New at Reason

Julian Sanchez | February 23, 2005

With genetic testing technology improving rapidly, is a Gattaca-style insurance market just around the corner? Ronald Bailey renders his diagnosis.

Comments

|2.23.05 @ 11:44AM|#

Speaking of Gattaca-style situations, did anyone watch Code 46? The premise was that artificial reproductive technology had been so abused that humanity had only a few genotypes to go around. As a result the world government segregated genotypes into geographic areas to prevent inappropriate matings. Anyone caught having relations with a person of the wrong genotype was guilty of a code 46 violation and exiled. If you know the first thing about genetics then you know the premise is bunk, but I could suspend disbelief for the sake of the story. The disbelief I couldn't suspend was that it would take a massive government effort to keep people from creating disastrously malformed children. Not surprisingly the film stars ultra-statist Tim Robbins.

P.S. Still a decent film and it features Samantha Morton nekkid.

|2.23.05 @ 12:45PM|#

Limiting information which can be used by insurance companies is akin to limiting political speech/information via McCain Finegold. It won't work - even though the statist senators voted 98 to Zero in favor.

The result: Insurance companies will move offshore to offer their prtoduct to those willing to test. Just like the gambling industry which has moved offshore to escape the stupid US laws.

Mike|2.23.05 @ 1:06PM|#

I understand that for most people, the bad genes and good genes will cancel each other out. But what about the outliers? The people who have a genetic disposition for cancer AND heart disease: it seems like a rational, unrestricted insurer would be loathe to cover such a person. Do we just allow them to go without coverage?

|2.23.05 @ 2:00PM|#

Don't you think we're asking the wrong questions here? What does insurance have to do with this? The idea of insurance is to cover you for some kind of event whose likelyhood you can't calculate accurately enough to prepare for otherwise. If you get one of these tests and you find out you're certainly not going to get some disease or other, why buy insurance? If you get the test and find out you certainly will, then you had better start saving!

We can argue about the basic injustice of genetic disease (and what policies we need or don't to ameliorate it), but insurance is beside the point.

Mike|2.23.05 @ 2:30PM|#

If you get the test and find out you certainly will, then you had better start saving!

The problem is, none of the tests are likely to be that clear. Do you buy insurance if you have an 80% chance of getting the disease? 50%? 10%?

We can argue about the basic injustice of genetic disease (and what policies we need or don't to ameliorate it), but insurance is beside the point.

Actually, insurance is entirely the point, because these genetic tests amount to probabilities. Right now insurance companies use population-wide probabilities. This would allow them to use individual probabilities, which could easily disqualify individuals.

Obviously, most of the time these are going to be edge cases -- my high blood pressure gene cancels out my low diabetes gene -- but the edge cases are going to be the ones that decide the issue.

|2.23.05 @ 2:37PM|#

Don't you think we're asking the wrong questions here? What does insurance have to do with this? The idea of insurance is to cover you for some kind of event whose likelyhood you can't calculate accurately enough to prepare for otherwise.

Thank you for putting it so plainly.

I am constantly amused (and frustrated) when women complain that their insurance does not pay for birth control pills or pap smears, or men complain that insurance doesn't pay for their annual EKG. Or that they can't get "insurance" to pay for drugs to treat a condition they already have. If people want a subsidy why don't they just ask for one?

|2.23.05 @ 2:45PM|#

You're right, mike, that right now these tests give us nothing more than probabilities. But the core issue of the article, and the real problem at hand, is that the better the tests become, the more certain the predictions will be. I'd argue that the more certain the tests get, the less this is about hedging against risk (insurance) and more about correcting the misfortune of some of use getting saddled with hundreds of thousands of dollars of medical bills.

|2.23.05 @ 4:06PM|#

In point of fact, though, it is only true up to a point that "the better the tests become, the more certain the predictions will be". Most diseases, as Bailey is at pains to point out in the article, have a considerable non-genetic component to their causation. That will not go away no matter how good the tests get, and it will not be any less insurable either.

|2.23.05 @ 4:36PM|#

As usual, a clearly thought out position on this matter will depend on where a person stands in regards to more foundational matters.

