The Creation Conundrum

The Creation Conundrum July 8, 2013


Photo by Alexandra Sophie “Empty Nest”

Here’s the thing I don’t understand about the Affordable Care Act. If the government can force private employees to provide insurance that will pay for contraceptives, then why isn’t the reverse true – why doesn’t the Affordable Care Act force employers to provide insurance to pay for fertility treatments for those woman having trouble getting pregnant?

If the federal government can demand that an employer provide health insurance that covers the cost of abortions, then why can’t the federal government also mandate the provision of health care that allows couples longing for babies a chance at conceiving one?

Yes, I understand that there was a time when infertility treatment was considered experimental, a risk. But then again, there was a time when open-heart surgery was considered experimental but most insurance companies cover that now.

As far as I know there is no ceiling cap on how many abortions a woman can have. No limit to how many different forms of contraceptives a couple may access. So if employers – even those whose faith traditions are in direct conflict with the use of contraceptives or abortion – are forced to make provision according to the Affordable Care Act, then doesn’t it only seem equitable that the Affordable Care Act also make provision for couples in need of fertility treatment?

It’s not like infertility is a new problem. American fertility rates hit a historical low in the late 1800s. So, we have been struggling with a creation conundrum for well over a century.

Currently, according to the Center for Disease Control, the number of women with an impaired ability to get pregnant is 6.7 million. An estimated 1.5 million married woman have been unable to conceive even after a year of unprotected sex with their husbands. In other words, 20 percent of all couples looking to conceive in the US are having problems.

But if those couples want to do even the most basic of fertility procedures, they are looking at paying thousands of dollars out-of-pocket.

Does that make any sense?

Why are there no headlines about the infertile lobbying Congress for health care? Why is there no collective voice demanding that these discriminatory laws that favor fecund couples be changed?

Somebody please explain to me, why we Americans consider it noble to champion the prevention of a life, and the termination of a life, but not the creation of a life?

Could it be because infertility is just another one of those “female” issues that a mostly male Congress chooses to ignore?

I bet if it was the men who birthed the babies, the powers that be would have mandated better insurance coverage for infertility a long time ago.


Karen Spears Zacharias is author of the forthcoming Mother of Rain (Mercer University Press).

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  • tanyam

    Generally speaking, I agree with you. But I do recognize that an abortion costs $300-800, and in vitro costs, on average, $12,000 per treatment. I bet insurance companies are the important players here and they would fight this tooth and nail. Contraception and abortions end up SAVING them money, in vitro only leads to higher health care costs–not only for the treatment, but also for the subsequent maternity care.

    Remember, we are talking about what insurance companies have negotiated in our political realm — not what the government pays for outright. Because of the Hyde amendment, the federal government (Medicare, Medicaid) does not pay for abortion.

    The Affordable Care Act has as much to do with what the business of health care would allow as any philosophical intention. If you think it is wrong, you are up against the health care industry’s lobbyists.

    • This seems to me to be a women’s rights issue. If $$ amounts determined whether or not insurance paid for care, we’d do away with treatment for cancer, and heart issues.

      • jasmine999

        Cancer and heart disease are life threatening (to put it mildly). In vitro is elective. The decisions are economic, not philosophical. A civilized nation needs to cover cancer care. A civilized nation doesn’t need to cover an expensive, elective procedure.

        • True, but some of that cancer and heart disease is caused by lifestyle choices. Should we not pay for cancer treatments for those who smoke, because smoking is elective? When you start putting such values on medical care, then do only vegetarians deserve treatment for heart disease?

          • Pofarmer

            Rates are typically higher for smokers.

          • If they are paying out of pocket but not if they are covered by group insurance.

