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GINA + effective genetic predictions = no health insurance

Tuesday, 29 April, 2008

The United States Senate has recently passed the Genetic Information Non-discrimination Act. This bans insurance agencies, and workplaces, from using information obtained from predictive genetic tests to discriminate against their clients (or workers). They can still use existing symptoms to adjust their premiums, but tests that suggest you might get cancer or a similar condition in the future will be off limits to insurers.

But this could provide some very serious problems if genetic tests become very good at predicting disease risks (and they will). If people know they will likely get a genetically-influenced disease in the future, they will take out comprehensive private health insurance. And if people know they very likely won’t get that disease, they will opt for a basic private health insurance plan to cover accidents and contagious diseases. (Those who don’t know their genetic disposition will probably stick with their moderate, employer-provided health plan – and most people say they won’t want to test their genome if GINA wasn’t there).

The effect of this is that insurance becomes less viable, because insurees are now cherry-picking their insurers rather than the reverse. Why would an insurance agency offer cancer cover, if the only people who opt for that will be people likely to get cancer? Offering such cover would be a net drain on the insurer! Therefore, private health insurance, though very profitable in the short term (before the diseases present themselves and claims start being made), will not be able to survive in the long run. No more private health insurance.

There are ways to avoid this. The obvious ways are to allow genetic discrimination (so premiums could be raised for the genetically at-risk), or to ban good genetic testing (not nice). A more likely prospect would be for insurers to be legally required to cover all genetically-determined or influenced conditions under all plans. This would, however, result in many people paying money for health care they will never need, but is arguably better than people going without.

The best (in my opinion), though also unlikely, would be for the United States to accept the death of private health insurance and move to a totally public health system, where all medical expenses are paid for by taxpayers. Taxes not used for health care each budget would be a surplus to cover previous/future deficits or create more facilities (instead of into the pockets of insurance company executives). Plus, genetic discrimination (typical or ‘reverse’) would be impossible.

Although I figured this out on my own, what I have said here has been, of course, said by many others. Here is the best one:

Personal genomics and the end of insurance

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