Health & Science
Could Health Care Reform Prevent Another Octomom?
How Obama’s plan could affect genetic testing and fertility treatment.
The various health care bills in front of Congress don’t specify which procedures insurance plans must provide upon passage of the legislation. That will probably be up to the Department of Health and Human Services, after President Obama signs the final bill into law. But what’s certain is that for the first time, insurers will be regulated. The result will be a basic package of care all insurers must provide.
Advocates on both sides are up in arms over whether abortion will be covered in that basic plan. But assisted reproduction, a field that has grown exponentially over the past decade, has so far been ignored. That’s shortsighted. Infertility treatments and prenatal genetic testing are becoming some of the most expensive and ethically controversial parts of our health care system. As the Octomom debacle demonstrated, the field is crying out for regulation. Done right, President Obama’s universal-health-care push could accomplish that. But first, policymakers will have to mediate some uncomfortable debates between advocates for reproductive rights and disability rights.
As couples are increasingly able to overcome infertility, and then learn about the DNA of their fetuses, two major concerns are emerging that affect the health reform debate. First, patients who can’t afford to pay out of pocket don’t have the same access to infertility treatments and prenatal genetic testing as patients who can. In addition, there is evidence that regardless of whether patients have insurance or can pay, they aren’t receiving accurate information about the failure rates of prenatal genetic tests or about what life is like for people who have genetic diseases. That could be contributing both to more abortions and to a greater stigma associated with raising a disabled child.
The menu for assisted reproduction and prenatal testing grows longer each year. For about $1,000, doctors can now screen prenatally not only for Down syndrome but also for cystic fibrosis, Huntington’s Disease, hemophilia, and sickle cell anemia. Expensive new technology is coming down the pike that will offer parents the option of getting a definitive prenatal Down syndrome diagnosis as early as the first trimester, through a blood test that isolates fetal DNA from maternal DNA. And in the near future, it may be possible to identify, in utero, a gene for autism.
With preimplantation genetic diagnosis, or PGD—which costs up to $5,000 and is rarely covered by insurance—even an embryo conceived in a Petri dish via IVF (up to $15,000 out of pocket) can be tested for genetic abnormalities. Selected embryos can be implanted in the uterus, often two, three, or even more at a time.
Who should get each of these services and tests, and how much should patients pay? Which procedures should Obama’s health care plan require insurance plans to cover—state-of-the-art testing and treatment, or a more basic and modest package? And what about the expense posed by pregnancies with multiple fetuses, because of the high health risks for both moms and babies—who bears it?
It’s no wonder that American couples battling infertility often opt for the combination of PGD and multiple implantation, which they believe will increase their chances of giving birth to a healthy baby without the travails of additional rounds of IVF. But luxury fertility treatments open up a tricky debate about the rationing of care. Remember President Obama’s vow to “bend the cost curve” by tamping down on unnecessary medical procedures? Many experts see PGD and multiple implantations as prime culprits for unaffordable spending. Exhibit A through G, of course, is Octomom Nadya Suleman, whose doctor ignored professional guidelines by implanting six embryos, two of which split into twins, in her uterus. Also to blame is the trend of for-profit clinics advertising elective PGD to couples who want to choose their baby’s sex or even eye and hair color. “Clinics are in this totally out-of-pocket, for-profit environment,” says Susannah Baruch, a Washington-based lawyer and policy consultant specializing in reproductive genetics.
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Comments
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By: Martin | Wed, 09/23/2009 - 05:34
Everyone is entitled for a basic health care. That is one of the necessities that is ought to provide by the government to the people. According to recent findings, just over half of the $2 trillion of health care costs in the US each year is due to wasteful practices. The health care costs that are indicated to be wasteful are behavioral, clinical, and procedural – what that means is that behavioral patterns could be addressed by someone other than a doctor, clinics order unnecessary tests, and health insurance companies might be padding their bills. The biggest cause of people needing an extra cash advance for medical care is overtesting – unnecessary procedures so the physician can cover himself legally, or just gouge patients for cash. Doctors padding bills – no wonder health care costs drive people to needing a payday loans for a simple check up
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single blastocyst transfer
By: Meredyth | Mon, 09/21/2009 - 16:20
For what it's worth, there is at least one quite venerable reproductive endocrinologist in the USA that encourages single blastocyst transfer. He and the embryologist he works with have been on the cutting edge of this field for literally decades and have developed a protocol that is very successful. According to statistics posted on his website, for patients age 37 or younger, they have a 62.3% success rate for fresh SBT. The total success rate of this program -- including fresh and frozen single blastocyst transfers -- is 80.6%. You can view the information regarding this doctor's protocol, and a chart with these and other statistics (comparing the SBT protocol with success rates of multiple embryo transfers) here: http://www.friscoinfertility.com/single-embryo-transfer-frisco-tx/expect...
luxury fertility treatments?
By: _Nancy_ | Sun, 09/20/2009 - 08:03
Please. It shouldn't be a luxury to give birth to a child with a debilitating genetic abnormality. I hate the whole tone of this. Patients facing infertility are more than capable of making these decisions - implant one embryo? Maybe, it depends on the person. What works for one patient will not necessarily work for another. Regulation will be just another unwelcome barrier between patients and doctors making the best decisions for them. (Insurance is the other barrier.)
The truth is nobody is octomom but octomom. It's stupid and insulting to bring her into the argument.
Control disguised as access
By: vpostrel | Wed, 09/16/2009 - 17:31
This piece is a remarkably honest revelation of the mindset that seeks to use health-care reform, which is justified as expanding access, as a way to assert more uniformity and top-down control over (other) people's health care choices--stamping out innovation along the way. Rationing, in this view, isn't a bug. It's a thrilling feature.
try some facts
By: PG in CA | Wed, 09/16/2009 - 17:07
I should have known that the writer of this article had no idea what she was talking about as soon as she used Nadia Suleman as her Exhibit A. Anyone who has spent 5 minutes in infertility treatment will tell you that this woman and her irresponsible doctors were gross anomalies and not at all indicative of some pervasive problem in infertility treatment. FYI, Dana-- some women will NEVER get pregnant if the doctor transfers only one embryo per cycle. Those same women would go on to carry normal pregnancies to term if the doctor transferred two. And, by the way, the term is "transfer." Embryos are transferred, not implanted, by the doctor. Implantation is a process that (if you're lucky) takes place after transfer. That's the point at which you are pregnant. If you're going to write about these issues, at least get your terminology right.