(Guest post from occasional Arkansas Project contributor Rep. Dan Greenberg)
My most recent failure—my proposal to reduce health insurance costs in Arkansas by removing the state’s mandated coverage for in vitro fertilization (IVF) treatment—is the topic of a story in this week’s Arkansas Times. You can get a taste of the Times’s customary cool-headedness and even-handedness from the headline: “Greenberg: Let Women Pay To Get Pregnant.”
I decided a while back not to proceed with this bill. (If the Arkansas Times had called me more recently than 24 days ago, at which point reporter Leslie Newell Peacock informed me breathlessly that “my deadline looms,” their just-published story might have included that relevant fact.)
When the costs of health care are hidden by the system we have today, where the employer pays for it and the recipient has little or no idea how much it costs, and the beneficiaries of the mandate have a disproportionate incentive to keep it as it is, it is just about impossible politically to lower health care costs by removing mandates. That is because even though the public might benefit greatly from ending a mandate, a relatively small beneficiary group is going to work much harder to preserve it.
The IVF mandate raises health insurance costs for every American citizen by about three to five percent (link opens as PDF file). That’s a nationwide figure, and I don’t know if Arkansas’ costs are any different. That’s one reason I prefiled the bill – to find out those kinds of questions, and to try to determine whether it would be in the interest of the people of Arkansas to end the mandate.
The price of that, I guess, is to endure Leslie Peacock’s vaguely conspiratorial innuendoes about my religious motivations (“Though he claims not to be inspired by religious activists,” she writes, “Greenberg’s proposal would sit well with the Vatican”). Despite her paraphrase, I said nothing whatsoever to Peacock about religious activists. (This, at any rate, is what I claim.) Furthermore, the suggestion in Peacock’s article that people with cancer are at fault for their illness (at the fourth paragraph from the bottom) is more than a little creepy.
I have great sympathy for people who want to, but can’t, conceive. But I am not as uncritical as Leslie Peacock is of the idea that infertility is just a disease, like cancer. There are plenty of people who just physically can’t do something they want to do: that does not mean that they are sick.
For instance, there have been plenty of people who would like to serve in the military who, for a variety of reasons, lack the capacity to do so. Military service is a really important thing and a commendable career goal. But if you don’t qualify to serve—if you just can’t run fast enough, for instance—I am not sure that demonstrates that you have a disease. It just means you aren’t physically capable of doing what you want to do. That’s true no matter how important your goal is to you, and it’s true whether your goal is professional or familial.
Here’s a reason that headlines like “Greenberg: Let Women Pay to Get Pregnant” are so lacking in seriousness: a moment’s thought will reveal that, whether we have the mandate or not, lots of women (and men) will pay to get pregnant. The mandate doesn’t make IVF treatments free: it just makes their costs hidden. I think it would be a step forward if we knew how much IVF treatments were costing everybody with health insurance; regrettably, the forces of reaction at the Arkansas Times think that it’s very dangerous to discuss this kind of thing publicly. Of course removing the mandate wouldn’t block health insurance companies from providing IVF coverage, and the Arkansas Times story is silly to pretend otherwise.
When I say that introducing this bill was my most recent failure, I’m not kidding. I got a couple of angry e-mails and phone calls from people who felt I was trying to abolish IVF treatments. And I certainly could have explained my thoughts better when discussing insurance mandates, and the way they raise costs and block access to health care for everyone, publicly.
But I can live with failure, and I will do my best to learn the right lessons from it. I am grateful to the people who took the time to explain to me how very important and personal an issue fertility treatments are to them. In their own way, they are a powerful force and their case has some merit. I will take measures next week to ensure that the bill doesn’t go anywhere, and I will explore other alternatives that might lower the cost of health insurance.
Update: I see Max Brantley at the Times blog has responded to my post, noting (or, as Leslie Peacock would say, “claiming”) that the article “debunked some of Greenberg’s operating assumptions.” Max, as usual, is very attentive to sportscasting; it’s just that he’s not so good at scoring goals. The only substantive criticism he makes of my post is clearly wrong.
Here’s the closest Max comes to actually making an argument: “Still missing after all the verbiage is an explanation for why he singled this particular mandate out for attention. There are many in the law, including more costly ones.”
The problem for Max is that complaining about the verbiage of others while at the same time misrepresenting it is rarely a powerful argument. If he had bothered to read my post before responding to it, he might have noticed these two paragraphs:
“I have great sympathy for people who want to, but can’t, conceive. But I am not as uncritical as Leslie Peacock is of the idea that infertility is just a disease, like cancer. There are plenty of people who just physically can’t do something they want to do: that does not mean that they are sick.
For instance, there have been plenty of people who would like to serve in the military who, for a variety of reasons, lack the capacity to do so. Military service is a really important thing and a commendable career goal. But if you don’t qualify to serve—if you just can’t run fast enough, for instance—I am not sure that demonstrates that you have a disease. It just means you aren’t physically capable of doing what you want to do. That’s true no matter how important your goal is to you, and it’s true whether your goal is professional or familial.”
Now, you may not like that explanation of why the IVF mandate is different than the others. Maybe you’d say it’s a really bad explanation. But the one thing that you cannot say is that it’s a missing explanation.
Of course, as Max says, there are many mandates in Arkansas law. But almost all of them are not nearly as costly, and almost every one responds to what is uncontroversially a medical problem. If Max had read the report I linked to, he would have found that it mentions 41 mandates in Arkansas. The IVF mandate is the second or third most expensive of all of them; only mental health parity and (possibly) dental benefits are more expensive.
In a world where people are denied access to health care because of the cost of health insurance, sometimes we need to think about the way that the cost of big-ticket items can increase the cost of health care for everyone. I’d like to minimize the problem of needy people being denied access; the attitude of the Arkansas Times is, as far as I can tell, that the problem doesn’t exist.
In short, the explanation whose absence Max complains about was right there in the original post. The IVF mandate is significantly different both in kind and in cost from just about every other mandate in Arkansas, as is evident from the report Max ignored. To sum up, Max gives us a post with a high sneer content but very little nutritional value.