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Fertility Coverage in Connecticut


An order of magnitude estimate for the procedures covered would probably average, with self payment, about $10K per couple.  That gives $700M per year, and probably represents a lower bound.  At an average annual cost of say $4000 per health care, that money would cover nearly 200,000 uninsured Connecticut residents.   Moreover, the success rate of the treatments is rather low; I think it is good that there is a cutoff age of 40, as I am assuming the law does not cover donor eggs and most responsible reproductive health practitioners won't take on a woman of over 40 with her own ova.  The odds are just way too low. 

 There is also the question of education; surely many are couples with fertility problems arising at youth.  However, for those who simply chose to wait, should we publicly subsidize their decision?  A woman who was interviewed for the piece who is over 40 lobbied hard for the law but was devastated by the limit on age.  I can understand the deep grief she feels, particularly since she has probably been pushing for this for some time, perhaps from before she was 40.  However, she went on to claim that the age limit (which insurance companies lobbied for) was tantamount to the insurance companies dictating how to lead her private life.  Frankly, I took offense to this.  When my wife and I went through a process of exploring fertility, we knew full well that our choices had led us to this and accepted the rather high cost.  I do not know whether this woman was rendered infertile by age or other, but there is no doubt that the combination will conspire to give exceptionally low odds to the fertility outcome, even more so than the dim prospects offered by age reduced viability of ova.    

 The other troubling aspect to all of this from my personal perspective is that while many friends have successfully undergone in vitro and have lovely families and children, there is the issue of adoption.  That was our initial choice, which we then temporarily abandoned in pursuit of the fertility dream after a number of our friends succeeded, and which we ultimately returned to after our fertility efforts came to naught.  Had we succeeded with the fertility efforts, we probably would not have come to know the two exceptional little kids that run around our house and brighten our lives, and we cannot imagine that we would have done better were those children the product of our own genes.  Having said this, though, I cannot deny the imposing desire of seeing my own genes running out in the world in my children, but I also cannot deny the profound sense of ease that came into both my wife and I when we returned to our original choice of adoption.  A multitude of anxieties simply lifted away. 

And, of course, adoption is not cheap either.
What I would thus favor is some extension of tax breaks or vouchers for adoption that are means tested, and for those with limited financial access who have infertility issues not associated solely with age that there be some limited form of mandatory coverage.   

Finally, I close on what might be the positive side of this law: my astute wife offered the perspective that this law (and the similar ones on the books in eleven other states) might help lower the costs of treatment by the insurance companies wrangling with doctors on costs.  If so, that would be a good thing.  ( I am not convinced, however.  The director of the Yale fertility clinic was interviewed and he said he considered the age limit a policy tragedy.  Call me cynical, but the fact that his potential market was considerably reduced by the age limit did not go unnoticed.)

 


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I have a feeling you are going to get creamed on this!!  It is ironic to read this because in 2 hours I have a job interview at an invitro fertilization center.  I also have three wonderful adopted children (two of whom are twins, now 16 years old!)  I did a year of fertilitry treatment in my late 30's, and then opted for adoption (in vitro never appealed to me as an option).  An aside:  Our first adoption cost $2,000, and the second (the two-fer) was $5,000; so, not all adoptions have to be expensive. 

The decisions we make about medical resources allocation is a dicey one.  At the moment it is pretty much in the hands of the for-profit insurance carriers.  I personally think this is not a good way to go, just as I don't think our public health should be managed at flu shot clinics at grocery stores, but that is another stream.

I believe that the decisions about who receives a particular therapy and who does not should come down to one main question:  Who can benefit from it?

Just as a previously healthy 20 year old with severe pneumonia is more likely to recover than a 90 year old with the same bacteriologic infection, predictions can be made for a broad range of medical conditions.  While both of the above-mentioned patients should receive antibiotics and respiratory therapy, if they both also were candidates for lung transplant, which one would be most likely to benefit by it?  Not who would be most worthy, not who would be most likely to be able to pay for it, not who would die sooner if not given this chance?  No, which hypothetical patient would actually benefit (get well and go on with life) from this therapy -- is the question that we should be asking when resources are limited.

In the case of infertility treatments, the limitation of resources here is strictly financial.  After all, the complaint is that the insurance won't cover it after the age of 40.  As you have said, the older a woman is, the older her ova are, and the less likely the couple is to be successful.  It seems to me that, because the best statistical models all have outlyers, another option would be to provide a limited number of rounds of treatment based on age, cause of infertility, etc. 

Take away all the judgemental arguments, and give the opportunity to couples, but within reasonable limits, and let the science of prediction remove the subjectivity of these decisions.That is my two-cents worth!!  Wish me luck -- I want this job!

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Worse than creamed, apparently, ignored.  Good luck on the fertility job.  I don't bemoan fertility treatments at all (it worked wonders for our friends), just question the public policy wisdom of blanket availability that is not suitably means tested and age limited.

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I agree with your points, and you are at the top of my "Recommended Reader Blogs" list, so maybe the people who have the most interest in this are at work. 

ps--I'm pretty sure I got the job.  Thanks

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