Taxpayer to pay for IVF for those who can't afford it.

[Brendan Burgess]

According to the RTE News, the Minister for Health is bringing a bill to cabinet today so that those who want IVF but can't afford it will have it paid for by the taxpayer.

Meanwhile, Minister for Health Simon Harris will bring proposals to Government to provide State funding for fertility treatment for couples who could not otherwise afford it, before the end of the year Mr Harris.


He will ask the Cabinet this morning to approve the drafting of a bill to enable people in need of assisted human reproduction to access these services.


The bill will also seek to regulate this area and will set down clear rules around the health of women and the welfare of the child.

Brendan

 

[Brendan Burgess]

I fee sorry for couples who can't have kids or who can't afford to have kids, but...

If they can't afford IVF, then they can't afford to have children.

The taxpayer will not just be paying for the IVF, we will be paying for providing for them throughout their childhood because the parents presumably wont' be able to afford that either. And they won't be able to continue living in their one bed apartment, so we will have to provide them with "decent housing" as well. And it won't pay them to work and pay for childcare, so we will have to provide social welfare to the parents as well.

Brendan

 

[Early Riser]

The taxpayer will not just be paying for the IVF, we will be paying for providing for them throughout their childhood because the parents presumably wont' be able to afford that either. And they won't be able to continue living in their one bed apartment, so we will have to provide them with "decent housing" as well. And it won't pay them to work and pay for childcare, so we will have to provide social welfare to the parents as well.

That's not all.The children will fail at school and go on to become either delinquents or Social Welfare scroungers. They won't support their parents in old age, leaving it to the taxpayer to provide medical and nursing care. They won't be able to bury them either so a taxpayer funded pauper's grave will be required. Then they will go on to have more children who will have to be supported by our children who will by then carry the tax burden. Presumably.

 

[odyssey06]

They should provide IVF to all or none. This is just creating more poverty traps.

 

[Delboy]

I think this is all very harsh and I had to read BB's 2nd post twice to make sure it wasn't a spoof.

Thankfully, I've not had to go the IVF route to have a family but my understanding of the process is that it is very expensive and could take a couple of attempts before it works. In the UK they pay for the first 2 treatments and your on your own after that.
I've seen lots of couples tell their stories who seemed like very loving people, responsible members of society, held downs jobs etc but just needed a bit of help starting a family as they couldn't get the money together up front now for the treatments. As a parent, you'd have to feel very sorry for them. And if they can be helped, then why not?

Don't get me wrong, I'm more right wing than most. But we are a society and people need help from time to time. Ideally, I'd like to see restrictions on this as to who could claim it etc but being Ireland, it'll be a free for all. And yes, there may be people who go for it who can't afford children and may even be using this route to get access to better social welfare/housing/way of life. But I'd hope they'd be in the minority and that a scheme like this would be for the greater good.

I agree with Odyssey - it should be free for all however or not available at all.

 

[rob oyle]

Our fertility rates are already high enough that we're adding an extra 110 to our population every day, before migration(an extra Longford to provide for every year, if you will). And we strain to provide housing, health care and education for those already here. If there are limited resources, why are they not put towards making adoption and fostering more available/affordable?

 

[qwerty5]

The article says they'll examine proposals for the state to provide funding for IVF treatments.

With that little information I don't know if I'm for or against. If they provide funding of a percentage of the funding so it doesn't cripple a working couple,then why not. If the percentage is 100% then I wouldn't be mad about it.

If you're a couple that are currently contributing to society and can't have kids then the small amount the state would provide to help in that situation is probably a drop in the ocean compared to what that kid / adult will provide in the long term.

I doubt the state will be providing funding for people who just have the perpetual hand out. You never know with some of our nutjob politicians though.

Idiocracy comes to mind. If you haven't seen that movie, look for it. It's comedy and a bit science fiction but the way I see the world going we'll probably look back at it as a documentary.

 

[RedOnion]

I fee sorry for couples who can't have kids or who can't afford to have kids, but...

If they can't afford IVF, then they can't afford to have children.

This is one of the most insensitive posts I've ever seen on AAM.

Luckily I didn't have to use IVF, but I've several friends who have. I know people who've remortgaged their homes to have children.

On average, you're looking at direct costs of about 15,000 for IVF in Ireland, with no guarantee of success.

I have 2 children who I'm well able to provide for, but there's no way I'd have been able to come up with 30,000 upfront to have them.

I think financial assistance to people who need it, and really want a family and can provide for them, would be a far better use of tax payers money than providing social welfare and housing benefits to those who have never worked and have children simply to game the system.

