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UK Allows Insurers To Use Genetic Test Results
np-complete writes: "According to this article from BBC News, the UK government has decided to allow insurers to deny cover or increase premiums for those who have tested positive for Huntingdon's Chorea, despite the recommendation by the Human Genetics Advisory Commission for a moratorium on the use of such information. The government has decided that insurers should be able to use information from genetic tests if it is deemed technically reliable by the Genetics and Insurance Committee. The report claims this makes Britain the first country in the world to approve this kind of commercial use of gene technology. The government says it's 'good for consumers.'"
As long as it's voluntary, then we all win - you can either take the test and get cheaper premiums, or you can not take the test and satisfy your urge for privacy. It's a win-win situation.
Not true. Voluntary tests harm the average consumer. Why should the average Joe have to pay for some other guy's debilitating hereditary disease? It's not his problem!
Look at it this way: most likely, most of your hard-earned money that you spend on medical insurance isn't going to you, it's going to some other sick guy with the same company. It's downright criminal that the insurance companies don't take reasonable measures to prevent unhealthy people from abusing the system in such fashions.
Now, don't accuse me of being callous. I donate to charities for this sort of thing. But people shouldn't be required so pay for the costs of other people's illnesses.
Well, if you "screen out" people who are likely to make claims, then you're left with a pool of people who are likely not to make a claim, so what's th epoint of paying insurance?
This is just profiteering, plain and simple.
New Labour, Old Conservatives.
I hope they get voted out in the next general, i just can't stand that ugly grining git's face any more. As for that hypocrite Straw, he can fuck off too.
Oh, and i'm going to vote Lib Dem. At least they're fuckin' honest about Tax.
that reminds me. I was actually just thinking about this this morning. according to star trek there was a eugenics war (not an actual war mind you with all the shooting and whatnot. more like a cold war with genetics) in the early 21st century. Khan was a direct product of that war. ten times stronger than any man but unfortunately very violent minded. so what's this mean? we're hitting every nail on the head when it comes to star trek. at this rate we should have WW3 in fifty years in which the major world govs will collaps all the politicians will die and the people will have to get along by themselves (fairly optimistic really the govs collapse before too many civilians are involved) and then some guy invents warp drive. so mabey it isn't looking so bad after all. that is so long as we remember to stick khan in cryo stasis and launch him into deep space.
For the complete oposite of this system look at the Irish system. Profileing of any description is illegal for health insurance. the only thing the insurance company is permitted to profile on is your age. To see an example of this at work get yourself a quote at http://www.vhihealthcare.com/on_quo_m.htm This system would strike me as the fairest but it should be noted that healthcare here is state-funded to a certain extent anyway.
Whether we like it or not, medicine has relaxed the natural pressures that keep our species from genetically deteriorating.
Perhaps letting insurance companies charge me a bit more because I have 20/800 eyesight and a bit less because I have a good immune system will motivate many of us to be more concerned about the blueprints we give to our children.
As when I signed up for my current health insurance, I had to undergo genetic screening.
(I'll see if I can find my copy of the form I had to sign, giving them permission to run the tests, and explaining what they would be checking for.)
As I recall, the form was a masterwork of fine print - on the front, in big letters it explained that it was to check to see if I had AIDS, or other serious diseases with a long latent period.
On the back, in very light colored letters it explained that I was also giving my consent for genetic screening for preexisting conditions..
The test itself was simple, a tissue sample from the inside of my mouth was sealed in a vial with was injected with some blue fluid, and then slapped in a mailer to some testing company.
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Is the optimum that a person's premimums are set so that over a lifetime of payment, they pay the cost of all their medical bills plus the overhead required to run the insurance companies overhead, make profit, etc? In this case, premimums that are strongly tied to risk factors (including genetic makeup) would be trend.
On the other extreme, is the goal that the cost of every customer's medical care over a lifetime equals the total paid premimums plus operating expenses, profit, etc? On this extreme, make a flat rate premimium would be possible (though not very probable when market forces are considered).
I'm sure economists debate this one. Which is it? (or better yet, where on the continuum is it?)
The only thing I find cheery in this is that it won't be a win for the healthy or the insurance industry.
The industry is moving to making money, not by insuring (that is, by averaging rick over many people), but rather by fleecing people who will never need insurance. So either the industry will be forced to make its profits gouging ever smaller pools of low-risk customers (as they redefine rick to be a narrower and narrower pool), or those people will wise up and realise that they don't need insurance, and the industry will go bust.
Most of the issue you cite are based on observed behaviour of a (potential) client. My no-claims bonus comes from the fact that I've driven on the road for more than 11 years without making a claim. I chose to live in a low crime area.
One observation I have on insurance: where it's mandatory, the comapnies gouge. Car insurance is ten times the cost (for me) in the UK that it is in New Zealand, and the main difference is that I'm required by law to have it in the UK and I'm not in New Zealand.
I see a lot of people outraged here, which I think comes from the American assumption that they're talking about *health* insurance here, which they're not.
Yes, it would be unfair to deny someone health insurance because of a genetic predisposition for a disease. (And as a poster above put it, this shows that insurance is a stupid system for delivering health care.)
But Britain has nationalized health care. (Which I wish we had in the US.) So they're talking about life insurance in the article. And allowing insurers to ask about Huntington's disease, including whether you've already been screened, is very reasonable. Otherwise, you've got a wide open chance for someone with the Huntington's gene to screw the insurance companies royally!
Think about it: suppose you knew that you had a genetic disease that pretty much guarantees that you'll die before age 50, but the insurance companies were prohibited from asking you. Wouldn't you go buy as much term life insurance as you possibly could? Have your benficiaries pay for it at a rate of 150%, skim that 50% off the top for yourself, and it would still be a good investment for them.
Americans: don't let your justifiable loathing of the health insurance companies and their support of a broken health-care system taint your opinion of other insurance companies, which are, in my experience, honest businesses that provide a good service. I do believe that access to quality health care should be a legal right. But life (and auto, and property) insurance should not be.
That might not even work. Most insurance companies have this clause about "pre-existing conditions", of which this probably counts. If you got insurance while you knew about this condition, that's usually grounds to have the insurance revoked (and they probably wouldn't give back the premiums, either).
...phil
...phil
"For a list of the ways which technology has failed to improve our quality of life, press 3."
>companies will just pocket any savings. Do you
>actually think you'll ever see a news article like
>"Insurance companies have announced a general
>rate decrease because of savings from exclusion
>of high-risk people." Not a chance in hell
Not to rain on your parade or anything, but I recently got 4 checks back, totalling a couple hundred dollers, from my auto insurance company (State Farm) because they had collected more in premiums than they had in claims. Now, maybe the payments didn't take their bank account to zero, but they didn't keep it all, either.
...phil
...phil
"For a list of the ways which technology has failed to improve our quality of life, press 3."
I have lived in both MA and NJ and have had a car since I was 20.
even with tickets I have never had insurance that hight, and thats with collision and theft coverage. on a toyota corola (old) and a new VW Passat.
my insurance on the Passat comes close as a 24 year old (not yet eligable for the 25 year old break) and with a $250 deductable on collision (the starndard is $500). I still pay $900 less than he does.
the main problem is the fact that he has to carry much higher insurance because the car is a lease, you often have to take a lower deductable and much higher levels of coverage, costing a considerable amount more.
kind of rough isnt it. but thats the price you pay for leasing. especialy if its a new $25,000 car especialy if it is high performace.
I hate leases myself, I could be paying less for less coverage if I wanted to, but in a lease you dont get that option because the dealer is taking the risk.
"In America, first you get the sugar, then you get the power, then you get the women..." -H. Simpson
If you have insurance you are (or your employer is) is almost definitely already paying more in than you will get out. Back when I looked into getting health insurance for myself it was something like $400 a month. I figured I'm young and healthy and while I might go to the doctor once a year for a checkup it certainly wouldn't cost me $5k for a checkup. I figured that if I put the $5k each year into savings then I'd have more than enough for medical expenses in 20 years when I might need it. I saw no good reason for having insurance.
That said, I've been reading up on probability theory recently and it occurred to me the other day that there is a rationale for having insurance. While having insurance increases the expected value of what you will pay for medical expenses, it decreases the variance. In other words, if something catastrophic happens to you physically it won't be as catastrophic financially. So even now, insurance only helps you in worst case scenerios, but that is useful in itself.
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I could sit here and criticize the lousy brits and their facist corporat-owned government, but we all know that the same thing is coming to a red-white-and-blue country near you soon. Just like the DMCA and UTICA.
These are my friends, See how they glisten. See this one shine, how he smiles in the light.
"As long as it's voluntary, then we all win - you can either take the test and get cheaper premiums, or you can not take the test and satisfy your urge for privacy. It's a win-win situation."
I hate that "win-win" expressions. That's what managers say when they're trying cover up something that really isn't that good for the other party.
Just because it's voluntary, it's not a good situation at all. When the number people taking the test rises so that non-testers are in a minority, it won't be much of a winning situation. Insurance companies will eventually be able to statisically treat non-tester as if they are as high as risk as those pre-disposed to the condition.
You can't help your genes, so I don't think that you should be judged by them. This is the first step to pre-natal genetic screening.
When you purchase an insurance policy (insurance against the unknown?), sure, if you're perfectly healthy, then you're paying more than you need to, and subsidising somebody else's health care, etc. You could potentially get it cheaper if you were genetically screened. But the insurance company still needs to bring in the same amount of revenue, so they'll jack up the prices for the higher-risk customers. As the number of people refusing screening falls into a minority, their rates will go up, and the people being screened will effectively no longer receive a discount. Healther people will feel forced to be screened just to pay a decent rate. That's hardly win-win.
I think the attitude that it is okay for screening if it is voluntary is very short-sighted.
I like the fact that car insurance companies jack up rates for high risk drivers. People can control their risk and make a conscious decision about how they want to drive. However, if mother nature has thrown you a curve-ball and given you bad genes, there's nothing that you can do about it, and it's hardly fair to be judged on it. Healthy people who want genetic screening are being selfish and callous.
People can make choices about how they drive. They have an element of control over their premiums.
Personally I think that young and old drivers should be priced out of the market. They put everybody elses lives at risk. (Sickness due to bad genes is a personal issue and doesn't threaten society in the same way).
Insurance based on genetical screening is wrong. People have no control over that. Well, not without pre-natal screening... but that's an altogether different can of worms.
Interesting idea. Wouldn't the insurance companies want it be covered as a pre-existing condition? In which case if you didn't declare it to the insurance company when you sign up, you would be liable? Makes you not want to know your own pre-dispositions!
... for a view of this situation taken to its logical conclusion. Hint: The insurance-company execs are not happy.
I refuse to believe corporations are people until Texas executes one. -- desert rain on http://www.dailykos.com/user/
You also failed to mention what kind of car you drive. A 1.9L 4 cylinder, or a 5.0L Mustang, or a Audi TT, or what? That would certainly make a difference, not only wrt to cost of paying out, but also gives the statistics another axis to play with.
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For now, yes. But just to play devil's advocate for a minute, what else are they doing with your genetic information? They claim they're testing for one specific defect. But what if they keep your genetic information on file, and at sometime in the future, a test for some completely separate defect is developed. You've alredy had an independent DNA test and verified that you're not susceptible to the initial defect they're checking for, so you happily consent to the DNA test. But then at a later date, they decide you're susceptible to something completely different, and hike up your premium (or even refuse cover completely). As I understand it, this can't happen yet, because they can't get a complete mapping of your genes in a sensible timeframe -- they can only check for one given problem. But how long before they can? If we've already accepted genetic testing, how can we ensure ethical use of that information in the future?
"The invisible and the non-existent look very much alike." -- Delos B. McKown
The thing is, they're right... if you're one of the lucky ones with the right genes. It'll mean lower premiums for the genetically "healthy" and higher premiums for those more susceptible to certain diseases. It's really just an extension of the existing system of higher premiums for smokers. The only question is where do you draw the line? Eventually, we'll end up with a system where the only people that can get life insurance are the ones that aren't going to need it anyway...
