Recently, I opposed former President Trump’s new IVF proposal to have the government subsidize or pay for In-vitro Fertilization (IVF). (Trump’s IVF Entitlement) While I’m not backing down from what I wrote, here is an opposing point of view.

Ira Stoll, writing in The Wall Street Journal, says current government policy is tilted against having children.  Federal law requires most health insurers to cover contraception at no cost to the patient. That includes birth-control pills, long-acting methods such as intrauterine devices, and often even surgical permanent sterilization methods like tubal ligation. He says Trump’s idea would restore the federal government’s neutrality on the decision to start a family.

Right now, the government, and many private insurers, will pay for medical procedures to prevent pregnancy. But they often won’t pay for IVF, the “test-tube baby” technology that’s existed for nearly 50 years and often is necessary to enable childbirth. This double standard is a recipe for population decline. It’s a policy prescription for, in JD Vance’s memorable phrase, a nation of “childless cat ladies.”\

Stoll points out we’re heading in the wrong direction when it comes to our fertility rate as a nation. In April, the National Center for Health Statistics announced that the fertility rate in the U.S. hit a record low. The current level of roughly 1.6 births per woman is below the replacement rate needed to maintain the population, absent immigration. What does this mean to us as a nation?

Stoll tells us the costs of low birthrates—empty cities and school buildings, an insufficient working-age population to support retiring baby boomers, a military that isn’t meeting its recruitment targets—far outweigh the costs of adding IVF to insurance coverage. Fourteen states and the District of Columbia already have fertility insurance laws that cover IVF, according to Resolve, a patient advocacy organization. Internationally, covering IVF hasn’t hindered Israel’s impressive economic performance as a “startup nation.”

He advocates a more sensible accounting of Mr. Trump’s proposal would include not only the costs of the medical procedure but the benefits to society of more souls, a concept conveyed in the biblical injunction to be fruitful and multiply. Found in Genesis 1:28 and again in Genesis 9:1, it is the first commandment in the Bible and one of the few that predates the Sinai covenant.

Stoll says, “The roughly $15,000 price of an IVF procedure is nothing compared with the priceless potential of an individual human being. That new person might start a company, cure a disease, inspire students or improve the world in any number of other ways. Almost certainly, that person will pay over a lifetime far more in taxes than the cost of the IVF procedure.”

It is the high cost of IVF procedures that makes this government entitlement hard to swallow. The cost of preventive measures such as contraception pills, IUDs, and even tubal ligation are much lower and therefore more easily justified. I would argue all of these healthcare costs should be subject to insurance premiums that justify the expense. I don’t think the government should be more willing to pay for these treatments to prevent pregnancy any more than those to enhance pregnancy.

I am certainly in favor of healthcare procedures that encourage life as much as those that prevent it. But let’s get back to insurance coverage, whether private or federally funded, that covers the healthcare needs of individuals, not a one-size-fits-all approach such as we’ve been burdened with since the passage of The Affordable Care Act known as ObamaCare. Then we won’t have men with healthcare insurance that covers mammograms or women with coverage for prostate exams – or fertility treatments they may never use.

In-vitro fertilization (IVF) has become the latest political football. Democrats want to paint Republicans as opposed to this infertility procedure as part of their campaign for “women’s reproductive rights.” Now, former President Donald Trump is pushing back by saying he not only approves of IVF, but he wants the federal government, or your insurance company, to pay for it. In this atmosphere of hot political rhetoric, cooler heads must prevail.

The Wall Street Journal editorial board is generally conservative, but they oppose Trump’s proposal. Here’s what they say, “Donald Trump this week proposed subsidizing in-vitro fertilization treatments for all Americans, and the politics aren’t hard to discern. Mr. Trump is trying to blunt a GOP liability with women voters, particularly on abortion. But a new federal fertility entitlement is a fiscal and cultural thicket Republicans don’t want to enter.”

Most Americans know someone who has struggled to conceive children, and couples often turn to IVF procedures that cost tens of thousands of dollars from egg retrievals to embryo transfers. Insurers don’t always cover IVF, though companies appear to be expanding fertility benefits as more Americans form families at later ages. In 2022 some 43% of large employers covered IVF, up from 27% in 2020, according to one survey.

WSJ editors say, “The irony is that Mr. Trump is mimicking Barack Obama and his Affordable Care Act, which demanded that insurers offer the federal government’s preferred benefits regardless of expense. The cost of fertility procedures for some will be buried across higher premiums for everyone else. If Mr. Trump forces Affordable Care Act plans to cover IVF, he will encourage more Americans to move to taxpayer subsidized plans from small business offerings that often can’t afford to cover IVF.”

