It’s an ill-conceived idea to fund in vitro fertilization
Motherhood is the quintessential motherhood issue for politicians.
But even the most family-friendly politician knows to tread carefully around that most emotive of motherhood issues: in vitro fertilization.
For a pro-family politician, it’s hard to be anti-in vitro at voting time. But when post-election realities set in, it’s even harder to find the funding.
IVF has become Ontario’s political perennial:
Seeking re-election in 2007, Dalton McGuinty made a campaign commitment to formally study IVF funding. As premier, he set up a citizens’ panel as promised — but had second thoughts, two years later, when its report called for funding in vitro.
Seeking re-election in 2014, Kathleen Wynne has made a pre-campaign commitment to set up yet another panel on IVF funding. This time, McGuinty’s successor has promised to proceed with partial funding — in principle.
Ontario would become only the second province, after Quebec, to pay for IVF. But the precise details won’t be ready for another year — well after an expected spring election.
In vitro fertilization is the political issue that refuses to die, reincarnated in every campaign.
The woman in the middle of this motherhood issue has been Deb Matthews. As McGuinty’s health minister, Matthews firmly rejected public funding of IVF. She disputed the panel’s claim that any extra costs could be offset by savings if the money were made contingent on clinics implanting only single embryos (multiple embryos lead to more twins or triplets with increased risks of medical complications that burden the system).
Health economists persuaded Matthews that funding IVF was “not as revenue neutral as I had hoped it would be — so it’s an additional cost,” she told me three years ago. And too costly.
Now the health minister — who also happens to be co-chair of the Liberal re-election team — has had a change of heart. Last week at a daycare photo-op, she announced a new “advisory body” would figure out how to fund an estimated 4,000 women trying to get pregnant.
Same health minister, several years of gestation. What changed, other than the election cycle?
Matthews cites the rapid decline in multiple births after Quebec started funding IVF in 2010 (hardly a surprise). Now Ontario is budgeting about $50 million a year (initial estimates were closer to $85 million), and is banking on “offsets” from reduced multiple births to cover those costs.
“Health economists will have a very healthy debate about what the offsets are,” Matthews told me this week, when reminded of what she’d said three years ago. It’s a costbenefit analysis:
“Can you, by funding IVF, reduce the multiple birth rate?”
The question of how to reduce twins and triplets, and the resulting complications, is a good one. But is giving people money the only way to reduce multiple births?
If implanting two or three embryos is medically unsound, why doesn’t the health minister persuade — or compel — fertility clinics to end the practice?
Matthews doesn’t dispute that she could crack down on dubious multiple births. She just prefers the carrot over the stick, using financial incentives rather than regulatory measures to keep clinics in line.
But is it the best use of public money at a time when the health care budget is approaching $50 billion a year, and consuming an ever-increasing share of the provincial budget — now about 42 per cent of program spending in Ontario? Couples with fertility problems argue that it is a medical condition that merits state support no less than any other disease.
Statistically, however, IVF compares poorly to most other medical procedures. In the U.K., about one in three women under 35 will give birth in one cycle of IVF. For women aged 38-39, it’s about 20 per cent. Ontario’s previous IVF panel recommended funding until age 42, yet the success rate for women aged 40-42 is a mere 14 per cent. Those are low odds. Even if the Wynne government were to carry out its promise, the money won’t stretch far: Ontario would only fund one cycle of IVF. Patients would still have to pay for the drug treatments, which can be a big part of the roughly $10,000 cost for each cycle — with some couples paying up to $50,000 as they keep trying. The IVF debate is always fraught for politicians. Yet one party leader who remains wary of public funding is Tory Leader Tim Hudak, who has spoken publicly about the challenges that couples face in child-bearing. He and his wife just had their second child after trying for several years, but he has long believed that IVF is not the best use of public money. On this issue, he’s right. Martin Regg Cohn’s provincial affairs column appears Tuesday, Thursday and Sunday. mcohn@thestar.ca, Twitter: @reggcohn