Several posts above seem to suggest that people have a 'right' to insurance. Others suggest that insurance is not a right of all individuals.

That needs to be decided before deciding 2nd or 3rd-tier questions that depend on it.

If insurance is a right everyone has, then it needs to be changed already-- some people are being denied.

If it isn't a right then why should genetic profiling be verboten?

This law seems to me to be as foolish as a law forbidding insurers to use actuarial tables would have been long ago.

|2.23.05 @ 9:06PM|#

c,
I'd argue that the more certain the tests get, the less this is about hedging against risk (insurance) and more about correcting the misfortune of some of us getting saddled with hundreds of thousands of dollars of medical bills.

I think it is already almost entirely about that. I believe that people who study the US healthcare system will immediately concede that the word "insurance" as commonly used in healthcare is an unfortunate misnomer. I think the viewpoint at which you express incredulity is just people recognizing how the system works today and was designed to work, despite the unfortunate use of the word "insurance". And for that matter, since it's largely a contract between an employee and an employer (disregarding the very significant exceptions of Medicaid and Medicare), I think people are free to demand/negotiate/expect whatever they want out of it.

|2.23.05 @ 9:07PM|#

Oops, 1st paragraph is a quote, second is mine. Musta biffed the html somehow.

|2.23.05 @ 9:10PM|#

Case in point, how else do you explain that virtually every insurance policy covers expenses associated with pregnancy and childbirth? They're hardly unpredictable...

|2.24.05 @ 9:35AM|#

First, I'm persuaded by Nicholas's contribution that we're not really in any danger of eliminating the uncertainty from our medical fates with these tests, or any in the near future. My original point was that the "uncertainty" part was crucial, since it made an insurance-style business model serve the public needs for 1) a hedge against the uncertain risk of catastrophic illness, and 2) a wealth-redistibution scheme by which lucky healthy people pay for the medical treatment of unlucky sick ones. Eliminate the uncertainty, and those two interests diverge, and private sector "health insurance" stops.

Second, the inclusion of predictable expenses in health insurance policies might at first look a little odd, but think about it this way: once you've made this bet with your insurance company that you're going to get sick, they have a interest in keeping you not sick. Considering how spectacularly cost-effective preventative care is, we should be more surprised that they don't make periodic tests and checkups a condition of your insurability!

|2.24.05 @ 10:21AM|#

....they have a interest in keeping you not sick. Considering how spectacularly cost-effective preventative care is, we should be more surprised that they don't make periodic tests and checkups a condition of your insurability!

This is a good point. But people need to understand that these costs are not what the insurance is for. My car warranty (an insurance policy whose premium was rolled into the purchase price of the car) and homeowners insurance have certain maintenance conditions (eg oil changes) but don't reimburse me for those costs.

Perhaps I am just getting hung up in semantics.

|2.24.05 @ 10:48AM|#

I wouldn't be dismissive of semantics. Having accurate and mutually understood words for things is important. At its heart, this is a semantic discussion, about what exactly insurance is. People who are disappointed with what's covered in their policy are in a basic sense in disagreement with their carrier about "what insurance is."

Considering that most of the world's people get their coverage from the jobs or countries, "shopping around" for a new carrier consists of changing careers or citizenship. Needless to say, these aren't changes we make because we have to open our wallet for a pap-smear. Because this traditional method of fixing the product offered by a company ("shopping around") can't really function, what we need to do is get together and talk over what we need and what's expected of whome. Like, for example, here. And in congress.

|2.24.05 @ 11:37AM|#

Considering that most of the world's people get their coverage from the jobs or countries, "shopping around" for a new carrier consists of changing careers or citizenship.

For that reason I have long held that divorcing health coverage from employment would be a positive move. Especially since its not really so traditional (unless you consider since WWII "traditional") and it started because of a govt policy induced market distortion in the first place.