"The invisible and the non-existent look very much alike." -- Delos B. McKown
It always has amazed me that this discrimination exists too...I say that if it were opposite (i.e. women as a group were considered the worse drivers) then gender based ratings would have already been prohibited.
Consider it this way, when you go to an insurance company and ask them for a rate, the question on gender breaks down to whether you have a penis or a vagina. The penis people seem to be worse drivers, but does that mean you (assuming you have a penis) are also a worse driver than if you had a vagina?
A Canadian friend of mine noted that car insurance in Canada is far more expensive than it is in the United States. Apparently, Canadian law requires you to have an absurd amount of liability insurance...like over $1,000,000 per year. That, and some other onerous regulations makes it very expensive.
I live in Ohio...one of the nation's cheapest states for insurance. While we have some really big population densities and high traffic (more land zoned urban than any other state) insurance costs by state are more dictated by laws and probability of auto theft. Michigan and Pennsylvania have really high rates because those are "no fault" states. NJ, FL, CA, TX have really high insurance rates because there is an extremely high probability of auto theft (thieves take the stolen vehicle across the border or the ocean.) Except for Lake Erie, Ohio is landlocked.
I am 22, own a 95 Saab Convertible, pay about $1300 per year, and am registered in a high population county.($250 deductible, 100/100/300)
..lation.
Look, it makes no sense to only insure those who have little to no risk. Back in the days when Blue Cross was a regulated non-profit they spread their risks across a wide population and adjusted the premiums accordingly.
Recently, after the advent of HMOs and other cost cutting measures, we've seen insurers divide their customer pool by various risk assessments in order to differentiate premiums across the population by various risk factors. This, and other genetic tests like it, provides the insurance industry with yet another mechanism to assess risk in order to deny coverage, or charge higher premiums.
At a certain point, after the risk assessment gets good enough to set premium policy at cost with the coverage of care, as a society we should ask ourselves "what good is paying this policy if it only serves to charge a fee atop whatever my doctor costs?" In other words, when various risk assessments such as genetic testing get good enough at predicting risk, insurance companies will simply be tacking on their fee directly atop your doctor's fee; thereby dismantling the primary purpose of insurance, that of spreading risk across a population.
Health Insurance companies are for-profit, generally. They exist to make their shareholders money. Therefore, whatever there is demand for, they will provide.
What is driving this scenario is DEMAND: low-risk individuals, who constitute the majority, demand lower premiums. The insurance companies realize they can make a bigger profit this way by denying coverage to high-risk individuals. Now, the technology exists to actually do this type of screening.
What I see happening is exactly what _should_ happen:
(1) Low-risk individuals will pay less.
(2) Medium-risk individuals will pay more.
(3) High-risk individuals will be unable to obtain health insurance.
Perhaps this will entice geneticists and technologists into fixing the problem at the source, now that we have the technology to do so. Having a healthier population is not a bad thing, and presumably if we can screen for a defective gene, we can also repair it before fertilization.
[ home ]
So would you outlaw no-claimes bonuses? Lower car insurance premiums for women and older drivers? How about insurance 'discrimination' based on whether you live in a high-crime or low-crime area?
-- Ed Avis ed@membled.com
No, they're based on observed behaviour of a particular group of people. Lower premiums for a new woman driver than for a man are based on the past record of other women. Of course there's nothing to say that the past record of a particular class of people will tell you anything about one member of that class, but in practice it works out pretty well.
So imagine a male driver who has just bought his first car and wants insurance. The high premiums he pays cannot be based on his past behaviour - he has never driven before except in lessons and the driving test. Yet it is a fact that young men are the most likely to have accidents, and that higher premiums are needed for them to be profitable customers. It's not this driver's 'fault' that he belongs to a high risk group. He may even be a very careful driver. It's not 'fair'. But why should everyone else pay extra to underwrite the risks of one particular group? And they won't, unless you pass laws to restrict everyone to buying from 'approved', non-discriminatory insurance companies.
It's similar with genetic predisposition to particular illnesses - it's not based on past actions, it's not anybody's fault, but indisputably there is a higher risk.
You mean you can afford to.
Maybe in New Zealand only the naturally cautious, risk-averse type of person buys car insurance. These people are probably safer drivers than the average.
-- Ed Avis ed@membled.com
How would you deal with the problem of somebody having a genetic test, finding out they're likely to get a particular illness, and then buying life insurance before any symptoms show? If that happened a lot, it would push premiums through the roof, or more likely make the whole life insurance business impossible.
-- Ed Avis ed@membled.com
A lot of insurance companies seem to disagree. They employ a lot of people whose job it is to work out how risky particular groups are, and they seem to have all reached the same conclusion. Are you saying that all the insurance companies are wrong, and that differences in premiums are a marketing gimmick? What research have you done in this area?
Right. They do have fewer accidents. You admit that this is a fact.
Insurance premiums aren't based on any sort of principles or sense of fairness. They're based on how much the company can get away with charging, which in a competitive market means how likely the customer is to make a claim. You may not like the fact that women or older people have fewer driving accidents than young men, but you'll just have to accept it.
-- Ed Avis ed@membled.com
So... if you were an insurer, and you had two customers...
Customer A: 'I have never made a claim on my insurance.'
Customer B: 'I've made five claims over the past ten years, but I can prove none of them were my fault.'
Can you honestly say that you'd be just as willing to insure B as you are to insure A at the same price? Would it be too much to admit that just maybe, B is more accident-prone than A? Perhaps he drives more often, or on more dangerous roads. Perhaps he's just unfortuate because he lives in an area full of idiotic drivers. But wouldn't any of these factors increase the risk?
I sympatize with you over the fence episode. All I can say is: choose a different insurer, or don't rely on the no-claims bonus. And remember that the company isn't obliged to sell you insurance at any particular price, any more than a shop is obliged to sell you goods at a particular price.
-- Ed Avis ed@membled.com
We are on the cusp of a long forseen revolution: evolutionary pressure on the human race based on hereditary meta-data (genetics). I think Darwin would be truly amazed.
;-)
This practice will put greater financial burden on those predisposed to inheritable deseases. Unfortunately, this will lead to an already forseen consequence caused by the fact that the poor reproduce at a higher rate than the well-off... de-evolution.
Ah well, you win some, you lose some. It's a damn good thing that human ingenuity of a few people can help make up for buggy genetic coding of many.
Now where did I leave my genetic debugger?
the growth in cynicism and rebellion has not been without cause
Basically, if you need insurance you'll be barred from it so they don't have to pay. Takes care of the liability side of the balance sheet now doesn't it.
But on the reverse side, if a company is willingto insure you, you can be sure that don't need it. That will certainly cause a divot on the asset side of the balance sheet.
And as for the poor souls who get thrown out in the street to hobble on their make-shift crutches:
WE DON'T GIVE A FUCK! WE'RE HEARTLESS AND HEALTHY (we hope) SONS-OF-BITCHES!
If you're sick, DIE!
MSBPodcast.com The opinions expressed here are my own. If you don't like 'em... Think up your own stuff.
Hey, I just realized something.
Everybody in my family eventually died of something.
I guess none of us are insurable. So why buy any? Ain't that a bitch...
Insurance for profit is a myth. Insurance should be so that the 85% of the population who's healthy (and which individuals are in that 85% changes,) can take care of the 15% who aren't (and likewise which individuals are in that 15% changes.)
MSBPodcast.com The opinions expressed here are my own. If you don't like 'em... Think up your own stuff.
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Americans are bred for stupidity.
What? You won't make as much money if you don't know in advance how we'll throw the ball? Hey, though shit! That's life!
Who the fuck you think you are? You're just a fucking company. You don't even have the fucking right to vote, so why the fuck should you get fucking special treatment?
That's the problem with companies: they think that they oughta get special treatment over the people.
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Americans are bred for stupidity.
The bourgeois subversion seems to be successful. We're gonna have to call for résistance.
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Americans are bred for stupidity.
Of course not. The purpose of the insurance industry is not to spread risk. The purpose of the insurance industry is to sell insurance policies and make the brokers rich.
A couple of other posts have mentioned having to pay extra in insurance premiums over and above the actual costs of treatment. This is true. But how many realize how much extra they're paying?
I've worked on databases for insurance companies. I've seen the numbers. 60% of what you pay in insurance premiums goes to commissions. Only 40% of what you pay is actually used to 'spread risk', the rest goes right into some insurance agent's pocket. (The cynical might suspect that they're so reluctant to pay out because every dollar paid in benefits is a dollar less to pay in commissions.)
Who else thinks this is the first step towards the societal "genetic discrimination" concept put forth in Gattica? (Gattica was a not very popular, but extremely interesting, SciFi movie that came out a few years ago.)
It's coming--
Job interviews consisting of nothing but a blood and urine sample analysis to determine genetic aptitude and/or purity...
Screening for predetermination for mental illness so you can pre-emptively commit someone to an institution...
SlashSigTheorem: Humorous, Political, Critical, Constructive- If you have a
Ok, so you an insurer. You can either screen people for genetic disorders and reject them accordingly, or you could not and take the monetary penalties for it. I'll screen people, thanks.
Unfortunately where does this stop? Do we screen people for asthma? cancer? predispositions to heart disease? What if they could screen someone and tell if they'll be a smoker or permiscuous and possibly get a deadly STD? Where does it stop? It doesn't. You either not do it at all, or it will eventually dominate. Look at HMO's and the way they've raped the health care industry. Before HMO, health care was not just about profit; it was about people. HMO's came along and made the bottom line profit. Go to Hartford CT, and look at all the 30y/o management majors making a butt-load of money working for the health care industry. They're making money off of denying people the right to live comfortably.
Well its worse than that. HMO's are still expensive. They don't pass down the savings to the people; they pocket it. The entire US needs to do what Minnesota has done: Ban for profit HMO's. Its that simple. Then when you need a liver transplant, you'll actually have a chance of getting one, instead of getting caught up in the red tape until you die.
I never said these people were inferior. I was making the point that they are in a dirty business that screws people for a living. I've experienced it myself. What I've also experienced is how many 30 y/o middle management people are making 200k+ working for Cigna, etc. who are buying big-ass houses which they wouldn't be doing before HMO's came about.
Insurance companies only care about profit. Thats the bottom line these days. 10 Years ago it was not like that. Profit _IS_ important, but to the extent that the organization needs to survive.
Many important people left the industry when they saw health insurance go from an industry for people to an industry for profit. Just look at the stock value for Cigna and how that changed in the early 90's when HMO's came about.
As for your job being inferior; I don't care what you do for a living. However if you're in the business of screwing over old ladies who need a new liver or an old man who needs a new heart, you can burn.
I've witnessed this. I have connections. I know how and when this happenned to the health care industry.
The larger problem is that any healthcare *period* has become so expensive in the US that no one can afford it. "Insurance" has become less about risk (ie, how sick will I become?) and more about a subsidizing all access to healthcare.
I went to a neurologist to have him provide a treatment and diagnosis of cluster headaches. I spent 45 minutes with him and his diagnosis consistent entirely of a patient history and a simple neurological exam. No drugs, equipment or facilities outside of the exam room. Total bill? $500. Trips to a general practicioner? 10 minutes and a simple perscription written? Over $200.
It's obvious that even the most *basic* medical care is too expensive for all but the wealthiest to pay out of pocket, so people like me with decent jobs rely on our insurance to subsidize our care.
The problem is, this gets away from the risk/payoff situation of insurance, and gets into healthcare subsidies that the insurance model of care is ill-equipped to deal with.
Health care costs need to be contained (part of which we could accomplish with a more modern attitude towards dying -- my mom incurred over $150,000 in the last six months of her life for hospital bills for treatments which would not extend her lifespan or materially improve the quality of life).
Insurance is a way to lower the impact of an unknown event. Once it becomes a known event, then you deal with it other ways. Maybe society says "We'll help you out because it's not your fault, but try not to pass those genes on". Or the individuals can plan for the eventuality by saving up. Or several other ways. But it's not insurance's job to cover those instances.
