More on Paying For Parenthood–News Notes from Here and There

I’ve come across a couple of new items that also address questions about the cost of IVF in particular, perhaps ART more generally.  I thought I’d add them in to the conversation around this earlier post

First, also thanks to The Spin Doctor, is this column from Canada.   It’s actually a columnist’s opinion piece from The Globe and Mail, one of Canada’s national newspapers.   It’s a consideration of the Quebec provincial policy of paying for IVF.  

It seems the idea, at least in part, was that this might be a cost-effective move.   Here’s how the theory would go.  If people pay for their own IFV, they might transfer two or more embryos, hoping that at least one would take.  This increases the likelihood a multiple–twins, triplets, etc.    Once the children are born, the state is responsible for medical care.   And medical care for multiples can be quite extensive.  

If instead the state pays for IVF it can condition payment on transfer of a single embryo.  While it is still possible that there will be twins, triplets, etc., it is far less likely.   Hence, though the IVF is expensive, the overall cost of care may be lowered.   

The columnist disputes this argument and you should read the piece to see how he makes his case.   Part of his conclusion, though, is pertinent to the earlier discussion here.   

As we undertake reforms of medicare to make it more cost-effective and fair, a distinction needs to be made between medically necessary services that should be covered by public insurance and other “frills” (for lack of a better word) that should be covered out-of-pocket, by private insurance or some other means.

Infertility can be a medical condition but helping women get pregnant with high-tech methods like IVF is not a medically necessary service that should be covered by medicare.

This is not to suggest that funding in vitro fertilization is not a legitimate social program that the state might choose to support for other reasons – compassion, a desire to increase the birth rate, an attempt to reduce multiple births, etc.

Let’s just be clear about the distinction between what is medically necessary and what is socially desirable.

Again the question of what medically necessary means and why it might matter.  (I suppose I could note as an aside that much insurance pays for Viagra and I could make an argument that it isn’t medically necessary either.)  

Closer to home, here’s a note from the ASRM.   Legislation has been introduced that would allow a tax credit for certain types of fertility procedures.   The credit would be available for procedures that allow a person to preserve fertility before other medical treatment.  I think this probably means things like freezing eggs before chemotherapy and things like that.

The tax credit idea is modelled on the tax credit you get for adoption.  But there may be an important distinction.   We subsidize adoption because it is good for the kids who are adopted.   These are already existing kids.   Fertility procedures do something different.  

This is not to say the legislation isn’t a good idea.  But it should be considered as a government subsidy and the question is whether this is an activity the government ought to subsidize.  

Once again, food for thought.


22 responses to “More on Paying For Parenthood–News Notes from Here and There

  1. Fascinating. This reminds me of something my Mom calls situational ethics. I love that term. See I’m a big fat hypocrite – I get terribly torn when it gets personal-and I have a helluvalota friends. I’m having dinner tonight with one of my very best friends in the whole world and her husband whose like the only decent husband on the planet as far as I can tell. Or at least he does a damn good job of playing his cards right. I want her to have a baby, she wants her to have a baby and I think he wants her to have one too but she’s turning 40 this year and its not going to happen naturally. I know the only way it will happen is with IVF and she does not have the money for it. I’m gonna tell her tonight to sell their car she has to get those eggs out of her quick. At the moment, I’d be happy if my tax money paid for IVF.

    She is, Julie, by the way, now the only adoptee I’ve ever helped that prefers to return to acting like she’s not adopted. She does not want to meet her family. Time passes and I too am introduced to new experiences.

    • I think they should have tried sooner, and it’s not like they are likely to succeed even if we pay for a dozen rounds of IVF. It’s not a big deal, it’s sad but there are millions of childless people we can feel sad for. I do however think that they have a right conceive and to medical and marital privacy that should allow them to use their own egg and sperm and do IVF, but I think it should be taxed heavily so that only the richest movie stars are able to afford it, and so that they’d be subsidizing actual medicine for sick people in the process.

    • I know I’ve been suspicious of the invocation of anecdote in the past, but I don’t want to overdo that stance. Clearly we are all informed by our own experiences and the experiences of those around us, particularly those we care about. So, for example, it is not surprise that the most significant predictor of a person’s attitude towards lesbian/gay rights generally is whether a person knows (and knows that they know) someone lesbian or gay. If nothing else we should learn from new experiences that we don’t always know what to expect and that there are immense variations in human response.

      Yet at the same time, law is (or maybe I need to say “should be”) general. It applies to range of people. That’s one of the hallmarks of law, in fact.

      I think there’s just bound to be tension there and I have no great solution except to be mindful both of the value and limits of anecdote/personal experience.

      • marilynn huff

        I love that! But I still owe you a debt of gratitude for inadvertently getting me to stretch my writing ability so that I do not have to rely on emo or pathos to make a point.

