Over at the Motherblog, Dana makes a great catch showing the ways in which reducing the profit motive in health care also reduces overtreatments, overspending, and poor health. The issue is in vitro fertilization, a method of artificial embryo implantation of giving sterile couples a chance at parenthood. In vitro doctors have a tough tradeoff to make: When you transfer more embryos, there's a higher likelihood of implantation, and thus, success. But the more embryos, the higher the likelihood of multiple implantations, with the attendant health risks (far higher rates of prematurity, lung impairments, cerebral palsy, and infant death). The American Society for Reproductive Medicine has released guidelines on how many embryos to implant at a time, but lots of clinics ignore the rules. As Peggy Orenstein explains, "What if a couple has only enough money for one round of treatment and wants to be sure — really, really sure — that it works? Or a clinic’s success rates, which are posted on the Web site of the Centers for Disease Control, begin to founder and need a boost to stay competitive? Such pressures may contribute to the high rate of I.V.F. multiples produced in this country. Only 1 percent to 2 percent of naturally conceived children are twins. Among I.V.F. babies, it’s 32 percent." In Europe, where universal health care covers the cost of in vitro treatments, the rate of multiples born from IVF is a mere 5 percent -- a huge difference. As Dana writes, "because Europeans know they will be covered if they seek a second or third implantation procedure, they don't take the risk of implanting 5 or 6 fertilized eggs during one procedure." Under the European system, the medical concerns take primacy, while the economic issues fade into the background. It's an example where the European model is not only cheaper (treating cerebral palsy is a helluva lot more expensive than paying for a few more IVF procedures), but also results in better care, period.
