Should the government pay for IVF?
I debated this with my colleague Danny Hay in front of our trainees yesterday. He spoke for government funding and I against. Here’s the gist of what I said, and what happened.
Fertility treatment fulfils none of the generally accepted criteria for state funding of healthcare. It is not a public good, something like a mosquito control programme in a malarial area, from which everyone benefits whether they pay or not, and which will only happen if funded collectively. Nor is it like an infectious disease, where we should subsidise treatment because curing one person benefits everyone they would have infected in future. Nor does state funding help the poor. Infertile couples are generally wealthy, having no children to pay for, so taxing everyone to pay for their treatment means taking money from poorer people to help richer ones. Finally, unlike diseases like heart attacks, cancer and broken bones, there is no emotional moral imperative, no “rule of rescue”, compelling us to treat infertility. There’s just no good reason for government funding.
And there are real benefits from private funding. Self-payers demand more efficient, higher quality services, and diverse funders respond more flexibly to the dilemmas of assisted reproduction. Overarching regulations would remain, but there would be no need to make centralised decisions about lesbians, single parents, or women over a certain age or body mass index.
I thought I couldn’t lose, so I allowed myself a little fun. I reminded the audience that many couples bore some responsibility because of their past behaviour – those with blocked tubes from unsafe sex, and those who had voluntarily delayed trying till late in life. This was dangerous ground. Most of the audience were young female doctors juggling the competing demands of partners and their jobs, with the biological imperative to not wait too long. They hated being reminded that the clock was ticking, so I rowed back a bit. What I said about responsibility was true, but I admitted it was a bad reason for not treating people. Responsibility for your problem is no reason for not getting NHS treatment. We treat smokers with lung cancer and injured mountain climbers for free, and so we should.
But it was all hopeless. I was up against Danny a polemical genius. He movingly reminded us of the tragedy of childlessness. He claimed that Samantha Cameron, Miriam Clegg and Bob Winston all support Government funding. He said it would only cost £1 billion a year, which would pay for itself as the children grew up and paid taxes – our colleague Bill Ledger, an infertility specialist, had told him that, so it must be true. He said government funding would lead to better research – really? And that trainees would learn more in NHS-funded units, because the consultants would leave them alone to do more of the procedures – true. At one point he even seemed to suggest that it was our patriotic duty to pay for IVF because the procedure had been invented in England. Oh why wasn’t I quick enough to remember that so was the machine gun!
Of course he won the day. And no-one should be the slightest bit surprised. Any group of specialists will always argue for state funding for their own field. Bakers want bread subsidy, butchers meat subsidy and arms manufacturers weapons subsidy. The world has always been thus.
It was a good day, and Danny deserved his win.