This relates to what I thought was the most inflammatory part of my post which no one responded to. What you're describing (and what insurance companies seem to be pursuing) is kind of a corporate, MBA-cost-benefit-analysis eugenics. We're litterally deciding who should live or do (ie, access v. no access) based upon a person's genetic makeup.
I can admire Nazi Germany for any number of qualities, but eugenics is not one of them. What's surprising is that while the concept of eugenics applied to races is considered "bad", we're quietly accepting this financially based eugenics as if a monetary justification was somehow acceptable.
The problem with insurance companies using DNA information is that eliminates risk on their part. They've been able to do this in the past by using statistics based on past behavior and population studies, but there's never been a guarantee.
The business idea behind insurance is that the insurance companies are, in exchange for money, assuming the financial component of risk -- the uncertainty of future events. By taking my money, they're in essence agreeing to assume my risk. And by paying them, I agree to forfeit money now to insure that I don't forfeit even more money. The risk I face is that I might not experience an event covered by my insurance, which is why insurance payments are generally foreited -- you don't get them back. (Except in the case of some life insurance policies that mature or expire).
By getting access to genetic information about what diseases people are either guaranteed or highly predisposed to get and being able to only insure those not likely to get those diseases, the insurance industry is in effect stacking the deck -- they're drastically eliminating their side of the risk equation. So where's the insurance?
This is in addition to the larger problem it creates for health care -- it distorts the risk pools. We'll have insurance carriers that only accept genetically healthy people -- those who would pay in more than they get out. And those who would get more out than they pay in? They're either non-insurable or they get stuck bloating inefficient government programs or paying ridiculous rates to the high-risk arms of the rich insurance carriers who won't mix risk pools.
In many ways this is corporate-sponsored eugenics, and it really scares me.
Solely? Of course not. You measure it the best that you can. Genetic testing is one such tool that increases the accuracy of that determination. It is less accurate than a crystal ball, and more accurate than assuming a fixed probability for the whole population.
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Government programs can prevent death and suffering? Holy shit, we must be living in Heaven on Earth!
From a fair payoff matrix to murder -- truly an amazing leap of logic.
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It's not bad if everyone shares the risk equally. But if they share it disproportionately, then it's about as bad as communism.
If everyone had the same risk, insurance would be fair, because no one would be getting something for nothing, and no one would be a victim. The probability of you having a disaster multiplied by the cost of that disaster, would be equal to your predictable premium (minus the overhead/profit of the insurance company, of course). That is fair. That is what risk sharing is all about, and it is the reason that insurance is justified.
But when that probabilty times expense is noticably unequal to the predictable premium, then something is wrong. If it's greater, you're a parasite that is getting something for nothing. If it's less, then you're a victim who is getting nothing for something.
The only way to make things fair is for everyone's premium to be equal to their probability-of-disaster times cost-of-disaster. Then people will be truly sharing risk equally.
The obvious solution to that problem is to eliminate government programs of insurance.
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They became a victim when they inherited the gene. The involuntary consequences of having that gene are indeed sad, but it is no moral failing if others choose to not share that misfortune. Their decision to not share, does not cause the genetic victim to become more of a victim.
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As copyright owner of this comment, I authorize everyone to defeat any technological measure which limits access to it.
Mod that up, somebody, because the truth of the above statement is pretty much the essence of the whole debate.
Some will say that any fortune/misfortune that is not the direct result of a conscious choice, should be shared by all -- it should take place outside of the normal economic system. If a rock falls out of the sky and hurts you, everyone should help you recover. If the rock turns out to be made out of gold, and instead of hurting you, it soft lands next to you, you should share that gold with everyone.
Others say it's every man for himself, although that certainly does not prevent people from cooperating (as is the case of insurance where everyone shares expense in proportion to their risk). And if some people have compassion and love for others, they are free to help their fellow men if they choose to.
I'm in the latter camp, because history has proven absolutely conclusively, that the former can never be achieved. Groups of people are untrustworthy and irresponsible. (Open your firewall and allow free shell accounts on your machine, if you don't believe me.) And whatever structure (e.g. government) oversees the redistribution of random undeserved weal/woe, never acts accountably.
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As copyright owner of this comment, I authorize everyone to defeat any technological measure which limits access to it.
No. (It sometimes happens, but that is quite rare. Perhaps some day people will be free to choose how much philathropy to engage in, instead of being told an involuntary amount (determined by a council of people who bought their seats in a meeting hall thousands of miles away), which is doled out in mysterious ways by unseen bureaucrats. But that day is far off.)
Who do I think should be first in line to pay for it? The victim. That's what makes them a victim. I know you don't want to hear it, but the world is a shitty place and bad things happen to people who never did anything to merit punishment from the gods. No economic or social system can change that.
A government program is the surest way to attract people who wish to scam the system. I can't think of anything more inviting to abuse, and held less accountable. His fate would be more pleasant even at the hands of the heartless evil Bill Gates giving out money for PR. And even that fate is dark compared to what would happen if he was cared for by people who love him.
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As copyright owner of this comment, I authorize everyone to defeat any technological measure which limits access to it.
One can see this as either fair, or unfair. I suppose that it depends on fair. To me the really unfair part is that the insurance companies get to select which statistics they use to determine your rates, and they can choose which set of weights to apply AFTER they have seen who you are. This means that they always get to choose the set of rules that is more favorable to themselves. (But young male would be one of the categories that they would use even if they had to select groupings blindly.)
Caution: Now approaching the (technological) singularity.
I think we've pushed this "anyone can grow up to be president" thing too far.
Some people would benefit with no insurance. Most people would benefit with self-insurance. At most 40% of the people benefit with a fairly run insurance plan. The problem is, if it is unfairly run, then the percentage of people who benefit drops, potentially to zero. If they are allowed to change the rules in mid-stream, then you can expect to be dumped off when you hit deep water, no matter what they promissed originally.
... but
When do you benefit from insurance?
If it is subsidised, or
if you are unlucky, or
if you can't save
this only works if they play fairly. Otherwise it's a bad buy from the word go. And you can only trust them if they aren't allowed to change their mind (e.g., cancellation, arbitrary premium hikes) just because a difficulty shows up.
Caution: Now approaching the (technological) singularity.
I think we've pushed this "anyone can grow up to be president" thing too far.
I think this is another issue of a monopoly (oligopoly) reaching for power.
It's almost funny. When I think back the original selling point of the HMO's is that they were going to cut medical bills and make health care available to more people. Well, I guess that waiting in a clinic office is available for more people, but if I'm feeling sick I don't dare go there anymore. That's no place for someone who is already weak and vulnerable. It's ok for routine physicals, I suppose, but I'm not really convinced that a doctor can learn much in a 15 minute session. Something blatant, I suppose. Maybe. But during the 60's-70's the free clinics gave away better care than I pay a lot for now. The buildings weren't as fancy. The lighting wasn't as good. And there wasn't as much clerical support (1 nurse / doctor I remember as the usual ratio).
FWIW, I know of doctors who have been retired from HMO's for spending too much time per patient. That figure of 15 minutes comes from there. My real experience has recently tended to be closer to 10 minutes average.
Caution: Now approaching the (technological) singularity.
I think we've pushed this "anyone can grow up to be president" thing too far.
If the government gives everyone adequate care, and private insurers are only offering bonuses on top of that (private instead of semi-private hosptial rooms, shorter waiting lists for elective surgery, "alternative" medicine), then I, despite my devout pinko sentiments, don't care what the private insurers do. The rich people with bad genes can't get gold-plated health insurance, but neither can the poor people with good genes. BFD.
If the government's plan doesn't give adequate care, then I'd rather see that care improved than impose restrictions on the UK private health insurance industry.
What do I mean by "adequate care"? Umm, I'll get back to you on that.
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send all spam to theotherwhitemeat@ropine.com
Oh yes, and those very few people are not consumers then I suppose?
Quite frankly, if there's only a small percentage, why in the world can't the insurance companies take the risk? They are supposed to offer security in exchange for out money, aren't they?
OTOH, if the percentage is big, then it's really not "good for consumers." Or actually... it depends on which group you belong to...
This is not a bad thing as long as you are in the "good DNA" side. But take it from the point of view of the person who actually needs insurance and gets screened out. As long as the state has its own programs of medical insurances it's not that bad, but imagine that tomorrow they decide to turn over all medical insurances to private business. You end up being someone who might very well need insurance but can't get it.
I mean... what's the point of selling insurances only to those who won't need it??
I am also a bit scared about possible abuses of this, but I guess I will have to wait and hope I'm wrong.
"When I was a little kid my mother told me not to stare into the sun...
"If liberty means anything at all, it means the right to tell people what they do not want to hear"
First it was making ISPs responsible for content, then it was piping all internet data via MI5 and now this!? The more I hear about this the less I want to return to live in that country. We all make a fuss about Cuba and China and their human rights, but the UK is starting to use George Orwell's 1984 as a guide book, rather than a list of warnings.
Jumpstart the tartan drive.
Unfortunately, you're right. The system is broken, for certain. However, the alternative you mentioned is probrably the lesser of the 2 evils.
Canada has guaranteed health care, and it works rather well, actually. There are some things that suck, like underpaid medical professionals, longer waits for surgery, etc., but for the most part people get the treatment they need. We do pay higher taxes to support the system, but at least if anyone is going to profit from sick people, it's the Government, which is elected by us. I'd have a real hard time buying health insurance from a company.
When you think of it, it's like the Insurance companies are trying to be Darwinian Agents - "if you've got this genetic anomality, you're likely to die soon since we won't insure you. Unless you have another trait (Big $) that can overcome this. We need to do this in order to survive ourselves." So, people will die in order that the Insurance company live - survival of the fittest.
As humans, we should be above this.
"Depression is merely anger without enthusiasm." - Anonymous
ANd that will be something that the *consumer* can most effectively fight.,
If people don't agree with genetic testing... DON'T BUY INSURANCE FROM THOSE WHO WANT TO DO IT!
They'll get the hint.
They can pry my genetic information from my cold dead hands. As Americans, we should be _very_ concerned about this. Now that something like this has happened in GB, insurance companies and others here in the States will be pushing for something very similar. I for one would rather pay more for my insurance than let some big coporation know about such intimate details of my life. Not only that, but once these tests start to include different cancers, nearly everyone in GB, and the rest of the world, will have to disclose some sort of genetic test in order to get insurance. This needs to be nipped in the bud here and now before it spreads and our children and beyond are paying the consquences!
Sometimes I feel like a nut... Ok so it's most of the time
Now, it's been happening already. The insurance industry WILL discriminate on any measurable factors that will influence your future. If you're older they'll charge you more, if you're a male between 18 and 25 they'll charge you more. If you smoke they'll charge you more.
The problem with all of this, however, is that it's just a market driven Eugenics program. A certain person got into a little trouble for this back when he wanted lots of blonde haired blue eyed boys and girls. It was decided soon afterwards that eugenics is a bad idea because people can cause all sorts of Bad Things (tm) to happen when they start meddling.
*ponders this for a moment* Right, well, that would be true if it also held true that those with the most money were breeding the most (or at least ensuring that their genes were propogating the most). But it's not. We have a situation where, in general, those with the most amount of money tend to have the fewest children. yay.
So, we have a reverse Eugenics program, hahahahahaha... the Insurers make sure that all the healthy people get lots of money, they then start having fewer children, all the genetically defective people have no money, have tons of kids and everyone is doomed.
Most of this logic is flawed...
I don't really know. Perhaps, as the proponents of eugenics say: if we find a successful way to direct the evolution of man, humanity will advance and evolve. If the market can do it, so be it. As an individual who currently doesn't know whether he's got some bugs in his genes, I don't like it one bit. If I turned out to be clean, well, I guess the smoking is going to kill me anyway :)
there is a definite advantage for consumers in allowing this kind of test.
No. There is some advantage to those who pass the test and huge disadvantage to those who fail it or refuse to take it.
