Wednesday, July 22, 2009

When is formula medicine and when is it nutrition?

So apparently the IRS has denied a family's attempt to set aside the cost of formula as a medical expense - despite the fact that the mother had undergone a double mastectomy and was physically unable to breastfeed.

I have to say I'm torn on this one. On the one hand, I would probably be pretty pissed if I wanted to breastfeed (this mom breastfed her previous child), couldn't because I had cancer, and had the IRS deny my request for tax relief for formula (which is expensive - this family spent $1,000). As the news story points out, footpads and prescription sunglasses are OK, but food to keep your child alive is not? The dad of this baby makes an excellent argument that this is a medical issue of the mother-child dyad - the baby needs formula because the mother's medical problem has interfered with his natural food source. That's no different from having footpads because your flat feet have interfered with your ability to walk comfortably - and food to keep a baby alive is considerably more important than flat feet.

On the other hand, I see arguments for the other side. There's a difference between formula and footpads. Footpads (and massage and hypnosis, which are also covered) are very unlikely to hurt you if you don't need them. But formula does carry risks and ideally should only be used when there are no other alternatives. Yet if you start OKing tax-free formula for some women, where do you draw the line? A woman with a double mastectomy definitely can't breastfeed. But lots of women will tell you they "couldn't" breastfeed (didn't make enough milk, for example) when the real problem was poor breastfeeding management and/or lack of support. How do you certify that a woman who does have breasts is actually physiologically unable to produce enough milk? What if she claims psychiatric issues - are those "good enough" reasons to formula feed and to have insurance cover? We start getting into when a formula is "medically necessary" and when it's just "personal choice".

On the third hand (isn't there always a third hand?) think about the father's argument that: "There is no alternate product to give the baby. It’s not like the baby can eat a granola bar and get developmental nutrition from a prescription product, which would be deductible. It’s breast milk or formula or the kid dies." True, but there's nothing that says it has to be the mother's own breast milk. I wonder if the IRS would see things differently if they had gotten a prescription for donor milk and purchased that instead?

Anyway, it's an interesting one. Thoughts?

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