Insurance.

Help!

Bhaji, after a run of what I like to call ‘bleeding civilised’ nights in that I got to stay in MY bed ALONE and Bhaji slept in HER bed and with only one four am hours of dark and ungodly wake up, decided last night was the night to mix things up a bit.

Internet, last night I was awake on the hour and for most of every hour starting from one forty five in the morning. There’s ungodly and there’s positively bloody heathen. Again I can only observe that it is hard to sleep when your arm is going numb and somebody is sucking on your chest at random intervals and that bit where Miss Nightshift startled me to full wakefulness at seven am by loudly shitting through her nappy, down both legs and up her back and ONTO MY SHEETS (again) was really just totally unnecessary Parent Torture Bonus Point scoring.

In other words, I am clutching my fourth coffee for the day, I am duly urinating like a big, black horsey, I have a mild tremor and I can’t really hold a train of thought for more than about half a sentence. What?

See.

So, unusually and on variation from form, I am going to ask YOU to tell ME about something political. Mostly because I think LS is being a hard arsed  raving nutter who should have a little more sympathy for people in the same reproductive boat as ourselves.

The tax man tells me that my medical expenses were twenty four thousand dollars in the Year Of Nightshift Conception. I expect the twins were little better three years back, ergo we, in a nation of snuggly ‘universal’ health coverage probably spent the best part of fifty kay generating three children.

I mean, seven kinds of holy crap, but ouch. Still, it could have been much more expensive if we’d lived elsewhere in the world. I’m factoring in six clomid cycles, three IVF stims and eight or nine or whatever it was embryo transfers, premature twins and a term singleton plus a reproductive partridge in a pear tree.

At over fifteen thousand dollars per child the little buggers really should be making my breakfast and ironing my work blouses because when you add THAT figure to my not inconsiderable study debts I am going to be able to retire comfortably some time in about the next century.

This is the post where I ask you if I’m mental or LS is, and yes, I am asking the Internet to award points on a political discussion.

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One of the things about living in the land of universal healthcare is that while we all justifiably enough bleat that it is big, unwieldy, inefficient and sloooooooow, at least there is some kind of IVF cover. Sure, the big clinics gouge a fairly healthy chunk more than the rebate paid and the rebate for reproductive things is capped lower than the rebate for new hips because babies are a lifestyle choice (insert your own opinion about this move here) after all, but at least there is coverage. A frozen transfer is about 1-2 k out of pocket, depending on your luck.

That’s not so bad.

We have significantly more elective single embryo transfers (eSET) than multiple ones these days because IVF is  relatively affordable. eSET is the norm at many clinics. Correct me if I’m wrong here, but the flavour around the IF blogosphere suggests you US-ian types pay ungodly amounts of money and unsurprisingly tend towards transferring scary-mucho amounts of embryos and just sucking up the risk a bit.

Over time and anecdotally I’ve lost count of the number of times I’ve read of young women with a high risk of multiple pregnancy transferring three or above embryos. Two seems to be the absolute minimum.

Not to horrify, but even twin pregnancies have a not-so-comfortable rate of Bad Things. Triplets are much scarier.

Locally, because eSET is common, the twin pregnancy rate from ART is now much lower than in times past. This has had a knock-on effect of fewer costly NICU admissions for premature twins i.e. the policy of at least partially funding IVF ultimately SAVES money, due to the  reduction in NICU bed demand.

That’s actually been proven in real dollar terms.

LS thinks that the solution for the US problem of a very high multiple birth rate and prematurity cost related to expensive ART is to refuse insurance coverage for NICU admissions from deliberate multiple embryo transfers.

I guess it’s one strategy, but personally I don’t think it’s got legs.

It’s rather harsh. What one of us when desperate for success and financially pressured as most couples on the ART-merry-go-round are really wouldn’t ever  transfer multiple embryos even with such a policy? I’m betting those ending up with twins and above would then just hope like crazy their twins would be the thirty eight week take home type. After all, fifty percent of twins are born at term,  it’s a coinflip statistic.

The way I see things, all that this sort of policy would generate is that the ten percent of twins and more of higher order multiples who are severely preterm, plus a big chunk of the moderately preterm would still be in the NICU, anyway, and in about the same numbers as before.

 The only difference is the debt punishment  to the parents for their conception and birth just became unmanageably high.

So why exactly don’t insurance companies cover IVF more over your North American way? Evidence here shows that doing so with eSET would probably not only save money, but heartache and bad outcomes as well.

I think LS is wrong. Very wrong. I also think insurance in the US is a bit screwey. Thoughts?

G