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Should the government pay for IVF?

September 10, 2011

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.

Jim Thornton

2 Comments leave one →
  1. September 15, 2011 4:44 pm

    When growing up, I had two ‘aunties’ who were childless and spent much time with them. Friends of my parents who, for whatever reason, certainly not wealth and age, were infertile.
    I am sure that this lack of children was a profound sadness to them.
    BUT, can we really have it all and should we be led to believe we can? We refuse cancer sufferers the latest most expensive drugs and they too could continue to work and pay taxes and have children who would.
    So why can’t we say, this is a sad situation, we feel for you, but it is not life threatening, move on?
    As long as there are unwanted babies in the world is it right to create more by chemical means?
    One of my friends was the first biological child of her parents, they had believed themselves unable to have children and adopted a son and once that pressure was off, lo and behold Gwyneth was conceived.
    By refusing to ever give up, people become caught up in ever increasing expense and emotional trauma, which I am convinced must be far worse than that of my ‘aunties’ who gradually learned they would not have children and gradually accepted it and who lived their lives regardless.
    I have told my children that the couple is important, their spouse or (oh hated word) ‘partner’ is the one to concentrate on and if that person is not enough, then they should not be with them. Having children is one of life’s lotteries and should be viewed as a possible bonus, not a right, because it is not a right.
    I had problems conceiving and told my husband that I would have one procedure, whatever the specialist decided that should be, and if that didn’t work, then that would be that, we would leave things to nature, I absolutely refused to get on a roundabout of ever more intrusive and expensive procedures to force my body to re-produce. You may say I would have changed my mind and kept trying, but I don’t think so. I don’t think childlessness is the worst thing to happen, it is a sad thing of course, but is it the end? No. And this is proved by ever more people choosing to be childless nowadays.
    The argument that children created will grow up and pay taxes is not necessarily credible, we don’t have jobs for the kids who are here already. Or maybe the argument works because most childless couples who use the system are middle aged and middle class? What of the childless couple on the dole, should they get free treatment to help them bring up another maybe non tax payer?
    We cannot have it all and we should not be encouraged to believe we can.

  2. September 26, 2012 11:33 pm

    Danny Hay, my opponent, writes – “I thought you would win as well. My argument was a heart-string tugger and had little substance really. The sort of case a junior career politician may have constructed to advance himself rather than his cause. I was elated that the audience didn’t rip it apart as an obvious piece of flim-flam. I was also concerned that you might have launched a similar broadside on the tragedy of diverting monies from more noble causes; the ‘kidney-machine gambit’. Sometimes you skate on thin ice but still get to the other bank. One thing made me laugh on the day and that was my fake RCOG report with intro by Sam Cameron and Sarah Brown. Jaya told me afterwards that he had made a note of “BABIES FOR BRITAIN” as he wanted to look it up. That was until my last slide with “counterfeit” stamped over the cover. Politics is such fun!

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