Should Medical Insurance Carriers Be Required To Cover Infertiltility Treatments?

Great Debates
1

I just came down to the office to confirm what I just heard upstairs. Word at the bar is that one of our congressmen, Anthony Weiner, is reintroducing his federal bill which will require medical insurance carriers to provide coverage for infertility.

My business partner, who spent a fortune trying to get his wife pregnant exclaimed, “Well, I guess I’m still a year late & a sperm short.”

My reaction was one of surprise.
"Do you think people would support such a law? Where does the something for nothing mentality end?

Upon googling and searching the SDMB for mentions of the bill (H.R. 2706 & 2774) I learned a couple of things:

  1. There’s a fairly large advocacy movement in this country to have private insurance companies pick up the tab for infertility treatments

  2. Some States already require Infertility treatments be covered.

  3. The oxymoron: infertility is heridary

  4. According to a sketchy 1999 Poll by Bertarelli: “Most Americans Believe Health Coverage Should Include Infertility Treatment”

I’m sorry, I have several close friends who fought the expensive infertility battle (FTR: 2 “won” / 2 “lost” and adopted) but:

A. I don’t see why or where this should become another shared burden placed on society as a whole.

B. Where does the line (both financial & personal) get drawn?
– Will the mandated coverage come with a fair cap?
– What if the infertility is caused by drug abuse or an STD?
– What if the infertile couple isn’t financially or mentally capable of raising a child? Or, God forbid - Ugly? (kidding)
– The questions could go on for hours: adoption, cloning, frozen embryos, etc. etc.

I know I’m coming off insensitive. Even though I know (second hand) the frustrations and burdens placed on infertile couples, I just don’t see mandated coverage as being fair or equitable. I also know first hand the joy and elation that comes with having a child. I just don’t want to see people who are barely getting by financially being forced to subsidize infertility treatments for others.

I’m sure there are 100’s of conditions where coverage is mandated that would serve as both reasoned metaphors & compassionate arguments that would lend support such a law’s passage: but that still doesn’t make it palletable to me.

So what say you?
More feel good mandates coming down from on high?
or
Compassionate legislation that provides a societal helping hand to the less fortunate?

2

Who says it’s a burden placed on society as a whole? The difference will be made up in insurance premiums paid by the policyholders. It’s a treatment for a disorder. How is it different from the coverage of other chronic disorders? Insurance probably pays for treatment of “erectile dysfunction,” which is not any more life-threatening than infertility.

3

And policy holders, and those who directly and indirectly pay for those policies aren’t members of society?

Wow, calm down. Infertility is life threatening? I don’t know if Viagra coverage is mandated anywhere and I’m too lazy to look. That being said, if I was forced to choose: Baby or Boner, Boner or Baby…Hmmm - I’ll pick wood.

4

Note that they are making this manditory. To me, this means that all carriers would have to provide this coverage. In that case, all people with insurance would pay for the coverage. So the only way I can avoid paying for someone else to fix their infertility problems is to not get health insurance. I don’t find that to be a viable alternative.
btw, some insurance companies do cover erectile disfunction, which imho is a crock as well.

5

Why not just require insurance companies to have, say, an Infertility Rider that you can purchase if you want to? That way if you want it, it’s available to you, and if you don’t want/need it, you don’t have to pay for it.

6

Here’s a thought, GET RID OF THE INSURANCE INDUSTRY! That’s right, ladies and gentelmen, get rid of it. And with it, Medicare, Medicade and ALL GOVERNMENT WELFARE PROGRAMS!

You see, it doesn’t really matter if invertility is life threatening, or if ED is more important than babies (although it would be difficult if a guy was impotent and a woman was barren to make a baby at all…I guess that’s what adoption agencies are for!) The fact of the matter is taxpayers and insurance companies are paying for your medical services. Why? Because you can’t afford to. Why can’t you? Because doctors charge exorbinant (SIC) amounts for treatment. Why do they? Becuase YOU’VE GOT $200,000 IN MEDICAL COVERAGE THROUGH YOUR INSURER!

