Questions about "free IVF"
politics and/or policy?
The current price of an IVF cycle is -- like all prices-- a fudge factor that equates the expected return on the capital invested, in this case in labs and people and equipment and knowledge, divided by the number of people that the capital deployed can comfortably and profitably treat.
In other words, a classic oligopoly, where competition is mainly in product differentiation, not price.
In this kind of marketplace, the effect of opening the gates of the market to a lot more people and letting them knock on the doors of the limited number of existing suppliers is that the price goes up, followed by a new round of investment into market expansion to accommodate some -- but not all -- of the new demand.
How do we triage the new, worthy aims of the government subsidy into more babies for more people versus the economic gravitational pull of just letting the price go up for doing what we've been doing all along?
3. Does shifting the out-of-pocket costs from patients to the government change the fundamental inefficiency of the IVF marketplace -- the fact that we sell something that nobody wants ie an IVF cycle with a chance at having a baby instead of what they do want, which is a baby.
The patients, now relieved of the fear of setting $10,000 on fire, never to be recovered if there is a negative pregnancy test, are now virtuously unburdened of that compounded bad outcome. Great for Team Access. But the prospect of the deepest of deep pockets paying for cycle and cycle perpetuates producing cycle after cycle, regardless of outcome.
(If asked, I would propose lower reimbursement for non-pregnancy cycles to avoid "cycle mills.")
4. How do keep people from watering the lawn in the rain?
If water is free, we waste it.
IVF in the US, minus the burden of huge out-of-pocket costs and the threat of getting nothing in return for spending your life savings, mortgaging your house and going into debt?
Hell yes, but let's do it right. That should be the debate.
This is an important and under-discussed topic. If everyone can have IVF on demand at very low cost, what happens to quality? If the lab has to cut corners (less personnel? decisions based on limited resources rather than best possible lab technique), what happens? If reimbursement is driven down by a single-payer or insurance oligopolies (or vertical monopolies like United Healthcare) are the physicians burdened with more cycles in less time just to make the payroll for the clinic? Optimization of these factors for best patient care is challenging. I know that technical innovations will help as might "re-engineering" patient care models. We MUST be careful to concentrate on what is best for the patients while avoiding incentivizing things that reduce our quality of care.