Remember folks, it's not mandatory,
Yeah, right. For how long? And aren't your premiums going to depend on whether you've taken the test?
anything that brings down those premiums is good
It is? I've got two suggestions for you and both will bring down these premiums. First, if a child is born with some genetic defects, you know, those that are expensive to treat and deal with, just kill him. It'll save a lot of money. Or just refuse medical care if his parent's can't pay -- it's the same thing. And, second, why waste money on old people? They are going to die soon anyway, right?
As long as it's voluntary, then we all win - you can either take the test and get cheaper premiums, or you can not take the test and satisfy your urge for privacy. It's a win-win situation.
Voluntary? Let's say the premiums used to be 100 zorkmids for everybody. Now the test comes. You can agree to the test and if you pass, your premiums are going to be 98 zorkmids. If you fail, though, your premium goes up to 1000 zorkmids -- we wouldn't want the insurance company to lose money, would we? And if you refuse to take the test?
Let's check how the thinking would go: "This guy can save himself 2 zorkmids by taking a test. He doesn't want to. This is suspicious. Why wouldn't he save 2 zorkmids? Of course! He has this genetic marker and is trying to rip us off! Yeah!"
"Sir? Your insurance rates are 1000 zorkmids.".
Kaa
Kaa
Kaa's Law: In any sufficiently large group of people most are idiots.
Insurance is for covering unknown risk.
... then you are RIPPING the insurance company off.
What is "unknown" risk? Let's say I gamble by flipping a coin. There is a 50% chance of me losing. Is it a risk? Sure. Is it unknown? No. Is it insurable? Of course.
Statistically I have an N% chance of having a heart attack while being insured by FooBar Insurance Group. Is the risk known? Sure, FooBar knows it, that's how they set their premiums.
If you know a risk exists, and the insurance company does [not]
Bullshit. The point of insurance is spreading the risk across the pool of population. How large should the pool be is an issue of social policy and what's perceived as justice, rather than a pure economics problems. Economically, each pool should be the size of one -- each person's expected health expenses should be evaluated individually and he should be charged that number + profit margin. However the great majority of people would not consider this an acceptable scenario.
Geez, guys, learn something about economics before you comment on an economics issue.
Geez, dude, learn to recognize a non-economic issue when it bites you on the ass. Economically the pool size should be set to one. Economically, also, all felons should be shot right after the trial (jails are expensive), terminally ill people should be denied medical care (they'll die soon anyway), and children with serious genetic defects should be put to death (they just suck off economic resources).
Kaa
Kaa
Kaa's Law: In any sufficiently large group of people most are idiots.
Let's say that you test positive for Huntington's Disease, but you live in the USA, which hasn't yet adopted Britain's methods. So you sign up for the best insurance coverage you can get at the cheap price of a healthy individual. Or your unborn child has a genetic test for leukemia or something similar.
Then we have a situation where the consumer knows far more about his conditions than the insurance company. In fact, that is the problem. A person with a genetic defect can now expect a private corporation to take care of them through life.
The problem comes when one party knows more about the risk than the other party. Therefore it almost seems justified to demand the insurance company gets all the info the customer does.
The problem is that this causes a situation where people can abuse the system, or the system might abuse the people. What if the test is flat wrong? (happens sometimes) What if the results aren't revealed by the insurance company, because they don't want any trouble with the applicant? What if the company decides to raise the rates of people with a 50% chance of getting the condition to a rate so high it can't be afforded? And then the person doesn't get that disease, but gets into a car accident? Isn't this killing individuals or loading them with debt so they can't reproduce?
Genetic testing is quickly leading to eugenics. People now have the technology and the reasons to abort babies who may have conditions. They will lose their insurance coverage if the child is carried to term! Surely, this must end somewhere. And if it ends with only healthy, quick dying individuals who put the least amount of strain on the health insurance industry as possible, well that's that.
So the basic problem is the tests, and society itself. We can test for anything society doesn't like and eliminate it directly or indirectly. Society now has the ability to shape what genes you are allowed (moreso than before, I guess).
-Ben
... by making insurance pointless. If an insurance company does full genetic tests, and have a VERY good idea of what the likely payouts they are going to have to make to you over the cost of your lifetime are, they are going to charge premiums which add up to more than that total cost. Thus you would be silly to pay them said premiums, when instead you could just invest them. Knowing too much would eventually cause insurers to put themselves out of business. Sure there's never going to be a 100% accurate prediction, but the better they get at it, the less worthwhile it is for us to insure with them.
:P
Reading at a high filter has it's disadvantages, can't tell if someone else has already said this and been sumarrily flamed for it.
OTOH, to get that protection in Maryland, you have to live in the state fighting with VA to be the first to pass UCITA, fighting with CA to have the strictest gun laws, and fighting with MA to have the worst buracracy (sp?) to provide medical care.
Sounds like a good trade to me. (NOT!)
Jesus was all right but his disciples were thick and ordinary. -John Lennon
The right decision would be allow insurance companies to exclude claims caused by the genetic condition, or to increase premiums for full coverage. What you have now is a situation where because I have a 50% chance of developing Huntingdon's Chorea, I can't insure myself against getting hit by a bus.
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--
E_NOSIG
"Have a gene which guarantees a certain disease? We aren't going to have the people with good genes subsidize your care -- you have to pay more because you, as a single individual, are unprofitable otherwise"
Sounds a lot like natural selection :) In our caveman days, before the advent of modern medicine, those without all the genetic problems were the advantaged ones who survived. So now, after a few brief centuries of modern medicine "evening the odds", technology has advanced sufficiently to bring us back to the caveman days, where we have those genetically fated to struggly more to survive.
I suppose we can hope that given a few more decades of genetic research, modern medicine will be able to all or almost all genetic diseases. That should even the odds again, and make this whole insurance issue a non-issue. In fact, this is probably the way things will go - making this insurance problem a temporary one that people only have to suffer for a few decades. I hope. There is a reasonable chance that we may see a cure for Huntington's (as an example) in the next 20 to 30 years, current research looks somewhat promising.
"If I test positive, the insurance company would be an idiot to insure me. Therefore, back to square one: no spreading of the risk, no benefit to me"
Many people don't want to take the test though. If you have one parent with it, you know you're at 50% risk, but many people don't want to find out while they're young. Huntingtons generally starts affecting people at +/- age 40 to 50. Knowing you have it can change the way you plan your life, e.g. you may decide not to get married.
So as long as the test isn't mandatory then, what is the insurance company to do, all they know is that you have a 50% chance of getting it? It would be very unethical to try to force people to take the test.
Of course, all of this is assuming that the disease will remain uncurable (looking at current research I'm guessing we may see a cure in the next 20 to 30 years.) Imagine you found out you had something like Huntington's, changed your entire life plans, didn't get married etc - then the cure is found as the disease is about to start affecting you. What a waste.
"A genetic predisposition to a disease does not indicate you're going to get it"
Generally, yes, but with Hungtington's, you either have it or you don't. If you don't have it, then the "genetic disposition" is gone, i.e. all of your kids or grandkids are no longer at risk. If one of your parents has it, you have a 50% chance, at time of conception, of getting it. If you've got it, you definitely will suffer from the symptoms (unless by chance you die before the age of onset, which averages around 40 - 50, but can be much later or earlier, so it doesn't happen often that people die before this), and if you don't have it, you can stop worrying. You've got the gene, or you don't.
I think this is different to a conventional "genetic predisposition", in which you may have the disease-carrying gene, but might still not develop the disease. That's slightly more blurry.
So if an insurance company knows you have the HD gene, they can be essentially 100% sure that at some stage you will start developing symptoms (unless you get run over by a bus before then.) That is all assuming that a cure isn't found any time soon.
Let me see, I bet I have had more HIV tests than the average person, why ? because every time I donate blood I get one ;)
I sure hope, BTW, that they won't start testing for other things behind my back, genetic profiling, whether it's done by the government, by the insurance companies, etc. is always bad.
-- the cake is a lie
Could you please include a link or some pointers on where to find more info on this practice ? Being a donor myself I am really interested.
-- the cake is a lie
Several times through this discussion it has been mentioned that without insurance one is not able to get a mortgage.
Where does this happen ? I bought my house last year here in Canada and nobody ever asked me if I had a life insurance or if I wanted one...
-- the cake is a lie
This lowers the rates for the majority of us without too many genetic defects, and allows those with such defects to know considerably earlier and take action. I see it as win-win.
So long and thanks for all the fish . . . !!!
With genetic screening would come far better ability to predict who is likely to be getting genetic linked diseases. Based on the capitalist ideal that 'if you express a need, someone, somewhere will try to sell it to you', I would say that most firms would want to sell to the genetically imperfect portion of the market at rates more realistic to their real risk. Right now there are firms which sell to diabetics, transplantees and of course a specialty market in buying life insurance policies off of the HIV positive.
Would people be denied coverage by some carriers? Certainly. Would they have no options at all? Not likely.
So long and thanks for all the fish . . . !!!
The fact is that if you've had a DNA test and there's no problem then you will be getting an advantage - companies will be more likely to insure you at a much cheaper rate. And seeing as anything that brings down those premiums is good, I don't really see how this can be construed as a negative move on behalf of the UK government
Hmmm. Let's look at this for a moment. It does in fact hurt the consumer, and I'll tell you why. There is no difference between charging more to one class of people and giving a discount to a different group. If they charge more to a particular group, then they'll set the base rate lower. If offering a "discount", they'll set the base rate higher.
When you control the base rates that you charge, it makes no difference if you offer discounts to one group, or charge more to a different group. It's discrimination no matter how you look at it, and discrimination based on genetic characteristics is just plain wrong.
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"Go Metallica. Die RIAA." -- Linus Torvalds
Good example. Now, what if the insurance company charges more for pine wood houses than for stone houses ? Would it be fair ?
What if the insurance company charges less (against burglary) for a house with an alarm, 5 locks on every door, and only reinforced doors ? Is it fair ?
The issue here is not about risk evaluation. It's about control. If you choose to build a stronger house, use a more secure car, or plug redundant power supply on your main server, you will pay less for your insurance.
But you can't change your genetic exposure to risk. You can't decide, after a genetic test, "well, I'm gonna a change this gene for a more secure one, this one is too risky". So, you'll have to choose not to change it. And the insurance company will charge you for this choice. And that is frightening.
That's not the case. The insurance companies aren't trying to make you take a test (not yet, anyway), just asking you (as is already the case with HIV tests) to disclose whether you have already had one. If you're at risk, you stand a good chance of having taken the test, and not disclosing it would be grounds for voiding your insurance.
In the 80's merely having taken an HIV test (not tested +ve) was grounds for being refused life insurance, mortgages, etc., due to logic that if you had to ask whether you were HIV +ve you must somehow be high risk. I'm not sure, but I believe the increasing number of people taking HIV tests (e.g. for employers benifit, rather than their own risk) means that you wouldn't necessarily be refused outright these days, but it's a similar situation and not one I'm very comfortable with.
John
You seem to express the belief that you have a right to be covered in the first place.
Aah, change is good. -- Rafiki
Yeah, but it ain't easy. -- Simba
Okay, let's play baseball. I get to have a hundred players. You get three. Are you willing to play me? If you stack the bases against corporations so they cannot make money, they're going to liquidate their assets and go out of business.
Do you think people should be able to sell the risk of something bad happening to you? If so, then do you think both you and an insurance company should have an equal shot at measuring the risk? Remember, you can get a genetics test without telling the insurance company.
-russ
Don't piss off The Angry Economist
s/insurance company does/insurance company does not/
Sorry. "Use the Preview Button!"
-russ
Don't piss off The Angry Economist
You guys have had your minds corrupted by our abuse of health "insurance." Most people in the US get their *ordinary care* paid for by insurance. This is completely WRONG. Insurance is for covering unknown risk. If you know a risk exists, and the insurance company does (hey, nothing's to stop you from getting a genetics test and keeping the information quiet), then you are RIPPING the insurance company off.
Geez, guys, learn something about economics before you comment on an economics issue. What you're saying makes no more sense to an economist than 3 + 3 = 7 to a mathemetician.
