Tuesday
Sep212010
Lifestyle choices and healthcare access (IVF and more...)
Tuesday, September 21, 2010
I don't like to floss. I never have liked flossing. I've gotten a number of holes in my teeth over the years, some of which may be the result of lack of flossing. Each time, the dentist reminds me to floss. But never does he suggest that perhaps the insurance company wouldn't pay for my fillings because I didn't floss. I have now gotten better about flossing, but not because anyone threatened to take away my access to dental care if I didn't floss. No, it is because the last filling I received was so uncomfortable that I now have more motivation to floss. Is it selfish of me to have been raising everyone else's insurance premiums over the years because I didn't floss as often as I should have? Maybe.
I know people who smoke. They started when they were teenagers. They probably knew something about the risks, but wanted to be cool, so they tried it anyway. Then they got hooked and they couldn't stop. Or could they have? Maybe if they tried harder they could have kicked the habit. I think maybe they could have. But who am I as a long-time non-flosser to suggest that they should have tried harder? I'm raising their healthcare costs by not flossing and they are raising my healthcare costs with their asthma drugs or their lung cancer treatments. Not to mention the people who eat too much fast food, the people who don't use appropriate safety equipment during sporting activities, the people who don't drink enough water, the people who can't put down the salt shaker, the people who lay around in the sun all day, and the people who don't exercise. All of them are raising my healthcare costs and your healthcare costs.
There is a role for public health in encouraging good health. There is a role for public health in educating people about the consequences of the lifestyle decisions that they make. But, in a universal healthcare system, we cannot be saying "too bad, so sad, you made the wrong choice and now your healthcare costs will not be covered."
So when I was listening to Ontario Today (on CBC Radio) this afternoon, I started to get a bit twitchy. The Quebec government recently announced that it will pay for in vitro fertilization (IVF) treatment for couples in the province of Quebec. It is doing this not only to ensure equal access to the opportunity to have a baby, but also because it hopes making the treatment available will raise the birth rate, which benefits the province financially and culturally. On Ontario Today, they were discussing whether Ontario should also be funding IVF. Of course, there were callers and "experts" saying that women shouldn't be waiting so long to have a baby. That their chances of conceiving are lower if they wait until after they are 35 years old and that the government and taxpayers should not be footing the bill for their lifestyle choices (never mind whether they hadn't met the right person earlier or wanted to be in a stable situation before having kids). This, I think is ridiculous.
Giving some women access to IVF because they are young enough or deserving enough and then denying access to other because they put their career first (wanting to be stable financially and professionally) or their relationship first (wanting to ensure their relationship was strong and stable enough to withstand adding kids), is like telling someone with lung cancer that they can only have treatment if they got it from secondhand smoke exposure, but that it won't be covered if they are a smoker. There are a myriad of reasons why people don't make optimal lifestyle choices all of the time and it is not the place of policy makers to sit in judgment of someone's choice of when to procreate anymore than it is their place to sit in judgment of people who light up.
I'm willing to bet that for every couple who needs access to IVF due to "lifestyle choices" there are at least 20 others having bypass surgery, lung cancer treatment, dental procedures and expensive drug treatments that no one questions their right of access to. Plus all of those other procedures only serve to prolong or improve that person's life, unlike IVF which brings another future taxpayer into the world.
Image credit: Einahpets32 on flickr
I know people who smoke. They started when they were teenagers. They probably knew something about the risks, but wanted to be cool, so they tried it anyway. Then they got hooked and they couldn't stop. Or could they have? Maybe if they tried harder they could have kicked the habit. I think maybe they could have. But who am I as a long-time non-flosser to suggest that they should have tried harder? I'm raising their healthcare costs by not flossing and they are raising my healthcare costs with their asthma drugs or their lung cancer treatments. Not to mention the people who eat too much fast food, the people who don't use appropriate safety equipment during sporting activities, the people who don't drink enough water, the people who can't put down the salt shaker, the people who lay around in the sun all day, and the people who don't exercise. All of them are raising my healthcare costs and your healthcare costs.
There is a role for public health in encouraging good health. There is a role for public health in educating people about the consequences of the lifestyle decisions that they make. But, in a universal healthcare system, we cannot be saying "too bad, so sad, you made the wrong choice and now your healthcare costs will not be covered."