  • AFRoger

    The health care system–mainly costs, billing, insurance, overhead and liability insurance costs–is FUBAR. Not only beyond recognition but beyond repair, it seems. Tanyam points out the high average cost of in vitro treatment. Several days ago, I read about the skyrocketing costs of maternity care and delivery in hospitals. It has outpaced even the rise of college tuition–as insurers are certainly aware. Just today, I read about the chronic and growing shortages of life-saving drugs and pharamaceuticals and the aging, crumbling infrastructure for producing them here in USA. Result: blatant health care rationing because the therapeutics themselves are rationed–with dim prospects for improvement.
    It’s not only our highways, bridges and power grids that are collapsing. If Ms. Palin wants to come out of hiding in Alaska and use her fame and influence, there would be any number of de facto “death panels” for her to address. Real ones, not straw versions.
    We got the ACA because we as a nation refused to open our eyes to realistic choices that work better and cheaper elsewhere and have documented track records that we could have learned from and even improved upon. If only we had been willing to look and be informed. In the ACA, our political system delivered us an unwieldy product that in the best of worlds is likely unaffordable, uncaring and mostly an act. We got what we got bacuse of polarized politics and fear of the loss of campaign money. In thrall of that toxic mix, we made choices. Choices have consequences.
    All other issues aside, a primary root cause of high unemployment has been the prolonged rise in cost of health care and health insurance plans. I’ve seen it time and again in my places of past employment. The employee becomes the enemy, unfortunately. Part-time, outsource, offshore, or do it by computer. Do it any way but by hiring a body you can’t afford. And we wonder why we aren’t “creating” jobs.

    • But it’s not really a matter of not having money, is it, Roger? This country has the money. It is just that the economic chasm is growing wider & deeper than the Grand Canyon. It’s not that companies can’t produce the drugs. They just don’t get as much profit from it and greed is the motor that drives this Capitalistic system of ours. If you are rich you can have all the drugs and medical care you could possible seek. Look at the income generated by plastic surgery in this country.

      • AFRoger

        Karen: Right. There is enough money. That’s the odd part. We could provide health care to everyone, but do it more cheaply than we do now, and stop shooting ourselves in the foot at the same time. So why NOT? It’s more complex than greed, although greed certainly factors in. Fear and ideology are factors at least as large as greed.
        I know some dear folks who just lost their grown son, a man I mentored over 30 years ago. This couple worked hard all their lives. He was a former U.S. Marine and was mostly self-employed as a carpenter. She was a nurse practitioner. They were in good health, or so they thought, and she decided to retire two years before eligibility for Medicare. They planned to travel. Then she had the heart attack followed by a stroke. Her life was saved, but the medical bills took everything they had. They lost their house and had to declare bankruptcy. This would not have happened in Canada. Yet we think Canada’s system is unfair while ours is fair?
        Since my wife’s brain tumor in 2009, we’ve had four followup MRI’s. For just the out-of-pocket part not covered by insurance, she could fly to Japan and back and pay for the same test done on the same equipment there. So why in the USA is there this giant balloon of extra costs that we need insurance to cover?
        Well, for one thing, there’s the high cost of health insurance plans for hospital employees and doctors on top of their malpractice insurance….
        No other modern industrialized nation operates the health care system the way we do in the United States of America. None. We have defined health care as a privilege, not a right, nor even a basic human need. We have defined health care as a profit center, not a utility. So isn’t it ironic that in serving our “profit centers”, we are in fact bankrupting ourselves? We are sacrificing more than our poor. We are sacrificing our future. And I guess we think that’s fair.

  • Reproductive health care should be covered, period.

    As the previous two commenters detailed, this is primarily a business decision, not a philosophical decision. The ACA is an attempt to put a bandaid on the gunshot wound that is our current health care system. It’s better than doing nothing, but not much.

    • Agreed. It should be covered. But here’s the thing — I think the infertile are made to feel shamed, guilty, isolated, etc., that they suffer in silence for the most part, instead of rallying together to push for legislative change. This needs to change.