-russ
Don't piss off The Angry Economist
Yes, insurance exists to spread risks across a population. If I know I have a greater risk because I've taken a genetic test, am I really part of that population?? Is it fair for me to say to you "Yeah, let's share risks, 50/50, share and share alike."? No, of course not. I'd be lying to you. Just because there's an insurance company between me and you, that doesn't mean that I'm not lying to you if I enter into a risk pool I don't belong in.
And yes, I agree with you -- once risk assessment becomes so accurate that there are no unknowns, there is no reason for buying insurance. A risk is something unknown. Once you learn about it, it's not a risk anymore.
-russ
Don't piss off The Angry Economist
How about a genetic test for Parliament? Naw, they probably could muster a quorum, unless they started importing French Canadians.
But those are factors within (a certain amount of) control within an individual, but genetic disposition IS NOT
How about if you're genetically disposed to alcoholism or smoking?
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Hmmm, I suppose that is why the French are rated as having the best healthcare system in the world. Damn shame for your theory that it is state funded ;-(
It's not mandatory yet. This is the same sort of thing insurance companies are going to use to get GPS-based "black box" recording devices into your car. It'll start out as a "discount" against the premium for those who agree. The "good drivers" with "nothing to hide" who don't drive fast, run lights, or hang out in "questionable" parts of town will readily agree to save a few bucks.
.It may never even become technically "mandatory"--it's just that insurance premiums for those who don't "agree" will be 10 times the premiums for those who do.
The only "win" situation here is that it will force parents to truly consider using abortion a tool to make sure that their offspring have a chance. This is a shortterm "win" from an economic stance.
This system creates a news class system and if your in the lower class, there is no little hope for a normal life compared to the upper class.
Yes, the disclosure of any DNA testing results is voluntary. However, the insurance companies are still allowed to use genetic testing.
The worry is that it will become mandatory. This legislation is a big first step towards that.
Welcome to Gattaca.
$250 a month? Maybe you just need to shop around more. I'm only a year older than you, gotten in a number of accidents, and I pay about half of what you do. Geico.com and progressive.com will both give you quotes online, though I haven't been impressed with the numbers they spit back. I've previously been with Hartford Insurance, but when their rates went up, I switched to Met Life.
Except that a lot of those statistics aren't in his control, it seems to me. How do you stop being 25 and male, except for spending vast amounts of money on surgery and waiting ten years? He is effectively starting in a hole that he has to dig himself out of.
Note, though, that I'm saying that higher insurance premiums are in any way as bad as not getting insurance because of genetic testing. I'm simply saying its another thing the insurance companies do.
--John
Yes, the test isn't legally mandated. But if all the insurance companies in Britain refuse to offer you insurance(which they can do according to the article), doesn't it then essentially become mandatory?
--John
With a new car, you probably have to pay a whopping amount of collision.
Or it could be the leasing, I've never leased a car.
Or it could be the type of car, are we talking an Escort station wagon of a Probe?
From memory, when I was in my early 20's (about 10 years ago), I drove a 10 year old station wagon and paid about $400 a year.
I bet if you drove an older used car, your insurance would really drop.
George
Statistically, you are more likely to get into an accident given your age. Insurance premiums are based not only on your past performance, but statistically in your demographic group, what your future performance may be. And in your demographic group, you are more likely to be in/cause an accident. Insurers pay lots of money to actuaries/statisticians to determine this.
However, your case is different from that of someone being genetically tested. Your auto premiums are based upon YOUR past/predicted future performance as a driver, something over which you have control. Your driving habits are within your control. Genetically though, if you are predisposed to some disease, you have no control over that. That's where the unfairness sets in. As you age, your car premiums will go down based on your age AND your continued good performance. But the unlucky cluck who tests positive for a disease-causing gene, will pay high premiums the remainer of his or her life. That person is the true victim.
EMUSE.NET
"We're sorry, but the website you're trying to reach has been disconnected."
Insurance is supposed to be a shared risk pool. That is, we're all throwing money in together for the possibility that we may get sick in the future. If another person gets sick and draws from the pool, that's the intent of the system. If I'm A+ healthy, then I don't draw from the pool and my premiums subsidize those who are sick.
This is not a BAD THING! This is the way the system is supposed to work. If insurance companies are allowed to screen out (via huge premiums) those who are most likely to have a disease occur, then you're left with a pool of healthy people paying somewhat less premiums (don't let the insurers fool you into thinking they're going to drastically lower rates) while the insurers make out like big dogs raking in profits off of healthy people.
And those screened out by genetic testing (screened out again by higher premiums that will likely not be affordable)? They'll go on a government program of insurance, which means, if you're healthy, you're going to be paying for them anyway with your taxes.
My bet is that the marginal cost that you'll pay in higher premiums by disallowing genetic profiling will be much less than the additional taxes you pay to support a bloated government health bureaucracy built to handle those people who were screened out.
EMUSE.NET
"We're sorry, but the website you're trying to reach has been disconnected."
It finally occured to me, reading this, that the real problem is that we expect people to use private insurance to pay for all medical care, in particular for any non-accident related illness.
It is one thing to rely on the private insurance industry for payment/treatment of accidental injury or illness. Different people are at different risk for being injured or contracting certain diseases based on their lifestyles. If you, say, drive to work every day instead of taking a subway, it is fair for you to pay a slightly higher premium because you are at a greater risk of being in a car accident.
But it really is something else again to have to rely on private insurance to get treatment for genetic or other in-born defect. You can't alter your lifestyle to do a damned thing to prevent it. Requiring participation in the insurance industry by people who have been damned by their genes seems amazingly unfair. It basically institutes a caste system: if you are born the wrong way, you will be deprived of sustanence, livelihood and in all likelihood years of life.
-*- Any technology indistinguishable from magic is insufficiently advanced -*-
But what happens if you are in perfect health, and you take a genetic test and they turn up some high risk factor? Then you can never again get health insurance, or if you can, it will be very expensive and have clauses excluding any disease related to your risk.
The test is only voluntary for now. With hundreds of other diseases waiting for approval to be included on the "statistically accurate" list, it may soon become mandatory for every person to be tested in order to claim health benefits.
This sounds like it will soon become a lose-lose situation for 20%-50% of the british populace, and only win-win for the perfectly healthy. That is not what insurance is about.
It may be time to dismantle the whole insurance industry, and replace it with a "universal coverage" overseen by the government. Something that ensures every citizen gets health care, whether their DNA shows a risk or not. Of course, britian's health coverage is a lousy example of this practice.
the AC
Hemos is like...sci-fi fans;he thinks technology is cool, but he hasn't bothered to understand the science it's based on
Ok, how about this: You never take the test and you never plan to, but people you are related to do. How hard is it really going to be to start collecting this information and cross referencing it with birth records?
Remember, once this gets out there we are going to going to be able to get it back and corporationsrarely do anything that does not benefit themselves.
-prak
Actually...
I remember hearing in the BBC Reith Lectures (from 1998, I think) the speaker describing almost exactly this situation. I tried to find a transcript on the BBC site but failed, I'm afraid.
The speaker was, I believe, the Professor for racial studies at a prominent US university. When she'd moved house, she had applied for a mortgage over the telephone and been quoted a figure for premiums to be paid. The company had sent her a form - already filled in based on what she'd said on the phone - for her to sign as confirmation.
Now, although the Professor was black she had, as she put it, a "white voice" - so the person taking her phone call had ticked the White/Caucasian box in the Ethnic Origin section on her form. The speaker described how she toyed with the idea of just leaving it be, but decided in the end to correct the mistake before returning the form.
The quoted figure for the premiums went up.
What had happened was _not_ that the mortgage-lender had arbitrarily increased them because she was black. Rather, the information about her was fed as statistical data into the company's projections for property values in the neighbourhood - and because there was a statistical correlation between black people moving into an area and value dropping subsequently, the estimated risk of lending to anyone moving there went up - and therefore so did the premiums.
Operationally, that looks pretty much like discrimination to me. So I'm afraid that minority groups do experience the sharp end of amorally-wielded statistics too.
Mat.
This is true. I drive a 4 door, 4 cylinder 2.0L Chrysler Neon. It's not a sports car, or an SUV, it's probably got less than 100HP in normal driving conditions (tops out at 132HP at 5600RPM, but anyone who drives this thing at 5600RPM is going to burn out their engine within a few months.)
I used to drive a 1987 k-car and I was paying $208/month for JUST LIABILITY. I only paid $700 for the car. Comprehensive Fire/Theft and Collision insurance don't cost me that much. It's all about liability, and when they determine liability, age, driving experience and gender are important factors.
I actually live in New Brunswick, Canada.
I DID shop around that's the best price I could get. I had a quote for $4986/year (== ~$415/month)
[as the subject says, this is slightly offtopic, but it IS about insurance, and rates and stuff.]
This is a rant I've been thinking on for the last year or so.
I'm a 20 year old male, leasing my own new car and not living with my parents. I pay a huge amount for insurance on said car every month. My lease payment is $300/month. My insurance payment is $250/month. Yes, that's right. No, I didn't accidentally put that 0 at the end of $250.
Why, you ask, is my insurance so high? I must've totalled my last car so my premiums went up, right? Or I must have at least been driving under then influence, without a seatbelt, doing 175 in a 60, with expired license plates, right?
Nope, truth is that my driving record is spotless. I've never been in an accident, or even received a traffic violation.
I'm victim to statistical analysis, based on age, and gender. You see, statistics PROVE that I am VERY likely to get into an accident because lots of other people my age and gender have done so.
This is similar to what these people are trying to do. It's not terribly bad YET, but this definately opens the door to a Gattaca type situation where the insurance company decides that my DNA is CLOSE to someone who had (ie)Lukemia, so I am likely to get it or have it or whatever, so my life insurance should be higher.
Sounds a little like my current situation, huh? My question is: How is gender profiling even legal? I mean, what if the SAME stats proved that Black(or Hispanic, or whatever the politically correct terms are... sorry.) people get in more accidents than white people? Well, obviously, there would be minority groups protesting as far as the eye can see. Or what if outspoken gay people get in more accidents than non-gay people? Same.
But what can I do? I'm just a straight white guy. I'm walking politically incorrectness.
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There are three kinds of lies: lies, damned lies, and statistics. - Benjamin Disraeli
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Aw, people can come up with statistics to prove anything, Kent. Forfty percent of all people know that. - Homer Simpson
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"Who do I think should be first in line to pay for it? The victim. That's what makes them a victim. I know you don't want to hear it, but the world is a shitty place and bad things happen to people who never did anything to merit punishment from the gods. No economic or social system can change that."
Except economic and social systems like social security, insurance, the legal system, the FDA...I know you probably don't approve of all these things, but they do in fact change the shittiness of the world. There is less poverty among the elderly because of social security, so the world has become less shitty for them. Its because the world CAN be a shitty place that it is important that we take care of each other.
The article actually says that whilst people won't be being asked to take tests, they will be asked the results of any test they've had, and that insurance companies "would have the right to refuse to offer insurance if a customer refused to reveal details". So whilst it's voluntary, there are weasel ways at work here. Sooner or later it's going become de facto, whether or not it's technically "part of" the process of gaining insurance.
But then it's the same brush as having had an HIV test in UK and subsequently going for insurance. Companies don't bother asking you what the result of any HIV test was, they just ask if you've had one. If you have, don't be surprised to be refused insurance because you're "high risk".
The obvious solution to that problem is to eliminate government programs of insurance.
And I guess you think some philanthropic private industry will take up the slack? Dream on! My father just had his right leg amputated, and what insurance can't or won't cover, we're hoping for Disability money from the Government. Government programs are not inherently bad, it's the people who abuse them... we lived next door to a man who had Lou Gerigh's [sp?] disease, and he was DENIED disability funds, and wasn't aware that you have to keep applying, many many times, to get approved. People with a real need like that are made to jump through hoops because of other people trying to scam the system.
Sorry for the rant, but I had to stick up for this.