So when I was listening to Ontario Today (on CBC Radio) this afternoon, I started to get a bit twitchy. The Quebec government recently announced that it will pay for in vitro fertilization (IVF) treatment for couples in the province of Quebec. It is doing this not only to ensure equal access to the opportunity to have a baby, but also because it hopes making the treatment available will raise the birth rate, which benefits the province financially and culturally. On Ontario Today, they were discussing whether Ontario should also be funding IVF. Of course, there were callers and "experts" saying that women shouldn't be waiting so long to have a baby. That their chances of conceiving are lower if they wait until after they are 35 years old and that the government and taxpayers should not be footing the bill for their lifestyle choices (never mind whether they hadn't met the right person earlier or wanted to be in a stable situation before having kids). This, I think is ridiculous.Giving some women access to IVF because they are young enough or deserving enough and then denying access to other because they put their career first (wanting to be stable financially and professionally) or their relationship first (wanting to ensure their relationship was strong and stable enough to withstand adding kids), is like telling someone with lung cancer that they can only have treatment if they got it from secondhand smoke exposure, but that it won't be covered if they are a smoker. There are a myriad of reasons why people don't make optimal lifestyle choices all of the time and it is not the place of policy makers to sit in judgment of someone's choice of when to procreate anymore than it is their place to sit in judgment of people who light up.
I'm willing to bet that for every couple who needs access to IVF due to "lifestyle choices" there are at least 20 others having bypass surgery, lung cancer treatment, dental procedures and expensive drug treatments that no one questions their right of access to. Plus all of those other procedures only serve to prolong or improve that person's life, unlike IVF which brings another future taxpayer into the world.
Image credit: Einahpets32 on flickr
Reader Comments (59)
Not especially. Though it is my sexist opinion that men care less about the whole thing than women do. Woman drives the train on fertility treatment. You don't read anguished dudeblogs about low sperm count issues.
Anyway, why can't Quebec do what we do and import truckloads of immigrants to shore up its demographic stats? Surely the people in Arizona would be willing to work a deal with them.
Quebec does accept a lot of immigrants...but they want French-speaking ones. Not sure the immigrants in Arizona would fit the profile.
And if educated women do not reproduce, societies die. There is value to ensuring women are successfully reproducing. I have been alarmed at how many woman are having to turn to this procedure who are under 30. It is a last resort.
While think it should be handled responsibly, IVF is one rare part of health care that will pay back society. Unlike a dental filing or cancer treatment, a future productive citizen will become a lifelong tax payer.
Great topic!
Bigots.
J/K.
Seriously, though, after a generation of kids in school, Quebec could have French-speaking Hispanics for bargain prices.
This is a great point Mollygirl.
Stacey M:
When considering quality of life, I think we need to consider people's physical AND mental well-being. I don't think that people should have to just "deal with the cards that they have been dealt." I think that the medical system can and should step in when it is possible to improve someone's quality of life. There are many elective procedures that improve people's quality of life by helping them to have their body function in the way that it should. I don't see why reproductive organs should be an exception to that rule.
To answer your question about how many children women should be able to conceive via IVF, I don't think there should be a limit. Until we are at a point where we are worrying about overpopulation due to too many babies being born, I think that the economic value of those babies will always outweigh the cost of conceiving them, so I'm not concerned. I think there should perhaps be limits on how many rounds of IVF are tried if it is NOT working, but if it IS working, then I don't think limits should be imposed.
As for your husband/boyfriend question, I don't think that tax money will help, but showing empathy for others might.
This kind of attitude is exactly why mental health is brushed under the rug and is still a taboo subject in our society. Mental health is just as important as physical health. You have no idea what kind of mental anguish women (and men!) deal with when they are unable to conceive.
And of course, let's not forget that for many couples infertility isn't a "choice". Being on an NHS waiting list for 4 years* was not my "choice". Trying for 8 1/2 years was not my "choice".
Of the infertiles I know, almost all of the "older" ones waited until they, shocker, found the one they wanted to marry and have children with instead of just randomly trying to procreate with any Tom, Dick, or Harry. Imagine that.
Okay, I'm losing sanity points just rehashing what I've been through, so I'm going to stop ranting here.
* and then my doctor called me at work - at work! - tell me I'd been kicked off the list for being too fat because the rules had changed. Hmm, yeah. That was a great day. Shorter: we moved to the US, paid for IVF and got pregnant on the very first (much fatter) time, shortly after my 39th birthday. The Chieftain is 2 1/2 and the delight of our lives.
Bravo! I couldn't agree more.