I don't believe it should be 100% paid for by the state, but we're light on details as to what might be proposed.

 

[gnf_ireland]

Thankfully we never had to go down this route, but we do know a few who had to and it is a very difficult journey for all

They should provide IVF to all or none.

Agree 100% with this statement. IVF is expensive and there are very few people who can afford to fork out for a number of IVF treatments in the hope of having a child. The majority of people who go down this route today have to be the professional classes - as others simply cannot afford it.

On average, you're looking at direct costs of about 15,000 for IVF in Ireland, with no guarantee of success.

I thought they were a bit lower than that at the moment, at around 10k. Please see sample costs from Rotunda as an example. But its definitely not cheap by any means.
[broken link removed]


I would have concerns around eligibility and a few other aspects of it:
1. I would like to see it discounted rather than free. Personally I don't believe in free anything, and there should always be a charge for people to value it
2. I would also like it to be linked to PRSI stamps, so a minimum number of stamps paid before people are eligible. Would the partners stamps make a woman eligible - no idea !
3. Does the person have to be in a co-habitation couple or married to avail of it? Should the state pay for IVF followed by single mother allowance for the life of the child? This is a damned if you do, damned if you don't scenario
4. How many rounds of IVR should the state support? UK limits it to 2 per lifetime - seems reasonable enough to be.
5. Success rates are not very high in general - would there need to be medical qualifying criteria to be able to avail of the scheme. Would it need to be referred to from a GP or other once all other avenues have been exhausted
6. Should there be limits on age - so should an 18 year old be allowed to avail of it; what about a 60 year old?
7. What if the couple already have 4 children - should the state pay for IVF if they want a 5th ?
8. What about other forms of intervention - surrogacy etc?

Like everything, the devil is in the detail of the proposal. I am in favour of support here, as long as it is reasonable, minimises abuse and is based on medical evidence. IVF is not an easy journey to take, and given the failure rates can be very hard emotionally on the couples, but the female in particular.

This is a very difficult event for a large amount of people, probably not helped by the professional classes in particular getting married older and trying to have kids older. I am sure there is some interesting reading for some on the below forum on fertility issues and experiences..

[broken link removed]

 

[Purple]

This is a result of a superb piece of lobbying from the healthcare industry in general and a specific private clinic in particular.
Speaking as someone with first hand experience of IVF I am completely against this proposal. It is yet another case of the heart leading the head with no control on cost. Once this is in the price the State is charged will just go up and up and RTE will run this, as always, as a human interest story without asking any hard questions.

 

[gnf_ireland]

Once this is in the price the State is charged will just go up and up

You could say this about anything that the state pays for - not just IVF. There would have to be caps/limits applied, and would probably have to be reviewed on a periodic basis as well.

Speaking as someone with first hand experience of IVF I am completely against this proposal.

The difference here is you could afford to pay for it, and therefore it was a financial decision for you. There are many who cannot afford to pay for it.

Lets assume cost is 10k - so the net cost is 8k after the tax relief. If they have 1k covered by health insurance, the net cost would be around 7200.
Lets say the government was to subsidise this by 50% of the cost up to 5k - so 5k cost on the person. Health insurance tends to cap it at around 1k, so and say its 800 euro tax relief. This would leave the person paying 3200. This is a big difference to most people.

Would the price of IVF rise - maybe, but they again every government subsidy rises prices by enlarge. Look at the Help to Buy scheme or anything similar
Would the price rise to cost by 50% - probably not ...

Sadly this is an emotive issue for a lot of people, and until you are affected by it, its really hard one to call...


@Purple lets say you and your partner could not afford the cost of IVF. Any idea on the emotional and mental cost of knowing that you could possible had a child if you could have managed to get 10k together to give it a go? You cleared make the decision to go down the IVF route for a reason - what if that route was not open?
The financial cost/exposure here is relatively low in the grand scheme of things....

 

[gnf_ireland]

I for one, will be supportive of a bill that assists those who worked hard to build their careers but in doing so got caught out on the other side when trying to start a family.

Ok, so how do you enforce that bit - base it on number of PRSI stamps paid? Age limit it etc?


I 100% agree with what you are saying and kind of alluded to the same thing above in my post - and to be honest I doubt many who know me would call me a 'bleeding heart'

 

[Purple]

The difference here is you could afford to pay for it, and therefore it was a financial decision for you. There are many who cannot afford to pay for it.

It's far more than a financial decision.