The Divine Creatrix in a Mortal Shell that stays Crunchy in Milk
The House Between - Original Sci-Fi Series
Some US states already have laws that do just the opposite. Namely, they prohibit insurers from making coverage decisions based on genetic test results. This, IMO is the correct approach. Maryland's statute is a good example.
I have a family history of cancer, heart disease, ADD and depression. My fiancee has a family history of heart disease, cancer and depression. Will our insurance company allow us to breed? If so, will they allow us to insure our offspring or will they merely segregate us into a high risk insurance group? Think carefully: I carry a gene that makes me much more likely to contract melanoma than the general world population. Not directly--what the gene causes is very fair skin that sunburns easily, which is pretty close to the ideal melanoma profile. I'll pay different rates based on the color of my skin. What if, as they say, homosexuality in males has a genetic component? If a child test positive for this gene, will insurance companies only cover him if his parents sign an AIDS waiver? This opens up a lot of extremely ugly scenarios, and I can't help but think how incredibly dangerous a combination is eugenics and economic interests, be they socialized medicine or paid health insurance.
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This is not my sandwich.
On a free market, people who are likely to get sick will pay more for health insurance, but less for pension schemes (another form of insurance), since they're unlikely to live long enough to collect what they pay in. So things would even out to a pretty large extent.
The government controlled pensions schemes that dominate the western world takes massive amounts of money from the unhealthy and poor, and gives it to the heathy and the rich. All in the name of helping the weak, and hardly 1 person in 100 even realizes it.
ok, how many of have donated plasma in the past 2 years? Did you realize that your blood/plasma has been genetically screened,and that the results *are* available to authorized agencies?
So the UK now uses results like this to determine insurance eligibility? Very Very scary. Imagine being denied insurance , for something genetic testing has shown a weakness for. I have always believed insurance was a bit of a scam, this clinches it. Of course insurance is not designed to protect those who need it, rather it is a capitalistic tool used by the rich to get richer.
"A society that will trade a little liberty for a little order will lose both, and deserve neither. " Ben Franklin
Once upon a time, when people got sick they visited or were visited by a doctor, and paid the doctor's bill directly. If you were very sick or injured very seriously, you could end up owing more than your means, but you didn't get thrown out in the street for it too often. Medical insurance was not common.
Then medicine got higher tech, and for a lot of money we could fix some kinds of really serious injury and illness, and postpone death by months in some other cases. Very expensive months. Insurance now looks attractive and is sold as a way to insure that your family will have access to these expensive medical techniques just in case.
Thanks to the corporate bottom lines, we are soon confronted with the basic dilemna -- how much is a person's life worth to society as a whole, and to them individually? Some positive things do result like a new concentration on preventive medicine. At first, it is left up to individuals so at least the freedom of choice is preserved, and insurance remains fairly apolitical.
Soon though, medical insurance began to be provided by employers, partly thanks to the unions, and partly because there is economic efficiency in large purchases. The company benefits by a healthier and happier workforce, and employees benefit by being covered for less money than they could arrange on their own. However the chance to choose how to arrange medical insurance disappeared for many -- the insurance companies didn't really need individual business anymore. There is much furor over which expensive treatments are covered and which aren't. Medical care has become political in a big way.
Today, insurance companies are actually paying for propaganda to discourage behaviors expensive for them, and interfering politically in matters such as drug testing. It appears that they will also set standards for "good" DNA and "bad" DNA in a way that will directly affect the quality and length of people's life. Equality of opportunity implies that you should not be penalized for who you are, and surely your DNA is not anything else.
We should look back at this point, now that many agree that basic universal coverage is probably desirable. We can cut insurance companies right out of the basic coverage loop and we should. This is not to say someone doesn't have to make the tough decisions about who and what doesn't get covered given the finite amount of money available for medical costs. But since this decision is highly emotional and political it belongs in the political arena, not corporate boardrooms.
OK, so the UK govt says, "you don't have to disclose your genetic screening to insurance companies.
:)
So, if you *don't* agree to a genetic marker screening, what do you think the insurance companies are most likely to assume?
a) you are a privacy advocate willing to pay higher premiums to make an intelectual point (much like some of us who encrypt data communications just so there will be more encrypted info for the NSA to sift through)
or b) you are aware of a genetic marker that would disqualify you for low rates?
Bonus points if you can figure out what's likely to happen to your insurance rates.
Volentarily is just another word here for guilty till proven innocent.
On the other hand the UK has good universal medical coverage last time I checked, so it's probably not such a big deal as it would be in the states.
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Remove the rocks from my head to send email
On the whole, I find that I prefer Slashdot posts to twitter ones because I don't get limited to 140 chars before
Remember that the UK has a universal health insurance system, with the government as the sole payer. You don't have to apply for coverage or pay premiums (except as taxes, of course). So this decision affects only *LIFE* insurance, *NOT* health coverage.
This issue will be much tougher in the US, becuase of the possibility of health insurance companies denying coverage based on these tests. Losing life insurance coverage might be a problem, but losing health coverage is a far bigger one - especially if you KNOW you are going to get sick.
12 Oct 2005 13:08 GMT
(MICHIGAN) Reuters
In a development sure to change the way Americans consume healthcare, ProxyMegaloInsuroBanc Incorporated announced today that it will decline to issue or renew health insurance policies to anyone who will ever become ill.
The startling move, made possible by recent advances in genetic testing, sent ProxyMegalo (PMIB) stock soaring in late trading, up 7 and 1/3 over yesterdays high close.
John Chambers, CEO of ProxyMegalo was quick to discount the rash of consumer group protests precipitated by today's decision.
"ProxyMegalo is dedicated to providing assistance to its policy holders in times of need. However, we have a business to run. What kind of profit margin do you think there is in insurance when everyone keeps dying all the time? With GeneticOne we expect our policy turnover to reduce to half or even one third of the current rate".
PMIB announced its intention to insure a small, random percentage of customers whose genetics tests indicate they will become ill. "Due to privacy reasons, this information would not be divulged to the consumer, of course," said Chambers. "After all, what is the point of buying insurance if you already know whether you will be sick?"
-konstant
Yes! We are all individuals! I'm not!
-konstant
Yes! We are all individuals! I'm not!
Just take out "test insurance" before you take the test. If you test positive for something nasty, this insurance pays out big (maybe big enough to pay the insurance premiums for the other insurance!) Insurance companies will surely offer this if there is a market for it.
AFAIK, for this reason, insurers who cover ordinary care (wellness) have lower claims costs, than they would if they didn't. So, these things do affect the loss distribution, and it is not 'completely wrong' nor is it 'against the point' of insurance to cover ordinary care.
Look at dental insurance. Most dental plans cover nearly 100% of all routine care, but only 50% of major procedures, since the correlation between routine care and low claims costs is even more pronounced in this area.
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You were a moderator with 5 points. You should have read the moderator guidelines before you did any moderating
Ah, maybe you should making an understandable argument to backup your widespread insulting.
You may be an economist but you are obviously no logician.
Some of the rules that insurance plans (here in the US, my experience...so hold off on flames pls), are totally ludicrous. At our most recent company meeting regarding insurance change, there were different rates for smokers as compared to non-smokers. Some insurance plans require an entrance physical. While the insurance company is only protecting their best interest, all of this is borderline discriminatory. Someone in their elder years, who's health may be less than up to par, may not be allowed to get certain health benefits. This is because the insurance company is out to make a buck, and they're covering their rump regarding 'risk'.
I think that using genetic information as a factor may be valid, since much can be determined regarding potential risk for some diseases (predisposition for cancer, etc.). There is one problem with all of this: it discriminates, completely. The flip-side of all of this is that if they want to cull out all the genetically impure folks from their insurance policies...they'll find that they're broke.
where does the line get drawn?
if my rights are determined by something completely out of my control, where does that put me? I can understand if I am a smoker, or a drug-abuser, or an alcoholic. These are things that I have control over. To use my own genetic profile to determine what kind of risk I am to your insurance company's profits is a little too much, particularly since just because I have the predisposition of getting cancer doesn't mean I will.
When easy possible to predict whose house is going to burn down, it's no longer "sharing the risk", but "helping people whose houses burn down". This is something that for-profit corporations don't tend to be good at.
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The shareholder is always right.
But what if insurance companies are not allowed to use the data, and we get to the point where individuals are able to find their own data easily? People who decide that they're not at risk for anything will buy less insurance, making insurance rates go up, and the unlucky people with bad genes are financially and psychologically screwed once again.
One possible solution to this problem is for health care to be universal, controlled by the government, and paid for through taxes. This wouldn't eliminate genetic tests, but it would shift the focus of the tests from figuring out which people can be covered cheaply to helping people avoid getting diseases that they're genetically predisposed to.
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The shareholder is always right.
Every one loves Darwin until they are the one that gets squashed.
It's the 21st Century Do you know what your government is doing
My proposed Turing Test for Race was as follows:
Actuaries are currently prohibited, by law, from using "race" in the much of their risk assessment. Probably the best Turing test for "race" would be to deregulate the insurance industry so actuarial teams can use whatever variables in whatever models to take money away from other actuarial teams.
Nothing like the threat of financial loss vs promise of financial reward to root out sloppy thinking in a jiffy.
I mean, either "race" has utility, relative to the constellation of other variables that "race" deniers would have us rely upon, or it doesn't.
Now, as someone who has been denied health insurance due to a physical affliction, I _should_ be among those interested in forcing insurance companies to subsidize me by ignoring my health attributes and including me in a "shared risk pool" -- but for some reason, this idea sounds a bit too much like a defector within the prisoner's dilemma running around telling everyone about the virtues of positive sum cooperation.
I can't abide it ethically.
The intense hostility toward genetics as a basis for acturarial risk estimate is strong evidence that there are genetic bases for evolutionary strategies involving defection within the prisoner's dilemma at work in civilization.
Indeed, the prevalence of this mentality among the responses to this article in a forum for technologists, the postive-sum hope of mankind, bodes very ill for the fate of civilization.
Seastead this.
Please check the following article on more information on why Government-run Health Care is a Bad Idea.
http://www.cato.org//pubs/pas/pa184.htm l (Scroll down to "single-payer systems")
Note: I don't like the thought of insurance companies performing pre-screening any more than you do since it reeks of Gattaca. I personally have a genetically-inherited bleeding disorder and, while it's extremely rare that I run into complications because of it, it is expensive to treat.
BUT, I'd far rather take my chances with privately-owned insurance companies rather than some big government bureaucracy which will inevitably foul things up.
Rule of Thumb: The rate of government foul-ups increases exponentially the larger it gets.
from simply not covering Huntingdon's Chorea?
For that matter, why don't the insurance companies offer policies that do and don't cover it, and let the customer decide (with the benefit of genetic testing, if they so choose) which coverage they want? Wouldn't this ammount to the same thing, but with less work for (and invasion by) the insurance companies?
-Hil
am FURIOUS! I was lucky enough to have a Genetics Counselor who explicitly told me to pay for this test myself ($450 US), because not doing so could fuck up my entire life. My father has HD, so that's why I was tested (even though I don't have any symptoms (yet).
BTW, Gene positive means that at some point (which is highly speculative) you will develop HD. You my be 8 or 80. The insurance companies can't predict how old you will be when you get it, so why can they push your premiums up?
I have met others with HD who have been screwed, and I'm happy to say that Deborah Senn, the State Insurance Comissioner of Washington State has lobbied for our cause. This shouldn't be allowed until we understand genetics far far better than we already do.
"Should these people be punished"? No, of course not. But why should the insurance company pay for them?
Can I be the naive yet loyal second-in-command who sacrifices his life so the rest of the band of rebels can get away during Act 2?
"Destroy science and religion. Science would re-emerge exactly the same; but not religion." - Penn Jillette, paraphrased
"I'm sorry sir, your test came back and your genetic makeup shows there's a high probability that you'll die in the next 80 years. We'll have to triple you rates now..."
"The obvious is that which is least understood and most difficult to prove." -- A fortune cookie
I just thought I'd lay out how close this is to the mass discrimination that is the core Science is evil plot device of the film. On of the scenes early on is where the "God Child" is refused entry to a school as he is an uninsurable risk. As this real world law filters through to company and corporate insurance schemes, all possible job candidates will get some simple genetic screening to ensure they will be covered under the mass insurance. If they won't be covered, they are pretty much unemployable, or can't even be part of mass education.
