right,” and I see where she’s coming from (and none of the following is directed at her...it just so happens I’d been musing about this a while ago and her post made me think of it again.). It seems to me, though, that if unlimited maternity care is available, then unlimited fertility treatment should also be available. And since you’ll never have an insurance company say, sorry, you’re only covered for 3 kids, why in the world should you only be covered for 3 IVFs?
Where do you draw the lines?
You see, I got to thinking about all of this after having Sadie. My pregnancy, while not particularly difficult (aside from the last 24 hours or so), was very, very high-tech. I got knocked up on my own, but from that point on I was very, very expensive. For the last seven weeks of it, I was seen four or five times every week. That would be 2 NSTs (minimum, had to go to the hospital a time or two for additional monitoring), an ultrasound, a midwife or OB appointment (they’d rotate), and every other week I’d see my PCP. Over the course of the pregnancy I had 3 appointments with a perinatologist for a level 2 ultrasound to verify appropriate growth and get his thoughts on management. I delivered at 39 weeks due to low fluid discovered at one of the weekly ultrasounds. 24 hours into the induction the baby stopped tolerating the contractions, and I had a C Section for fetal distress. Spent a total of 6 days and five nights in the hospital, and had multiple follow-up appointments the first week after I got out.
And that was nothing compared to what some people go through.
All of that cost me, out of pocket, less than a thousand dollars. And should I get pregnant again, the insurance company will pay for it again. Nobody says to me that it’s too expensive for me to be pregnant, so I’m not covered for additional pregnancies. And as far as I’m concerned, they damned well shouldn’t (you’d faint at what we pay, they’ll make it up before too long).
The thing is, if I hadn’t had all of that high-tech assistance, my chances of having a live baby at the end of my pregnancy would probably be pretty damned close to zero. And I can’t help but wonder what the difference is between me and someone who has trouble getting pregnant in the first place (I know there’s a huge experiential difference, but I’m talking people-thinking-it-shouldn’t-be-covered-wise). Neither of us would likely have a baby without all of this marvelous medical science. So where, again, do we want to draw the line? I can get knocked up by myself but have risky pregnancies so I’m covered, but a woman who might have perfectly reasonable pregnancies, you won’t help her get pregnant in the first place? I’m entitled to have a child, courtesy of my insurance company, and she isn’t? Simply because my daughter was conceived (presumably) in a fallopian tube?
Seems like a strange place to draw the line, to me.
If my insurance company woke up tomorrow and decided I wasn’t covered for maternity anymore because I couldn’t have a baby without a doctor’s assistance, I’d be furious. Heck, I could probably drum up a pretty good public outrage over it. What in the hell is the difference between that and the insurance refusing to pay for fertility treatment? Or if they told me I could have three children, no more, because it was too expensive...why would that provoke outrage, while a limit of 3 chances to have a child seems perfectly reasonable to people?
Weird line.
I have a medical condition that makes it difficult to have a baby. Those who struggle with infertility have a medical condition that makes it difficult to have a baby. Why would I be covered fully and they wouldn’t be?
Weird line.
Which is why I’ve grown opposed to drawing lines. I’ve come to believe very firmly that if maternity coverage is mandatory, infertility coverage ought to be, too. I don’t know how well I’ve explained myself, but I just don’t see what’s so essential about the pregnancy starting without intervention that makes one worthy of payment and the other not.
All of this points up, really, why government-paid health care--or even the heavily government-regulated health care we have--is problematic. On the other hand, I don’t think there’s any chance in the world of a free-market solution to any of this, because we as a people aren’t going to tolerate that. So we’re stuck with these decisions, and they’re a lot bigger and more problematic than just what reproductive technologies we’ll fund or allow or compell insurance companies to fund.
If reproduction is a lifestyle choice, then the logical thing to do would be to stop covering pregnancy at all. (Heck, if kids are just a lifestyle choice, why cover them?) If we’re not going to do that, then covering infertility is the logically consistent (and, IMHO, the compassionate and appropriate) thing to do.
So sayeth the Deb.
UPDATE:
James R. Rummel has some excellent points about just how big a pickle we’ll get into if we head down the socialized medicine path. I don’t know that I was entirely clear about the fact that I don’t think that socialized medicine is viable. I don’t think that it is. I was more musing on the sorts of decisions that would need to be made, and reflecting on how difficult it is to draw lines past which treatment can’t go. I do believe it is illogical to fully cover pregnancy but not infertility, but I certainly have no illusions that any state-run system could be competent at handling either one. In any case, he’s got a good, link-rich post that is certainly worth taking a look at if you have an interest in this topic.