Hillary Clinton

I was surprised to read recently that Hillary Clinton had endometriosis and the Clintons experienced infertility and wanted more kids other than Chelsea. She even admitted to thinking of ways to expand their family while they were in the White House! Could you imagine a caseworker showing up in the WH for a home study? Or what about being a birthmother and going through profiles only to see the president and first lady?! Now I think the Obamas are doing the best they can with small kids, but that is not exactly the best situation in which to raise a child.

Also, I voted for Obama in both the primary and the general election and am glad we had some major health insurance reform, but it did make me wonder how a President Hillary Clinton might have inserted IF coverage in there.

And since we are on the topic of health care reform, the recent court ruling has me concerned. One, I don't want to see the law overturned. But more importantly to my own self interest, the extension of the adoption tax credit was in the health care law. So if the whole thing is overturned, what does that do to the tax credit?

Insurance

We are in the open enrollment period for benefits at work. So we have a chance to decide what insurance plan is best for us. I'm trying to figure out what would be best for us.

I work for a very large company, and we are fortunate that we have 3 options. They have varying levels of premiums, co-pays, deductibles, and co-insurance. If our medical expenses for next year are about the same as they were this year, then one option is much cheaper. The disadvantage of that plan, though, is that it has the highest out of pocket maximum, so in the worst case scenario, we would end up paying $2K more than the other plans. So we have to decide how we feel about that risk.

But here's where it gets even trickier. None of the plans pay for the treatment of IF, but they do pay for the diagnosis of it. Our expenses this year were exclusively for diagnosis (they all have the same prescription drug plan so I'm not including costs for cl.omid or fem.ara in figuring this out). But, assuming we are not successful this cycle, we are going to start getting more aggressive and will start IUI. So we will move from diagnosis to treatment as our major contributor to costs.

I can also get a health savings account where basically I can put some of my income in an account specifically for medical costs (and this is good for fertility treatments) without paying taxes on it. But this amount does not carry over at the end of the year, so if I don't use, I lose it. Since this account can be used for IUI and IVF, my first inclination is to put a lot of money in there and save on taxes. But assuming I'm not pregnant now, I hope to do one IUI cycle before the end of the year. And then of course we have no idea how many cycles we will need.

What would you guys do in this situation?

Social security and IF treatments

As you can tell from my recent post, I've been thinking about IF and medical coverage and how much we should require insurance to cover.

Today I thought of a great reason why the rest of the country should care about our fertility: social security. For those of reading from other countries or those just unsure of how social security is funded, this is it works. Current workers (usually those age 18-65) pay taxes that then pay for benefits for current retirees (those 65 and older, but for us young'uns, we won't be eligible until age 67). One big problem with this method of funding social security is that life expectancy is increasing and birth rates are going down. This means the ratio of current workers to current retirees is going down. In just 8 years, the ratio is expected to be low enough that we will begin paying more out in benefits than it receives in benefits. In 2041 (conveniently just as I hit retirement age), the social security trust fund will run out of money and will only be able to pay 78 cents on the dollar for benefits we are expecting.

(By the way, I know this b/c today I received my yearly social security statement, so it's not like I have this info at the top of my head).

So, wouldn't an investment of $15,000 to pay for IF treatments help offset this declining ratio of current workers to retirees? If part of the problem is low birth rates, shouldn't we try to increase the birth rate? I mean, if the feds paid for us to have a baby, in 20 years or so that's one more worker who will surely pay more than $15K over the course of his/her working life in social security taxes to help fund social security.

To be honest, I'm not really sure if I'm half joking with this or not. When I first had this thought, I meant it as a joke. But now it's beginning to make sense.

Health insurance and IF

You may have noticed a few people are talking about health care now. I'm a political junkie and have been following it closely. I'll even admit to having my congressman's phone number on speed dial. He hears from me often, especially since he gets lots of money from the health insurance industry.

But in all the time I've spent thinking about health care reform, there is one thing I'm not sure about. How much should we require either a public option or private insurance companies to cover IF treatments?

I work for a large employer and we get pretty good health benefits (although premiums and the deductible do keep going up). My plan will cover the diagnosis of IF, but not the treatment. We have not made the move into expensive treatment yet, but still the co-pays, deductibles, and prescriptions have totaled more than $500 out of pocket so far this year. True, that's not a whole lot of money yet, but as we think about moving forward with more expensive treatment, we get worried.

I believe we need health care reform so that everyone can have access to some basic level of high quality health care. But the question is what do we consider a "basic level?" I have a feeling my definition of basic coverage for everyone would be higher than most people, but still I still hesitate at saying it should include IF treatments. Do we have a moral responsibility to help couples have a child in the same way (I believe) we have a moral responsibility to help people who have cancer?

On the other hand, IF is a medical condition, just as there are many other non-life threatening medical conditions that we seem to think of as worthy of health insurance. We also value health care that increases the quality of our lives, not just those that extend our lives. IF treatment certainly fits that category.

Plus there are a variety of medical conditions that insurance will pay for that are really optional. For example, my cousin is a great high school athlete. She recently had a knee injury, a similar knee injury that I had in college. My doctor told me that for my lifestyle, surgery was not necessary. I've never had surgery and my activity is not inhibited at all. After an initial healing process (in which physical therapy was the only treatment), you couldn't even tell my cousin had a bad knee. She would walk, run around, do all the daily activities she used to. Except she wasn't allowed back on her basketball team. If she wanted to continue playing sports at a level where she can get a college scholarship, she needed surgery. So she had it, and her insurance paid. Why do we think insurance should pay for something that is only necessary if we want a college scholarship, but not for something that is only necessary if we want a baby?

And I can't mention this topic of elective medical treatments without bringing up one important example. Most health insurance plans will pay for viagra and similar pills. How is that any different from covering cl.omid?

So, my blogging friends, what do you think? Where do you think we should draw the line on insurance paying for IF? To what extent is your perspective influenced by whether you have insurance coverage for it?