Lets assume cost is 10k - so the net cost is 8k after the tax relief. If they have 1k covered by health insurance, the net cost would be around 7200.
Lets say the government was to subsidise this by 50% of the cost up to 5k - so 5k cost on the person. Health insurance tends to cap it at around 1k, so and say its 800 euro tax relief. This would leave the person paying 3200. This is a big difference to most people.

The average cost per round is €5,000 without donor eggs, €10,000 with donor eggs. The important thing is that cost is per round. The more thy fail the more they make. Please don't delude yourself into thinking that isn't a factor for the businesses which offer the service.

Sadly this is an emotive issue for a lot of people, and until you are affected by it, its really hard one to call...

That's the problem; it's an emotive issue. The medical industry knows that and uses it to steer the conversation and focus away from that they are actually doing and why they are doing it.

@Purple lets say you and your partner could not afford the cost of IVF. Any idea on the emotional and mental cost of knowing that you could possible had a child if you could have managed to get 10k together to give it a go? You cleared make the decision to go down the IVF route for a reason - what if that route was not open?
The financial cost/exposure here is relatively low in the grand scheme of things....

In my experience it involved many failed rounds with some very dubious medical advice based on a totally incorrect diagnosis. On the up-side we did pay them enough to buy someone a boat so at least there was some winner.
The overall impression I got was that they were like a dodgy second hand car dealer, confidence men playing on vulnerable people.

 

[torblednam]

To give a real life perspective on it, and the type of dilemmas that real-life, working couples who pay plenty of taxes, face:

A previous poster has already pointed out that this type of dilemma is most likely to only affect the professional classes, or as I would call them, responsible people.

My wife and I had both been affected by the recession, losing ground career-wise, earnings-wise and savings wise during our mid-late 20's with us each experiencing unemployment / underemployment.

So we found ourselves saving as best we could towards our first house whilst also conscious of the clock ticking for starting a family as we entered our 30s. Unsure of when and where we would be able to buy, we decided we had best start trying to conceive before buying, which proved fortunate because we only learned of a fertility problem after nearly 2 years without success.

So we saw a substantial chunk of our savings towards a house swallowed up by the rounds of IVF that it took to successfully conceive. If it weren't for the help to buy scheme lowering the hurdle for us, we still wouldn't have been able to buy, as prices have increased and kids are expensive, so it takes a lot longer to save that money the second time around.

Sure, we could have decided to buy a house first, but that's the thing with fertility related matters, time is not your friend and it becomes all consuming when you're in that situation. I've heard and seen horror stories of couples who end up broken up, indebted and broken as a result of keeping rolling the IVF dice in the hopes of bringing a child into the world. There but for the grace of god...

Of all things that the State can set aside resources for, I think this is an extremely worthwhile one. It's merely a question of how much and how that State support should be delivered.

Tax relief should apply at the marginal rate for most, if not all, medical expenses, and certainly for fertility treatment. If you want to facilitate people having babies it should be the ones who have an income capable of supporting them so this is one area where there's a logical justification for the State favouring the higher earner.

There also should separately be a hefty subsidy or support in whatever form, for childless people accessing treatment. From personal experience, there's a fundamental difference between struggling to conceive your first child versus subsequent ones.

 

[TheBigShort]

Ok, so how do you enforce that bit - base it on number of PRSI stamps paid? Age limit it etc?

Obviously it is a complex issue and you raise some interesting questions in your post.
I don't have direct experience with IVF but I know two couples that have gone down that route.
But one of the other factors for infertility is lifestyle habits, unhealthy eating, heavy drinking, smoking, drugs etc.
My understanding is that the IVF assessment requires applicants to be adhering to a healthy lifestyle. So people with high alcohol levels in their bloodstream, high blood pressure, who smoke, are overweight or obese etc will not be accepted for the program because the chances of failure are vastly increased with such conditions.
The second thing I would imagine, is that women coming close to the end of the normal reproductive age cycle will be prioritized ie women in mid to early forties.
So a young couple at 18yrs of age will not qualify (unless in exceptional circumstances) because of the time available to investigate reasons for the infertility and propose alternative, cheaper treatments to be tried.
That is my assumption, based on what I know so far.

 

[gnf_ireland]

My understanding is that the IVF assessment requires applicants to be adhering to a healthy lifestyle. So people with high alcohol levels in their bloodstream, high blood pressure, who smoke, are overweight or obese etc will not be accepted for the program because the chances of failure are vastly increased with such conditions.