When government subsidizes ANYTHING, including healthcare, prices go up. There is no incentive to keep prices down because either the government or a for-profit insurer will pay the cost. Look at it from a cost-analysis standpoint. Doctor A provides Patient A with Treatment A at $10.00. NOW! Doctor B provides Patient A with Treatment B, a ‘generic’ treatment for what ails Patient A, for $5.00. Treatment B is equally effective. Now, YOU are PATIENT A. YOU MUST PAY OUT OF POCKET. Which would you choose? Of course, you’d go with the less expensive of the two. It’s just common sense. NOW! Say you’ve got insurance which pays upto 80% of your treatment costs, with the remainder being in the form of a co-pay or deductable, but you must get only ‘brand name’ treatments. Now, you only pay $2.00 for Doctor A’s treatment, where as you’d still have to pay $5 for Doc B’s. Sooo…knowing that you could pay $10 anyway, but that your insurance will cover 80% of your cost, Doctor A JACKS UP THE PRICE TO $50, knowing insurance and/or government will pick up the 80% (EG, $40) and leaves you with a bill for $10. Customers complain to their insurance providers, who then provide ‘generic’ coverage. Now, insurance provides 75% coverage for Treatment B. Doc B charges $5.00, so it only costs Patient A $1.25. Patient A is happy…so, Doc B wises up and decides to cash in, bringing his charged price up to $20 knowing you’d be able to pay the $5 anyway, and sticking the rest to your insurance company. THEY then complain and jack up your rate. Prices get higher, and then GOVERNMENT steps in and in a classic show of stupidity, ‘cap’ prices and benifits. So instead of simply letting Doc C step in with an even CHEAPER and EQUALLY EFFECTIVE (remember the FDA here!) Treatment C, everything remains fucked up.

If government and private insurers went away, costs would have to fall because there would be no way for patients to make up the shortfall. Most hospitals are for-profit, and as such, would do their best to turn a buck. If patients stop going to them because it’s too expensive, then they’d have to lower prices or go out of business.

I mean, my god, is it that hard?

7

Having headed an underwriting operation for workers compensation, I can offer some observattions:[ul][]Covering infertility treatments on a group policy would work a lot better than on an individual policy. E.g., employee health coverage is on a group basis. A few claims for infertility wouldn’t destroy the program. However, those who buy individual health coverage might be able to take advantage if they knew they had an infertility problem. They could buy the coverage knowing that they would collect more in benefits than their premiums.[]Infertility is a medical problem with large costs, so it fits the definition of health insurance.[]TANSTAAFL. If infertility coverage is mandated on employee health insurance, it will drive up the premium. The additional premium may be passed on to employees. Or, the employer might pay it, but reduce salaries a bit. Or, the employer might become less competitive than foreign competition and shut down. Or, the employer might drop health coverage altogether.[]In general it’s a bad idea to mandate specific coverage, because unforeseen consequences may ensue. Mandates reduce the flexibility to deal with consequences. ISTM that the state ought to mandate coverage only when it’s very clearly necessary and appropriate. I don’t think infertility treatment meets this standard. However, if some employers voluntarily included infertility treatment in their medical plan, I’d support that.[/ul]

8

SnoopyFan, there’s a problem called “adverse selection.” If insurance is set up so that everyone who buys it will file a claims, then there’s no pool of customers to spread the cost among. So, the premium would have to be as high as the average claim amount (plus expenses.) This would be unaffordable and pointless. .

9

Amen, Stemba! I’ve been beating that drum for years. It is simple supply and demand; when you artificially increase the supply of dollars available for medical treatment, inflation invariably follows. Americans pay far more in premiums that the medicine is worth. The insurance industry is a barren parasite that has insinuated itself between the patient and the doctor; it adds no value, yet consumes dwindling resources. Still, America chooses to believe the fear mongering about financial ruin and physical decay if we stop paying the extortion wrung out of us by the insurance leeches. It is a pyramid scheme that will eventually come crashing down when medical care becomes the single greatest expense dragging down the economy, and the patient will simply not survive the treatment.

10

Stemba and Fear Itself,

Cosmetic surgery is an area where there is almost no insurance coverage offered. Yet, cosmetic surgery prices are extremely high. Using your reasoning, shouldn’t cosmetic surgery prices be falling?

11

No, because the demand for cosmetic surgery is being fed by vain, narcissistic culture whores with more money than sense who are convinced their lives are better with preternaturally firm breasts or faces immmobilized with botox grins. In short, it is entirely elective, with no more relevance to medical inflation than automotive bodywork.

12

I still am not understanding this. Uninsured cosmetic surgery leads to high prices even though people don’t need it, so they can pass on it if the price is too high.