      • Pofarmer

        Where do you come up with shamed and guity? If that is the case then it is of there own doing. Let’s loom at this another way. There are 350 million or people in the U.S, with many unemployed and many only partially employed. Billions around the world live in slums and poverty. Does it REALLY make sense for others to pay for the cost to make someone fertile? Is there a shortage of humans somewhere?

        • You just made my point.

          • Pofarmer

            What point is that?

          • jesse

            I think the point was this.. Couples shouldn’t have insurance for reproduction b/c there is not a shortage of humans.

          • @Jesse: The financial burden of adoption isn’t any less than fertility treatments. Are you suggesting insurance ought to cover the cost of adoption for infertile couples? Because I’d be in favor of that. What I’m not in favor of is a mandated insurance that allows unfettered access to abortion and contraceptives while making no allowances for those suffering from infertility. That was the point @pofarmer.

          • Pofarmer

            How about insurance covers none of the above?

          • Evangeline Claire

            Why not respond to the people making good points – prevention of suffering, all these people poor (and with children), etc… that should be a priority. Sustaining the life we have now. I don’t see how that means we should pay for bringing more life in just because it also falls under the word “reproduction.” Contraceptives are nothing like creating life. They’re like anything else we do to help sustain life.

            If someone made a point that adoption /should be covered by insurance/, that’s interesting. I never thought of that. Maybe it should be partially covered at least, to again, help out people that are already alive.

          • Evangeline Claire

            ‘ I don’t see how that means we should pay for bringing more life in just because it also falls under the word “reproduction.” ‘

            I want to add to that: Especially since it’s not necessary to bring more life in to have a child.

  • Newp Ort

    My wife and I went through fertility treatment all the way up to in-vitro and it fucking sucked. Emotionally it’s like being dragged over gravel (not too far off physically for the woman). A lot of married couples divorce during or after due to the strain it puts on the relationship.

    It’s like the world’s biggest gamble. You struggle through and dump tons of cash in and if you’re lucky you get a new life and a family. Or you end up sadder, poorer and possibly wiser.

    (we didn’t have success, but we have been blessed with a wonderful adopted son. so obviously I am biased)

    None of this bears much on whether or not it should be covered by insurance, of course. I think it should. But I have a jaded eye towards the whole thing.

    Perhaps if its covered some kind of brief education and counseling could be required first. People would know better what they’re getting into. Also I think many doctors overrate the chances a couple has to actually conceive.

    • Yep. Exactly. Not only the physical and financial burden but the emotional one as well. Thank you for sharing your story. Thankful that you have a son to cherish.

  • Evangeline Claire

    I don’t see why preventing bad things from happening would make someone say “why don’t they also do the opposite.” Why would one mean one should do the other? Preventing pregnancies in certain cases is preventing bad things. On the other hand, bringing more children into the world is someone’s desire but it’s not prevention of anything bad and not /necessary./ Those couples can adopt.

    What about the sustaining of life that already exists?

    And as we both know, if they did that for people expecting children (sounds like a lot of moolah) rather than the opposite, you wouldn’t write an article about this.

    • Of course many times preventing pregnancy is simply a convenience for the self-absorbed. Someone’s desire for a life unfettered by responsibility. Either the responsibility of using birth control or a child as a result of that selfishness.

      Those couples can adopt.

      Statements like that are the very reason infertile couples bear their sufferings in silence.

      Because people who have never know the longing for a child, and the trauma of infertility say flippant off-the-cuff remarks like you just did. As if adopting a child is as easy as running out to the store to buy a gallon of milk. As if this desire to reproduce — a God-created desire mind you – is something selfish.

      When in fact, being a good parent is one of the selfless acts any of us will ever accomplish.

      As to your last sentence, I have no idea what you are trying to say.

  • kenofken

    Fertility treatments can cost many tens of thousands of dollars and can also lead to very expensive long-term health problems in both the mother and any children born from it.

    Politically it’s also a loser. Your Catholic allies in the pro-life movement consider IVF as equivalent to abortion, and they’d be shrieking like a tortured wolverine if coverage for this was mandated.