Culture & Ethics
Why We Will Never Control Medical Costs
The purposes of medicine are expanding rapidly beyond treating actual illnesses/injuries and promoting wellness, to also facilitating life fulfillment and making personal dreams come true.
Latest case in point: A gay couple has filed a class-action complaint with the U.S. Equal Employment Opportunity Commission (EEOC) against the City of New York, suing for unlawful workplace discrimination because they were denied coverage for fertility services. If successful, health insurance nationally may eventually be required to pay for IVF/surrogacy services for male gay couples. From the Guardian story:
Corey Briskin and Nicholas Maggipinto met in law school in 2011, were engaged by 2014, and had their 2016 wedding announced in the New York Times. They moved to a waterfront apartment block in Williamsburg, Brooklyn, with a bright playroom for families on the ground floor. “We got married and then we wanted all the trappings: house, children, 401K [retirement saving plan], etc,” Maggipinto, 37, tells me in their building’s shared meeting room, tapping the table in sequence with the progression of each idea.
Briskin, 30, grew up assuming he’d have children. He came out in college. “Once I had come out to myself and others, I don’t think my expectation of what my life would look like changed all that much.” With marriage equality won years ago, they expected to be able to have a conventional married life.
But the couple, both being male, cannot have children together. Hence, the litigation.
Briskin used to work for the City of New York as an assistant district attorney, earning about $60,000 a year. His employment benefits had included generous health insurance. But when they read the policy, they discovered they were the only class of people to be excluded from IVF coverage. Infertility was defined as an inability to have a child through heterosexual sex or intrauterine insemination. That meant straight people and lesbians working for the City of New York would have the costs of IVF covered, but gay male couples could never be eligible.
This isn’t an oversight, it’s discrimination, Briskin says. “The policy is the product of a time when there was a misconception, a stereotype, a prejudice against couples that were made up of two men – that they were not capable of raising children because there was no female figure in that relationship.”
Wait a Minute
In the examples given, fertility services were covered because the patients experienced a pathology, i.e., an inability to conceive. Neither of the gentlemen suing, as far as we know, is infertile. They are gay. They cannot conceive together because both are male. That is not a pathology. It’s basic biology. Hence, refusing coverage is not discrimination.
But these days, saying such a truth is often called hateful as political pressure is brought to bear to ensure that insurance pays for services that are about attaining lifestyle desires, not overcoming actual health impairments. For example, California passed a law some time ago requiring group health insurance to cover gay couples as they do infertile heterosexual couples — which actually discriminates against heterosexual couples because they have to demonstrate a medical inability to conceive, while gay couples do not.
But what about this?
Briskin was working alongside colleagues who were happily availing themselves of the benefits he wasn’t entitled to. One of his co-workers — an older, single woman — became a mother using donor sperm, IVF and surrogacy.
The Story Doesn’t Say
But if the woman in question was beyond normal childbearing years, it should not have been covered either because inability to conceive would be caused by biology, not a medical problem.
So, we grind our teeth about the gargantuan cost of health care in this country — as we continually expand the circumstances in which non-health-care services are required to be covered by health insurance. For example, arguments are already being made that transgender women should be eligible for uterus transplants so they can experience gestation.
We need to find the courage at some point to say no to the expansion of medicine’s jurisdiction, or there won’t be enough money in the pot to pay for it all.