Someone suggested a while ago that we need to appoint at least one person in each government that is the science/technology advisor. This person has to be young, well paid and extremely knowledgeable. Their job is to vet out laws like this so that our idiot politicians don't get the chance to pander to big business as a trade off to our personal rights.
Any brits have any publically successful friends that have a logical turn of mind and technological knowledge that could apply to the house of lords selection committee? They are after all accepting public nominations this time around.
Insurance companies are given special legal protections (can't be sued). In exchange for those, they ought to be required to provide comprehensive information to the government.
The net effect is that the blame might be on the court system, or it might be on an inefficient insurance system. We just don't know.
Nope.
There are three possible outcomes here:
- You take the test and find out that you are at risk.
- You take the test and find that you are not at risk.
- You don't take the test.
So your best chance is to get tested and find out that you are out of danger. But even then, you will only get part of the insurance companys savings.You're screwed. Or rather, if the test shows that you have 50% risk of developing the disease, your premium will be increased by (cost of treating disease)*0.50 + X, where X is the insurance companys margin of profit on you.
You'll get a lousy deal. Your premium will be decreased by (cost of treating disease)*(percentage of population who gets the disease) - X, that is, the insurance company will still charge you X£ to cover a disease you now know that you won't get (plus you paid for the test)
Your premium will not be affected, at first, but (no decrease) + (sligtly higher annual increase) = (higher premium) You are now pooled in a group where the premium is calculated according to (cost of treating disease)*(population)*(risk of disease)/((population) - (tested and OK)) whereas your personal risk of getting the disease is constant. In other words, you face the same risk, but will have to pay a higher premium to insure yourself against it.
All opinions are my own - until criticized
So... If British health care is adequate, nobody should need health insurance, or at least, if they cannot get it for whatever reason, it isn't a problem. If the health care is _not_ adequate, then my argument still stands.
Plenty of people have high insurance premiums because of factors that are discoverable _without_ technology. We don't prevent the insurance companies from demanding to know about those factors, do we? It would be unfair to mandate that insurance companies not ask people about their family history, or their past health, just because the company might raise the premium or refuse the insurance. What has technology got to do with it?
Surely the point is that insurance is a crap way to care for the sick. The people who are sick from birth can't get insurance, or if they can, they can't afford it. People at high risk of ill health for _any_ reason are in the same boat. In a society that agrees that the sick should be cared for if they cannot care for themselves, there needs to be another way to pay for it besides insurance.
Well - normally this kind of insanity hits US first - and it's really suprising to see such a conservative country as UK accept this kind of treatment..
Not that I have an answer as to how to give everyone medical help, but this system sure as hell isn't doing it. People with pre-existing conditions can't get coverage. That means that the people who are very sick, and require very expensive medicines(cause making medicine is a business too) have to pay up the ass just to live.
I'm just waiting for this law to be proposed in the US. Though congrats to the British for having a dumb idea to hurt their people before us. Anyday it's not gonna be voluntary, and then, well, we're screwed.
Those who don't know me, probably shouldn't trust me. Those that do know me, DEFINITELY shouldn't trust me.
Regardless of whether or not insurance companies deny coverage if you take the test or not, allowing them to use genetic information to determine insurance coverage turns genetic testing into a gamble. We should strive for decreased genetic ingnorance to better prepare for our future (to know whether we have a disease or not) and decide whether or not to have children (whether we should have children naturally or adopt). However, this ruling creates a deterrant to testing because you could be severely penalized if the test turns out to show something bad. All this ruling will do is to make people want to be ignorant of their own bodies.
I really think this would be a great incentive for people to be really cautious rather than reckless during this age. Think of it.. if you start driving at 18 and collect 7 years of surcharges at 25, that's going to be something like $4200 (assuming a surcharge of $50/month) .. not bad!
I'm sure this could apply to other high-risk groups, with different rules to help create a feedback system which would be beneficial for the customer and in a small way for the insurance companies by helping reduce claims for the insurance companies by these high-risk groups.
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EFF Member #11254
Please consider making an automatic monthly recurring donation to the EFF
You also live in a litigous society that tends not to wear seat belts...
In the UK we've started seeing car insurance premiums go up as "no win-no fee" lawyers have started appearing.
As an example, my wife crashed her Peugeot 205 (very small car) into the back of a articulated truck last year. He sued her for whiplash, despite the fact he almost failed to notice the accident had happened, and her insurance company paid out...
The point is that insurance companies can no longer support "shared risk". There are so many claims being made now that they need to be a lot smarter in the way they charge premiums...
The problem is that the health insurance megacorps can make coverage for untested people VERY expensive. So while it will never be mandatory, eventually choosing the privacy option might triple your premium.
Big companies will do whatever they can to maximize profit, and so will do whatever they can to make people take the genetic tests. So either take the test, get tested positive for one of 10,000 possible diseases and pay higher rates, or choose to keep your privacy, and pay higher rates. Maybe you'll get lucky and not test positive for anything, and you'll pay "reduced rates" (i.e. the rates you were paying before they hiked everyone else's)
It's a "they win"-"you lose" situation once you factor in typical corprate greed.
Genetic testing can determine whether or not a gene is present, however, the difference between two copies of a recessive gene being present (victim of a disease) and one copy (asymptomatic carrier) is likely to be lost in the data, particularly using the kinds of rapid assays that are common in the large commercial testing labs, versus smaller academic labs where volume/speed isn't such a concern. Basically, the little well will change color/floresce(sp)/whatever if the test is positive, or not if it's negative. Think of an over-the-counter pregnancy test and you'll not be too far off.
You're correct in saying that these diseases affect only a small part of the population, but the whole point of insurance is to spread the costs of risks over as many people as possible. Let's say it costs $100,000 per year to treat someone with genetic disease X, and 10,000 people in the US have it. That's $1,000,000,000 per year in costs for those people. Insurance companies have, let's say 100,000,000 policyholders in the US. That works out to $10 per year per policyholder, versus $100,000 per year per victim. Of course I've ignored tons of factors here, such as insurance companies only covering y% of the cost of anything, caps for how much they'll pay out per procedure (try to find a doctor/dentist that charges what your insurance company considers 'reasonable and customary'), per year and per lifetime, which would cut the amount covered, so we're probably down to $5 or so.
It's also important to remember that there is absolutely no way to not get one of these diseases if it's locked into your genome. Should these people be punished for something they have no control over? Now think about the things that the vast majority of health insurance payouts are for and how controllable they are. How much does the total of health costs for heart attacks by people who are sedentary and/or overeat and/or smoke, all of which are much more controllable than Huntingdon's Chorea, cost policyholders? Now add in people who get cancer from smoking, liver disease from drinking, broken necks from driving stupid and how does that $5 per year compare? Funny though, you never hear about people who are 30 lbs. overwieght smokers getting rejected for coverage. Why? Because there's be a generalized revolt by voters against this sort of heavy-handed activity by insurance companies. But hey, who cares about it if a disease is rare enough that Joe Bagodonuts doesn't know anyone with it, right?
"Bugger this, I want a better world." - Jenny Sparks
The simple fact is that American accountants in service of the insurance agencies are a bunch of idiots and should be put down for the greater good
They've created a point system for physicians that requires them to keep inane records of certain details of their encounters with patients and regulates their compensation for visits/services based on point scores. This obscene mess is based on the fantastic, reality-free models these financial geniuses have created to represent patient treatment. In the typical accountant's ficition, a patient comes in with a clear, concise description of a specific, easily recognized condition -- a circumstance that almost never occurs, as anyone in the healthcare field could easily have told these idiots. Then the doctor is supposed to ask a few focused questions about the complaint (and possibly patient and family history--you get more points for that whether the info is relevant or not!) and then come to a diagnosis and treatment plan. The transaction should only take a few minutes,and the healthcare provider will only be paid for a few minutes work, regardless of actual circumstances. The fact that this bullshit has no connection whatsoever with the actual practice of medicine hasn't prevented the HMOs and other insurance providers from imposing these ridiculous systems on doctors -- one result of which is that most doctors now engage in something close to fraud as they manipulate these ludicrous point systems to provide themselves some reimbursment for the actual work they do. Sadly, some physicians follow the rules rather closely and resort to providing substandard care.
The whole stinking mess reminds me of the economists' fantasies about the restructuring of Eastern Europe in the aftermath of the fall of the Soviet empire. The theories these academic pinheads came up with failed to take into account trivial details like the existence of organized crime or the ignorance of even the educated about the elementary workings of a market system...
Actually, I take back the bit about putting the accountants down -- death's to good for them. They should be given chronic diseases and left to fend for themselves in the system they've created, that would be real justice.
I think that we need to get back to older attitudes regarding death, i.e. it happens and it's inevitable. American culture, in particular is very squeamish about the topic of natural death and dying (as opposed to violent death, which we splatter on our TV and theater screens nightly). Really, there comes a point when the human body can no longer repair itself. At that point, the person should have the option of going into a hospice program to manage any pain that they have, and die naturally with a minimum amount of suffering for both them and their families.
To email me,subtract my nick from my email address, starting with the second character. (hint: adto.uiuc.edu is wrong)
Speaking of things being on file, what about blood samples? How long does the hospital keep blood samples they take? What are the chances that the insurance company doesn't even ask if doing a genetic test is ok. They may already have the material they need... just run it through a quick test....
Although it would probably be illegal, I don't think that would stop them from doing it. Then they would just have to find another reason to deny you... (like reviewing your Saveway Club Card purchases.... you're not eating too healthy. No insurance)
Need a website host? Try out http://WebQualityHost.net
...is that this is publicity. period.
The UK has thrown away another of it's society's rights to "be the first". What kind of sick, twisted world do we live in? I'm disgusted.
Remove the NOSPAM to spam me...
dnnrly
As the industry allows more and more detailed genetic and statistical analysis, removing the element of chance, and identifying exactly who the people are who will get hit by an event... what the heck will the point of having insurance be?
If I test negative for Huntington's, I would be an idiot to get insured for it. If I test positive, the insurance company would be an idiot to insure me. Therefore, back to square one: no spreading of the risk, no benefit to me, or to the society, from the insurance industry. Now obviously, Huntington's isn't the only risk that might affect me, but nonetheless, the direction the industry is headed doesn't make long-term societal sense.
I`m sure you could get anonymous gps boxes, no-one would know who was going where until you reported it stolen. End of (surveillance) problem.
:)
On a related note, i think it`ll be great when gps boxes are a few pounds/dollars. I`d stick one inside my tv, video, computer etc.
I imagine it`ll be a lot more fun to go and `recover` your stolen property yourself, or with a few friends...
Also, it seems a little unfair that genetic stuff is being tested but not lifestyle choices. Someone who smokes 80 cigs a day could potentially have lower insurance premiums than someone who is perfectly healthy but who is at risk from something later on in life.
What does insurance do? It protects you from unknown risk. The insurers do their best to try and beat the system by making more from your premiums than they have to pay out in losses.
Let's scale it down a bit. An insurance company insures 10 cars. The known odds of 1 of those cars getting into an accident in a year is 10%. So the insurance company charges everybody 15% of the cost of an accident for insurance, and the person who gets into the accident "wins" because he pays less in insurance than he gets in payout. Everyone else loses because they paid more than they used. But they got peace of mind since they couldn't afford 100% of an accident.
But the insurance company isn't happy with their extra 50% that they make on the deal. So they try and tell everybody "in order to be fair we're going to figure out who is truly more likely to have an accident and charge him more money and everyone else will get charged less." So they figure out that 1 of their 10 has a speeding ticket, and that makes them 5% more likely to get into an accident. So they reduce everyone else by 0.1%, increase that guy by 10% and pocket the difference. They make more money.