Absolutely agree in theory, but this would be a tricky one in a number of cases. Some people have naturally higher blood pressure, others have higher BMI (I am told muscle weights more than fat) etc. Trying to define a one size fits all is really tough thing to do, and even harder when relating to medical. But I agree with the principle

The second thing I would imagine, is that women coming close to the end of the normal reproductive age cycle will be prioritized ie women in mid to early forties.

Early-mid 40's would be deemed a very old mother in general terms. I think when we were going through the maternity cycles, any first time mother over 35 was deemed in the high risk category. This should also be kept in mind, but I imagine cutting off based on age is probably illegal !

 

[Purple]

So people with high alcohol levels in their bloodstream, high blood pressure, who smoke, are overweight or obese etc will not be accepted for the program because the chances of failure are vastly increased with such conditions.

That is incorrect in my experience.
You can be as fat as you like as long as you have the cash.

 

[gnf_ireland]

It's far more than a financial decision.

The average cost per round is €5,000 without donor eggs, €10,000 with donor eggs. The important thing is that cost is per round. The more thy fail the more they make. Please don't delide yourself into thinking that isn't a factor for the businesses which offer the service.

That's the problem; it's an emotive issue. The medical industry knows that and uses it to steer the conversation and focus away from that they are actually doing and why they are doing it.

In my experience it involved many failed rounds with some very dubious medical advice based on a totally incorrect diagnosis. On the up-side we did pay them enough to buy someone a boat so at least there was some winner.
The overall impression I got was that they were like a dodgy second hand car dealer, confidence men playing on vulnerable people.

@Purple - without having first hand knowledge of the 'game/industry', nothing of what you say above would surprise me. Certain emotive issues pull at the heart strings more than others, and the medical industry knows how to play the game more than most. Add to the fact this is a private area means there will always be a financial motive.

The quote "confidence men playing on vulnerable people" does sound about right. They are selling a dream to fulfill the 'textbook' lifestyle, but its only a gamble and the more you lose, the more they gain from it.


There is a way to address this however, if the government are serious about it:
1. Set up 4 centres around the country to support the service, run by a special unit within the HSE/maternity structures
2. The medical assessment and consultations are done by the special unit, not the private operators
3. Sign the private operators up on a 5 year contact with fixed price per treatment - open it up to tender and make it transparent
4. After the assessment is done, the private operator and HSE unit review the file and jointly recommend the course of action - but HSE unit has final authority
5. In the 5 year window, build the expertise up in the HSE units to allow them undertake the work, so there are no longer a need for private operators within the scheme.
Basically, the role of the private operators needs to reduce in the medium term, and removing them from the assessment means recommendations are likely to be based on medical evidence rather than financially motivated.


Despite all of this, I don't believe the principle behind the scheme is wrong, but it could be very badly implemented if done wrong

 

[TheBigShort]

Absolutely agree in theory, but this would be a tricky one in a number of cases. Some people have naturally higher blood pressure, others have higher BMI (I am told muscle weights more than fat) etc. Trying to define a one size fits all is really tough thing to do, and even harder when relating to medical. But I agree with the principle

It wouldn't be the State defining the health it would be the medical practitioners. As far as I know, the IVF treatment has greatest chance of success where an applicant to be treated is free of conditions such obesity and isn't a smoker or heavy drinker. In other words, you would only qualify for state benefit if a medical practioner deems that you fit into the category of reasonable to high chance of success. If a practioner considers your chances low to zero ( because you smoke) then you can still have the treatment but will not receive state benefit - you pay for it yourself.

Early-mid 40's would be deemed a very old mother in general terms. I think when we were going through the maternity cycles, any first time mother over 35 was deemed in the high risk category. This should also be kept in mind, but I imagine cutting off based on age is probably illegal !

Not if people have being postponing starting a family due to their careers it would not. I'm not suggesting any age should be cut off, rather that those women from mid thirties on would be prioritised. 18yrs olds still have time on their hands and can try vastly cheaper treatments.

 

[gnf_ireland]

That is incorrect in my experience.
You can be as fat as you like as long as you have the cash.

True in the private financial set-up - if you have the cash you can pay for whatever you fancy

In the UK, the rules are different and assume we would align to those somewhat

http://www.nhs.uk/Conditions/IVF/Pages/Availability.aspx

CCGs may have additional criteria you need to meet before you can have IVF on the NHS, such as:

• not having any children already, from both your current and any previous relationships
• being a healthy weight
• not smoking
• falling into a certain age range (for example, some CCGs only fund treatment for women under 35)

In some cases, only one cycle of IVF may be routinely offered, instead of the three recommended by NICE.

https://www.nice.org.uk/guidance/cg156