        When a person’s right, there is plenty else to draw upon to make ones point. 😉

        (Take that in the spirit in which it was intended – quite affectionately)

      • marilynn huff

        Yeah I know lots of Gay and Lesbian people. I’m so grateful that I was raised here in SF. I never was exposed to people that gravitated toward their own racial group or well even in high school well over 20 years ago it was no secret certain kids were (gonna be) either gay or lesbian. I’d have to get into a deep conversation to find out if anyone ever really picked on any of my friends for that. I’m sure it happened but where I come from we’d pretty much kick a kids ass for being a red-neck like that. There had to be an element of safety for kids whose parents were not straight or who were not straight themselves, knowing that they had back-up all they had to do was say someone was giving them a hard time. Who would I have been if I were raised somewhere else? Would I think straight people had the market cornered on functional family life? Would I think it was acceptable for an ex wife to prevent her children from seeing their Gay father and his partner? Would I look down on women raising children without any help from the children’s father? Would I walk past a homeless person laying face down on the street without stopping to see if he was alive and offer him help? My personal experience here in San Francisco is a blessing I have no money, but I feel really good.

  2. Who says it can’t happen naturally, just cuz she’s 40?

    I don’t see why this makes you hypocritical, when have you objected to people using IVF with their own eggs?

    • It won’t happen naturally. She’s heavy. And by heavy I mean really really heavy. I don’t think sex is possible.

      • I don’t think you should be telling her to do IVF to have children. Not just her, but anyone. But at the same time, if she’s too heavy for sex, she’s too heavy for running around after a toddler too. Not that I would advocate foster care to rescue children of obese parents unless it was an extreme situation, but I certainly wouldn’t advocate trying to have children either. I think you are allowing your emotions to cloud your thinking, as if telling her to do IVF and have kids would piss off mean people like me who don’t think she should do IVF to have kids. Pissing men like me off shouldn’t be your underlying motivation for anything. We are usually right.

      • you’d be surprised how creative people can be when it gets to sex. unless she’s actually told you otherwise why make such an assumption.
        Even so, not being able to have intercourse is not in itself an indication for IVF, although it would be an indication for manual insemination. (Either self administered or medically assisted)
        Of course extreme obesity can interfere with her hormones but you can’t assume that without being told explicitly.

        • Oh Huh! Your right insemination – she could do that at home! Kisarita! Your so smart! I just love you!

          And John why would I want to piss you off? Your just as entertaining when your calm as when your all agrovaated. Sides half the time I agree with you any way and your right I am letting my emotions get the better of me. In fact I always let my emotions get the better of me…I spend my personal time helping people find their children and I’ll never meet most of them.
          My boss says I am the most organized scatterbrain he’s ever met. I’m also the most logical bleeding heart in the world

    • well I have not objected to IVF with people using their own eggs although the idea scares the hell out of me – two of my dearest friends could easily loose their children to unscrupulous doctors playing god with his sperm and her eggs which is why dna is so critical and everyone that uses those services should have their babies tested at birth to make sure they got their baby and not someone elses. If someone else gets their baby or one of their babys i want them to give it back or at least share custody

  3. Hmm why should insurances cover viagra?
    lots of reasons.
    1. cost, it’s cheap so why not
    2. The people making the rules are mostly 50 year old men.

    • The latter reason is an explanation but not a justification. Everyone probably has a tendancy to think that their own needs are important/legitimate and so if you are lucky enough to be a rule-maker, you might act on that. Unsurprising, but not a legitimate reason for action.

  4. The article asks us to differentiate between what is medically necessary and what is socially desirable. But when we are talking about socialized medicine, the good of society should be a strong deciding factor. There is no reason that a society that wants to increase the birth rate should develop non-coercive mechanisms for doing so, same as a society that wishes to decrease the birth rate.

    • two thumbs u p

    • Good point. Many societies do try to manipulate population numbers. Some want more children (lots of northern european countries these days) and so offer various types of incentives–some direct, some less so (things like generous parenting leave). Other societies want fewer children (the main example that comes to my mind is China) and so arrange different policies. (A tricky idea here might be “non-coercive.” I don’t mean to say that I’m in favor of coercion–I am not. But when is something coercive? If we say a family having a third child must pay a tax is that coercieve?)

      In any event, you’ve drawn a very important distinction–between medically necessary and socially desireable. Is it ever medically necessary to have a child?

      • marilynn huff

        Not that I agree with this Julie but to some people having a child is medically necessary – to save another child’s life for instance. There was an article about that recently.

        • which leads to another ethical dilemma. After all what does it mean to be the child that was conceived to save someone’s life?
          I am reminded of a book I read, whose title I can’t recall. It was about a girl so conceived, suing for medical emancipation who had to always donate something or other to her sister. I don’t knwo if this is a realistic scenario for a minor but you get the idea.

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