The G.I.N.A. could be a bad thing for healthcare.

The DNA Network batted this issue around several months ago, but it’s coming back in the form of a Letter to Nature.

His argument is that there’s no guarantee that making insurance companies remain ignorant of a patient’s genetic risks will prevent discrimination against those who have the unlucky combination of poor economic status and genetic risk factors.

I think he’s right. For one thing, the government would have to force people to not voluntarily disclose their info to the insurers, perhaps in exchange for a premium reduction, and that would be a little heavy-handed, wouldn’t it? Currently, the system helps those with higher risks obtain insurance by essentially letting the people who pay in without making claims subsidize the rates for those who make more claims than they pay in. Why couldn’t it work the same way if the insurers were able to take genetic risks into consideration? It might even lower the total cost of insuring everyone, allowing the insurers to cover more people for the same costs, or the same amount of people for much less cost with the high risk people picked up by programs similar to those which cover the homes of those in flood-prone areas. (As a New Orleanian, I’m not one to sign the praises of FEMA, believe me, so I’m not holding the NFIP up as an example, I just think the actuarial considerations are similar). Maybe we could even make enrollment of a certain amount of high-risk people a condition of being allowed to set rates based on genetic profiling?

This is all jumping the gun a little, because actual rock-solid, high-confidence correlations between a genetic feature and a disease are still rather rare, but one thing’s for sure: The better you see what’s ahead, the better you can plan for it (whether a insurance company or an individual), and having a good plan leads to better outcomes for everyone. Everyone’s worried about enabling social injustice, but it can’t really be said that our current insurance system in which many are so under-served is really all that great to begin with, so let that temper your thoughts, as well.

Genetic-Future via Genome Technology

About Mr. Gunn

Science, Scholarly Communication, and Mendeley

20. March 2008 by Mr. Gunn
Categories: Uncategorized | Tags: , , , | 6 comments

Comments (6)

  1. Good post. I hope to read more from you on this and related subjects in the future.

  2. The technology and policy is still new but we’ll have to wait and see how it pans out for us to be able to determine whether it is a success or not. I still have my mistrust of FEMA though.

  3. Yeah, we all do. I’m more worried about the Corps of Engineers, but that’s another story.

  4. If barack obama gets his way… we might as well start changing the prices on the back of our books to match Canada’s pricing on national healthcare in a socialist economy. The banks will be run by the government and all hell just might break loose.

  5. There’s a number of things wrong with what you just said, so I’m not quite sure where to start, but let me start from the back and work forwards.

    First, I don’t know if you’ve noticed, but all hell has already broken loose. Hell officially broke loose around August of last year, but was breaking little by little over the past several years. This happened because in charge of things people assumed the market would solve its own problems in every case. As it turns out, it does solve most problems itself, but there are certain exceptions which break it. Follow me now, because I’m about to take a sharp turn. Finance is the very role model for efficient market theory. If a market failure can exist in finance, it can exist anywhere. Healthcare and education are two cases where the free market is currently failing, so there’s every reason to be even more worried here than in finance. In healthcare, significant externalities exist. The value of healthcare fails to be properly set by the market because people largely don’t understand how to take care of themselves or what treatments are most effective for their money. They don’t have the background to understand, because the technology is so advanced and there’s no incentive to educate people. Because people can’t fully understand everything about health and medicine, they trust doctors to know and handle their health for them, kinda like how most people don’t fully understand finance and expect(ed) their 401k fund manager to handle their money for them. See where I’m going with this?

    We’re not able to take care of everyone who needs treatment if we wait for them, or their well-meaning-but-overworked doctor, to decide to get treatment for something that could have been prevented in the early stages for a lot cheaper a lot earlier. We can ignore the looming disaster in healthcare, like we overlooked the looming problems in the securities market, or we can move to a hybrid model which attempts to correct for things the free market fails at handling, like preventative care or speculative bubbles. Or we can just let the inefficiencies ride and let costs increase to the point where only the wealthy can afford good care. Sounds fair, until the peasants revolt. Getting shot is a “Black Swan” healthcare event, which could happen to anyone, no matter how carefully they watched their health, and would be a heck of a lot more likely if basic healthcare wasn’t available to everyone. Of course, if you’ve got the money, you can still pay for whatever procedure you want, but insurance can and should only cover what can be shown to be effective. The choice is between maybe not having a treatment covered because everyone has the same coverage or denying coverage to large numbers of people. We’re not at that point yet, but this time maybe we shouldn’t wait for the shit to hit the fan before doing something, eh? (get it, eh? That’s what they say Canada.) It’s not going to be socialized healthcare, or banks. The only freedom they’re losing is the freedom to fail catastrophically. Market forces will still be brought to bear on healthcare, but externalities arising from the fact the people don’t understand and don’t have time to learn everything they need to know to make the best decision will be controlled, and they’ll be controlled by using the most democratic practice possible: empirical proof. If what you want to do and what the best available science suggests you should do conflict, you can still do it, you’ll just have to pay out of pocket to do so. In return, the poor sap on the corner will be able to get treatment for his appendicitis, and hey, maybe he’ll even be able to go back to work. You know, get a job, pay taxes, that sort of thing. Maybe he won’t remain on the corner and mug your grandma when she walks by. Hegelian Dialectic, anyone?

    OK, so I’m out of time, so I’ll leave the book pricing /healthcare pricing discussion till later. Maybe that’s best, anyways.

    That said, finance and healthcare are minor compared to the looming disaster we face from failing to educate people.

  6. I’m not in favor of the Government forcing people to do things they don’t want to do (or to not do things they might otherwise choose to do). It also seems that when the government gets to involved in the market we get market players (insurance companies) who unfairly benefit or get destroyed – neither result is a good one. So although I don’t love the idea of government health care, if we are going to have it I would prefer that it be provided directly (open the VA hospitals to all who need them?) while the rest of the market be left alone to work or fail according to the true costs and true needs of the consumers.

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