Our genes, medical insurance and tax.

[sophiecentaur]

Any insurance is, essentially, a gamble. Someone (a company) with more money than us is prepared to gamble, offering a huge stake (the payout) against our small stake (the premium). The Insurer works out the probability of a payout and calculates the premium that they want so that they make a profit on hundreds of clients but offer attractive enough rates to attract business.
If all the facts were known, the total premium would be equal to the expected payout plus some profit minus some factor due to the fact that they can invest your premiums for a while.
In the future, in the case of health insurance, it will by possible to predict very accurately, by looking at personal genetic makeup, the likelihood of an individual making large claims for many conditions. This means that insurance will cost more and more for potentially less healthy people.
Where can it end? One could argue that this is not 'fair'.

The NHS doesn't do it that way. Instead, they run out of money and services dwindle for everyone when total contributions are not high enough. Everyone complains at the suggestion of increased taxes for health but at least the taxes would be (ideally) spread around in a more 'fair' way.

Which do 'we' want? If I am a healthy person, I want the Private Medical Insurance model. If I am a potentially unhealthy person I want the NHS model.

Taxes are, in general, a very mild sort of leveling mechanism. The richest remain the richest, despite paying more tax. Should a health tax maintain the hierarchy of health in the same way that other taxes maintains the hierarchy of wealth?

 

[Andy Resnick]

In the future, in the case of health insurance, it will by possible to predict very accurately, by looking at personal genetic makeup, the likelihood of an individual making large claims for many conditions.

You've correctly identified a very real problem. AFAIK, there are no discussions about this currently taking place (in the US) at the level it matters- policymakers.

 

[Kerrie]

Genetics play a huge role of course in someone's health, but so do the choices a healthy person makes. The insurance company can't predict what choices you will make. And being a matter of opinion, I don't think health insurance companies should operate as a for-profit organization. Regence Blue Cross here in Oregon is one insurance company that is non-profit and still provides top quality care plus a great selection of private policies.

I would agree to having a genetic screening along with a general health screening if it meant a lower rate on my policy. Life insurance policies do the same, and so do auto insurance policies (in running your driving record). Then again, I am already extremely healthy and I take very good care of my health.

 

[Pengwuino]

I would agree to having a genetic screening along with a general health screening if it meant a lower rate on my policy. Life insurance policies do the same, and so do auto insurance policies (in running your driving record). Then again, I am already extremely healthy and I take very good care of my health.

There's the question though, would it mean a lower rate? That's assuming they don't find something bad.

I don't think this concept would fly in the grand scheme of things. People seem to be pretty dumb and if you introduced this idea, they'd start thinking (and some already do) genetics pre-determines (as opposed to simply increases chances of certain things) your life and they'd have a just argument in saying "why should I pay more for something I can't control?".

 

[Andy Resnick]

Genetics play a huge role of course in someone's health, but so do the choices a healthy person makes.

There's the question though, would it mean a lower rate? That's assuming they don't find something bad.

That's the essence of the problem- we are learning new genetic markers for disease practically *daily* (BRCA1 and CARD 15 are good examples), but the science is much more ambivalent than the popular press indicates.

Should you bear a greater cost in insurance payments if you test positive for a defective gene that results in a (say) 30% increase in the chance of getting cancer? What about putative genetic foundations of alcoholism? If you have 'bad genes', should there be financial pressure for you not to have children, by say, increased cost of prenatal care? And your children will also (likely) have higher insurance rates...

There is already social pressure to perform genetic testing at birth because of severe diseases like muscular dystrophy.

And then, of course, there's financial pressure to put all of *your* medical records into electronic format that can be accessed online by docs and insurance companies. And it's obviously safe, because nobody would ever hack those records.

 

[Kerrie]

There's the question though, would it mean a lower rate? That's assuming they don't find something bad.

I don't think this concept would fly in the grand scheme of things. People seem to be pretty dumb and if you introduced this idea, they'd start thinking (and some already do) genetics pre-determines (as opposed to simply increases chances of certain things) your life and they'd have a just argument in saying "why should I pay more for something I can't control?".

Yes, I would certainly agree that genetics testing most likely would cause some uproar, however, not knowing what our tendencies are in our health can also make it worse. If we know ahead of time that we have a higher chance of getting cancer, we can choose to take healthy steps to reduce our risks. In theory, if the health insurers know you are making healthy choices despite your genetics, this might offset your premiums.

Then, there are those who have perfect health, but choose to drink more than what is deemed healthy, or they smoke, or they engage in risky hobbies such as rock climbing that insurance companies are taking a really big gamble on. Last year, my husband & I purchased life insurance, and those policies require blood & urine draws, plus a full background of health issues within the family. The chances are a lot less that I will use the life insurance policies (heaven forbid!) over a health insurance policy. Health insurance companies don't do this sort of screening to determine your rate-and there is a higher chance of utilizing the money paid into those policies over the life insurance policies.

We Americans are very reactive in our healthcare instead of proactive, and I believe the reactive approach costs our country and the public system a lot more money then necessary. Now, we are trying to fix a broken system with not really fixing the real problem, which is centering our lives around being healthy-eating correctly, getting enough exercise & rest, and indulging in our vices in very little moderation. (Ok, I admit I AM addicted to caffeine!)

 

[sophiecentaur]

From the replies, I can see that the NHS (UK) idea is not familiar - and possibly not attractive.
You mostly seem to be looking at the question in terms of "how does it affect me?" rather than "how should it affect the way that healthcare is arranged for everyone?"
My question was really along political / moral lines. Should the inherently healthy benefit overmuch from their good fortune? We all would agree, at least in theory, that people who don't 'look after themselves' don't necessarily deserve all the benefits of someone who lives carefully but when should selflessness kick in?
I know of someone who lives near me who has been refused treatment on the grounds that they have refused to quit smoking. On the face of it that sounds reasonable but some people find it extremely hard to quit - is it just 'their hard luck' or should they really be penalised for that?
Genome studies are a pandora's box and the possible consequences really must be looked at and some policies (laws) established to 'make us', as a society be relatively generous in this matter before things really begin to bite. By which time, the self interest of the healthy and wealthy becomes too hard set to give 'the rest' a fair deal.

The point has already been made of the close association between genetic knowledge and Kismet.

 

[Andy Resnick]

I know of someone who lives near me who has been refused treatment on the grounds that they have refused to quit smoking. On the face of it that sounds reasonable [...]

Wow. Regardless of my personal habits and beliefs, that an alien concept to me. For example, although there are guidelines for organ recipients here in the US, those guidelines are often waived if the patient is wealthy/famous (see, for example, David Crosby).

 

[ViewsofMars]

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