The editors are correct in saying this mimics the worst aspects of ObamaCare, the Affordable Care Act. Obama promised, “We’ll lower premiums by up to $2,500 for a typical family per year. . . . We’ll do it by the end of my first term.” (6/5/08). But premiums actually more than doubled. The main reason for the increase was the ACA mandated certain healthcare coverage in all policies – even prostate exams for women and mammograms for men. By mandating coverage not everyone needed, the price went up for everyone! The same thing would happen if Trump mandated IVF coverage for everyone.

WSJ goes on to explain the cost could run into the tens of billions annually, not least if Medicaid had to cover IVF, which it inevitably will if ObamaCare plans do. The government would dictate how many attempts are covered when an IVF cycle fails, and micromanage the quality of clinics. If you think IVF is expensive now, wait until it’s “free.”

It’s easy to understand why Trump is making this proposal this late in the election campaign. With Kamala Harris promising to continue the Biden Administration policies of college debt forgiveness, and pushing her own ideas of free healthcare for illegal immigrants, and even housing subsidies up to $25,000 for illegals, Trump feels like he’s in a bidding war for the American voter. Harris even promises a $6,000 tax credit for newborns!

But someone has to pay for all this government largess. We’re $35 trillion in debt now and that “someone” is the American taxpayer. If we don’t reign in the spending, the loser will be the defense budget and that’s just not acceptable in a world on the brink of WWIII.

IVF can be a wonderful solution to infertility problems, but let’s let couples make their own decision to attach such coverage to their health insurance. Trump’s proposal will only raise the cost of healthcare for everyone, including seniors like me who have no need for IVF.

If you think you’re waiting longer in the emergency room, or to get an appointment with your doctor, you’re not alone. It’s a simple supply and demand problem – increasing demand as our population grows and ages and decreasing supply as doctors retire earlier and faster than new doctors can be trained.

This is nothing new – but it is getting worse. Primary care and emergency medicine are the two areas hit the hardest. The average wait time to see a doctor has increased since 2017 and continued to rise after the demand spike brought on by the Covid-19 pandemic.

Autumn Spredemann, writing for The Epoch Times, tells us a survey conducted by AMN Healthcare in 2022 of 15 large metro markets revealed that the average time to see a physician was 26 days – an 8 percent increase from 2017 and a 24 percent spike since 2004. Staff constraints are also felt in hospital emergency departments. Nearly 140 million Americans visited a hospital emergency department in 2021, based on data from the Centers for Disease Control and Prevention (CDC). Of those, about 13 percent resulted in hospital admission, and thousands waited hours to see health care providers. Many patients leave before being seen by doctors.

One study analyzed more than 1,000 hospitals between 2017 and the end of 2021 and found that those with the worst performance had 4.4 percent of emergency room patients leave before a medical evaluation was conducted. At the end of 2021, that number had risen to more than 10 percent. Compounding the problem is that nearly half of the doctor population will reach retirement age within the next 10 years and career burnout is hitting the rest harder than ever, according to data from the Association of American Medical Colleges.

Just how bad is the problem?

Almost 50 percent of doctors report that they feel burned out, according to a 2024 Medscape report. Physician Thrive’s 2023 study states that the United States may have a shortage of 124,000 doctors by 2034.Within that shortfall, up to 48,000 will likely be lost from primary care, while the industry is projected to lose another 58,000 specialists, surgeons, and nurse practitioners.

What’s causing this shortage?

There are many reasons for this shortage, to name just a few:

• Increasing insurance company restrictions on the practice of medicine – which frustrates physicians and leads to burnout.
• Increasing percentage of doctors employed by hospitals and corporations – who control the way physicians practice medicine.
• Increasing numbers of patients enrolled in Medicaid – who can’t get in to see their doctors and resort to emergency rooms for primary care.
• Increasing time physicians must spend on paperwork and data entry – which keeps physicians from actually seeing patients.
• Increasing population aging with greater healthcare needs – which increases the demands for physician time.
• Decreasing respect for physicians in general – which adds to burnout
• Declining medical school applications – as medicine becomes less attractive
• Inadequate expansion of medical training programs – due to high cost and capital expansion demands

All of this should make you appreciate your doctor more if you have a good working relationship. But if you don’t, you’ve got lots of company!