While necessary medical treatments would lead to lower prices without insurance even though people would not be able to pass on treatment if the price is too high.

Perhaps this is a hijack of this thread, but I’m still not understanding how something which you do not have an option of buying follows supply-demand rules while something which you do have an option of buying doesn’t.

13

BrightNShiny, a very good point, but with that statement, you must also look exactly what you’re asking. While I was speaking more in terms of actual medical treatments, the chemotherapies and open heart surgeries that ANYONE and EVERYONE can look forward to in their lives (or the lives of a loved one,) you’re asking about something which is generally medically unnecessary. According to the American Academy of Cosmetic Surgery, some 82% of cosmetic surgeries are elective and medically unnecessary, such as breast enhancements and microderm abrasions. Of those 82%, how many do you think really (I mean REALLY) need those things, like silicon boobs or hair plugs? Um…none. They’re medically unnecessary. These folks can afford to pay the doctor’s fees, and do so out of pocket.

Now look at the other 18%, the medically necessary. I’d wager dollars to donuts that if you looked at your insurance, there is coverage for reconstructive surgeries. If you NEED a new face, the insurance company will provide it to you.

Now if you were to cut out the insurance industry, those who were buying tits would still do so as they wern’t getting assistance from their insurance providers, where as Bob who needs a new face after his car accident can go to my aformentioned Doc B and get a cheaper deal because he’s in competition with Doc A (who charges a higher price.)

14

The one hole in STEMBA’S paragraph is the medical malpractice insurance (again with the effin insurance leeches). Using STEMBA’S own example…

Doctor A treats patient B with medication C, Patient B goes blind in one eye and can’t use his left pinky. Doctor A gets sued for not knowing every single solitary possible side effect of this direct marketed drug. Doctor A gets sued for 10 mil. Doctor A settles for 3 mil at the behest of her insurance, which has, because of this settlement, jacked her premium up to nearly 225,000 per year (for insurance, yes, the numbers are close, though not really for general practitioners) Doctor A only makes, after her overhead and expenses, 265,000 a year. Doctor A, with nearly half a million dollars in student loans, jacks up HER prices to continue to make medicine profitable. This is just another thing that we need, as a society, to focus on. The feeling of righteous indignation that wells up within us when some one else (Goddess forbid it) makes a bloody mistake.

There must be reform in this arena, there simply must. If we are to continue for any length of time, we must re-examine the ins and outs of our own reality regarding our supposed entitlement subsequent to an honest mistake.

15

I had Lasek surgery a few years ago and went from blind-as-a-bat to nearly normal vision. This is a type of surgery that isn’t covered by insurance, and the prices are plummeting.

16

Getting rid of the insurance industry is a most preposterous idea:

a) If you cut out the insurance industry, you cut out doctors. No doctors will practice medicine for basement prices. There are some industries in which a premium will be charged regardless of the supply curve.

b) If you cut out the insurance industry, you have also cut out med-mal insurance. So now you must cut out all lawsuits against doctors all together. You must also make all medical schools free, so hat doctors won’t have to pay $125,000 in student loans on a $30,000 salary.

c) Stepping away from medicine, if you cut out insurance, you must cut out tort law all together. If Joe Blow steps into a small business owner’s store, slips, and sues, that business owner is out of business. Supply and demand doesn’t mean jack to that storeowner or the attorney who is suing him.

17

Cost to raise a baby 1 year: ~$15,000+(may be higher)
Infertility treatments: $6,000 - $10,000/cycle(may require multiple cycles)

If you can’t afford to save up for a couple of years to get the treatments you probably can’t afford a baby. I’ll leave it to others to argue whether everyone should have babies regardless of finances.

18

No, the point I was making was that neither condition is life-threatening. However, from what I’ve heard, treatment of ED is frequently covered by health insurance. <hijack> In fact, I’ve heard of cases where insurance pays for ED but not for birth control. Not that there’s a male conspiracy or anything. </hijack>

19

Just FYI:

We did this debate not too long ago. I think the consensus was that since there are so many more important things that aren’t covered by insurance, having it cover infertility treatment is an expensive and unnecessary luxury.

http://boards.straightdope.com/sdmb/showthread.php?s=&threadid=133689&highlight=insurance

20

Thanks for the link, a good read. (Sorry! I only searched insurance / infertility on last 6 months)

David B, Gaudere or MEBuckner, please close at your convenience