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In an interesting move, a panel of health care experts recommended that the province of Ontario, Canada consider covering in-vitro fertilization as part of their government provided health care plan. The panel thinks this will save as much as $400-500 million per year on health care spending.
So how does adding to the treatments covered save money? Simple. The panel says it will cut down on those pesky multiple births. At the moment, a couple has to pay for their own IVF, but the state plan covers the babies once their born. Multiples are much more likely to be born early or low weight, and generally require more health care resources at birth than a singleton.
The panel feels that couples paying for their own IVF want to transfer extra embryos in hopes of at least one successful birth, and this practice results in a lot more multiple births when multiple embryos are successfully carried to term. The thinking is that if couples don't have to pay for the treatment themselves, they will be a lot more willing to transfer a single embryo. It isn't clear how their savings estimates were done, but it is a well studied phenomenon that use of fertility treatments goes way up if people aren't paying out of pocket. Currently the multiple birth rate for couples who use fertility treatments in Ontario is about 30% and under the plan clinics who had a multiple birth rate higher than 10% would be penalized.
There are quite a few thorny issues related to this policy. Would the government then be mandating IVF instead of other methods such as IUI and drugs to stimulate egg production? These types of treatments give very little control over how many embryos develop since part of the process is to encourage as many eggs as possible. The Gosselins, America's most famous family of multiples, reportedly didn't use IVF and they ended up with sextuplets. If the whole idea is to decrease the instances of multiple births, then it would be logical to restrict choices and force couples to use IVF despite the more invasive nature and the higher loss of viable embryos. While IVF has its advantages, it needs to be a decision made by each individual couple and their doctor, rather than dictated by what's best for society as a whole.
A policy like this might also affect a couple's choices on when to start a family. Couples can delay having children longer with the idea that they have a safety net in the form of free fertility treatments if they wait too long. This is already becoming a trend, and government sponsored IVF would accelerate it.
It also isn't clear whether private fertility clinics would still be operating. If taxpayer funded fertility treatment drives them out of business, then public policy is what determines who has access to the treatments. That's just a single election induced regime change away from preventing people from having children because they're poor, or they're not sufficiently educated, or for any number of other reasons. Reviewing some online comments can give an idea of just what some people are willing to inflict on others. One comment suggests that rather than have taxpayers pay for IVF to cut down on multiple births, the government just fine the clinics for any multiple births which resulted from their procedures. (And that policy is just one phone call to a health care industry lobbyist from lots of new mothers paying a fine for having twins.) Another comment suggested a psychological screening process (for reasons unstated) and that anyone who complained 'has something to hide'.
Obviously taxpayer funded IVF isn't something on the horizon here in the U.S., but some states do require insurance companies to cover it. West Virgina was the first back in 1977, and today fifteen states mandate some sort of insurance coverage for fertility treatments (Tennessee is not one of them). Since health insurance is handled by private companies in the US it doesn't have quite the potential for government intervention. Some countries do cover IVF treatments as part of their national health care system and it obviously hasn't resulted in the end of the world, but the consequences of government involvement in this type of decision do need to be considered very carefully.
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