But imagine if they had perfect knowledge. They know exactly who is going to get into an accident. If they have this knowledge, then the only way for them to stay in business is if they don't let the information out -- otherwise if I know I'm not going to get into an accident, why should I have insurance? And if they charge the guy who is going to get into an accident a lot of money, they can't charge him more than the cost of the accident would cost them, so no one can pay their overhead. The insurance company would wind up insuring no one.
Translating this example to health insurance is harder, but the theory is the same. If I am shown that I don't have a genetic disposition to get horrific diseases, then why should I get anything but the most basic insurance? And if I am shown to have a genetic disposition to get horrific diseases that will surely bankrupt me either by high premiums or high medical bills, then why should I pay the insurance companies' overhead along with my medical bills?
"Perfect information that everyone knows" is a road they don't want to go down. I predict the insurance companies will fight to keep this type of information away from the consumer so that only they know the outcome of the game.
Ralph
I'm not a 30 y/o management major. I'm just one of the inferior American actuaries in Hartford, considering switching professions for a lighter workload and more money.
As many have pointed out, this is a written invitation for corporate eugenics. What may not have been pointed out are some of the complexities involved.
Take sicle cell anemia, for instance. The same gene that causes this painful blood disease also inhibits malaria. So, if we eliminate genes like sicle cell, the population may get wiped out by malaria. This is just one example. Surely there are other genes that produce proteins with both positive and negative effects.
In the case of this insurance, we would be selecting for individuals that don't put a burden on the health care system. Well, right now the health care system may be more oriented towards physical health rather than mental health. How much burden does the typical psycho-killer put on the health care system? He might put a burden on the criminal and mental system, but only if caught. How much burden does the typical musician, poet, or artist put on the system? Maybe more, since drinking and smoking seem to be more common in the arts.
Do you see what I'm getting at here? In the short run, the English may save a buck and weed out some sicklings. In the long run, they may breed a bland, milktoast, jock, face-man sort of society with a dull sort of sameness about it. They may breed out creativity, and some other traits that aren't so apparent. This is eugenic's fatal flaw.
The survival of a nation depends less on the health of individuals, and more on the ability of the nation to function as a collective whole. Can anybody really begin to fathom the importance of the less healthy individuals to the health of the nation as a whole? Just consider Winston Churchill--who was addicted to tobacco and suffered from depression. Would England have endured WWII without his leadership?
If totalitarianism arises from Europe once again, it may be greeted by an army full of beautiful bodies who are nevertheless, dull specimens; strapping young men with chiseled physiques--and no creative officers to lead them.
For all intensive purposes, "whom" is no longer a word. That begs the question, "who cares"?
I wonder how many instances of "GATTACA" are in my genome.
Shouldn't be too hard to work out. 7 letters. 4 possibilities. 4^7 = 2^14 = 16384. Therefore, simply divide the length of your genome by 16384 to get a fairly accurate figure for the number of occurances. Shame I don't now all the figures.
Way to go Britain, now you support partitioning people in insurance via their own health records. :-(
Whereas of course the US healthcare is a paragon of excellence and doesn't do anything the rest of the civilised world considers insane such as exclude about 40m people from cover or anything...
And it's not as though healthcare costs 15% of GNP and rising in the US as compared with 6-12% in the EU.
Stick to your knitting and your Cato Institute, sonny boy, and leave microeconomics to people who know the relevant theory.
Well, how about this: people used to buy insurance because they "don't know what the unknown, black, scarry future has in store! Oh no!!" But now, if Insurance companies use genetic data to deny you coverage because you're at a high risk of prostate cancer, then DON'T BUY INSURANCE. I want to see a new kind of company that sees your genetic data(by permission of course) and sits you down with a doctor and says "Looks you're at high risk of Prostate Cancer. Let's look at the numbers and see how you can start preparing to meet this potential need in the future. Dr. Soandso recomends these adjustments to your eating habits to help reduce your risk.." I mean, if you know that on January 21st, 2003 that you're going to suffer from [insert illness], wouldn't you be preparing? Let's start seeing more companies that provide SOLUTIONS to health problems, instead of just throwing around money.
*45*
I'm not one to argue for the sanity of the US BUT as most night owl NRA infomercial watchers will tell you the UK (effectivly) gave up the right to bear arms faster than the US will (wakey wakey CA) and it seems they have (in a way) given up the right to confidential DNA first as well. I would LIKE to keep my DNA a secret until I can go halves on a "clone" wi a nice girl and we see what we get on our spin of the punnet square.
gattaca
"He's a real midnight golfer"
When the first designer babies come along in 25 years, see how much you appreciate being told your children will cost twice as much to insure as happily-tested, genetic-condition free whippersnappers. Do you risk getting your children tested? What if it turns out they are 'at risk?' You, and your kids, for that matter, are pretty screwed now, aren't you, since we have already seen in the last year alone what a great job of keeping information and medical records private big companies do--especially those that thrive on information, i.e. insurance companies.
Sure, this step is no big deal, since about .0001% of the population has this particular condition, nasty as it is, so you are better off getting tested, and saving a few bucks a month. But wait--in 5 years, the test for prostate cancer becomes 'technically reliable', and your genetic test is still on file somewhere. Lets just double check that real quick, shall we? Ooops, you just got denied coverage.
Dont think that when tests for the big killers, cancers and heart disease and the like, are 'technically reliable', that you will have the option of opting out of the testing. That quick blood test at the doctor's checkup when you get your coverage will be testing for a whole lot more than it does today.
And seeing as anything that brings down those premiums is good,You could do a lot of things to bring down premium costs that are most assuredly not good.
lilnobody
Except that a positive genetic test doesn't nessecarily mean that any tendencies will be shown, and a negative test doesn't mean they won't
With a sudden surge in advertisements for American style accident litigation over the summer on British TV, the cost of insurance has risen rapidly here.
Genetic screening would allow insurers to keep their premiums lower, and provided that they make the screening results available to the applicant, it would allow the applicant to make alternative arrangements to insurance, such as investing an amount of money to pay for their medical care.
This isn't actually as bad as it sounds, as we do still have a free National Health Service here, so medical insurance isn't as important as say, in the States.
I'm sure the hype this decision will cause will cause some insurers not to take it up, and advertise this fact, just as some advertise "No medical required" at the moment.
If you're a Huntingdons victim you'll most likely die young... probably before fifty. If you get the gene then you get the condition sooner or later. If you have a family history of Huntingdons - no tests, no needles, no blood samples, just history -you will find it almost impossible to get life insurance cover as things stand. But under new legislation, if you take the test and are clear then you CAN get life insurance, when previosuly it would have been nigh-on impossible. If you take the test and are not clear then you've got bigger problems than life insurance... This cannot be a bad development.
erroneous: look me up in a dictionary
I've worked for a life assurance company in the UK, worked there for 10 years. Assurance companies don't exist to make you feel safe. They don't exist to make you money. They exist to make profits that they can return to shareholders as dividends. The use of genetic testing will allow them to weed out those they consider to be high risk and refuse or penalise them when they ask for insurance. Today it's one test for one genetic condition, tomorrow it will be as many tests as they can do for as many conditions as they know how to find. All I'm hoping right now is that some of the assurance companies decide on ethical grounds not to use such tests. Such a company would be likely to offer higher premiums than the others, yet I'd be willing to pay just to reduce the other companies profits. I'd urge everyone who values their personal freedom to do the same. Since the Labour government got voted in over here they've made a number of bad decisions. This looks to me to be by far the worst.
Because insurance is about pooling risks, not pricing them. If you allow some players to price risks and take a certain segment out of the market, you reduce the efficiency of the overall pooling. You also alter the characteristics of the remaining population, with no guarantee that the remaining population will represent an insurable risk. In general, the largest pool of risks is the most efficient from the viewpoint of society; this may even be the case at the industry level as well. Certainly, the insurance industry is by no means unanimously in support of genetic testing.
-- the most controversial site on the Web
It's worth adding that the insurance industry is by no means unanimous in supporting this kind of proposition; it's an industry which has developed over the years for an environment of pooling of unknown risks. The idea that major health risks can become non-random has all sorts of competitive ramifications for the market. For a start, it makes all currently calculated actuarial tables unusable. Second, it brings the spectre of an "adverse selection" problem; this is the phenomenon whereby the only people who are prepared to buy insurance are those who the companies are not prepared to sell it to (trying to buy insurance is a signal that you need it and therefore should not be sold it). It's quite easy, in theoretical models of this sort of market, to get situations where no sort of market can exist.
-- the most controversial site on the Web
The first effect of this policy is to make all existing actuarial tables redundant; they were calculated for a general undifferentiated population and cannot be applied to a selected sub-population.
A possible further effect is that the tests end up creating an unstable equilibrium, whereby the insurer's decision to sell insurance to you is a signal to you that you're better off self-insuring and vice versa. It's not difficult when you play with the economics of these things to get "no trade theorems" -- results when the introduction of a little bit of information destroys the entire market, because it gives opportunities for people to behave in ways which are individually rational but collectively destructive.
There's a lot of good stuff on this issue at The Institute and Faculty of Actuaries, the vastly superior British actuarial body (this is not a flame on USians; the fact is that USian actuaries are basically auditors of insurance companies and the mathematical content of their training is about four years less).
-- the most controversial site on the Web
Considering what will happen to consumers if insurers are permitted to discriminate based on genetic testing is only half the issue. Suppose discrimination is prohibited. What happens in the insurance trade then?
First, people who learn they have Huntingdon's Cholera become more likely than average to purchase insurance, because it is a much better deal for them. They know their costs will be high, but they only have to pay the average price, which may be much lower than their costs.
Second, insurance companies raise their rates to make up for their increased costs. Then this is repeated for Alzheimer's, cancer, et cetera. Every disease that can be tested causes another pool of people who learn they have that disease to become more likely to buy insurance at a bargain rate. Every time they do, the price goes up for everybody.
You may think that is fine so far, that everybody will have to pay more to help out the people who were unfortunate. But there is another problem. If all the increases necessitated by people with diseases (present or probable) raise the price of insurance above its value to the average healthy person, then the average healthy person will not buy insurance. In other words, if the price goes above what a healthy person can expect to pay for health care on average, plus some additional money for the value of knowing they are covered in case of catastrophe, then health insurance becomes a bad deal for a healthy person. They will not pay too much for it.
Once that happens, healthy people drop out of the insurance pool. Customers who paid a lot and cost little leave, and the insurers lose money. Prices have to rise again. Then it becomes a cycle that cannot be stopped. People in the pool who have less expensive diseases than others will find they are paying more for insurance than they will have to pay for health care, so they drop out too.
I am not sure there is a solution for that. If insurer and insured agreed upon a price before genetic testing were performed and committed to a permanent contract, this problem wouldn't occur. But you can't bind customers to a permanent contract, because society just wouldn't accept it. Not in a private contract, anyway, although the government form, socialism, hasn't entirely been rejected. But that has its own problems.
Those replies saying insurance exists to spread risk across a population are missing an important factor. The purpose of insurance is not, and cannot be, to distribute the mean cost of an event (health problems, fire, flood, whatever) over a population. I explained why in another post, but I will do it here with a more mathematical orientation. The purpose of insurance is to reduce the standard deviation of cost of an event in a population without changing the mean cost for each individual.
Suppose two (or more) people are situated with a probability distribution of various costs occurring -- their house might be flood or struct by lightening, or whatever. Their costs in a particular year may be 99.9% of being zero and .1% of being $100,000 (just for illustration). Mean cost: $100. Standard deviation: $3,160. If they form a contract that each will share the costs, then when one house burns down, they each pay half. If both burn down, nothing has been accomplished, but suppose they live in different areas so floods occur simultaneously only by chance. Mean cost: $100. Standard deviation: $2,235. The mean is still the same because the chances of damages have not changed. The standard deviation is lower because they are sharing.
With two people, the standard deviation is 70.7% of its previous value (1/sqrt(2)). Do it with a million people, and the standard deviation drops to .1% of its previous value -- $3 a year. Insurance reduces the standard deviation. It does not alter the mean, except to increase it for the costs of administration and profit.
When you try to spread the risk among differently situation people with different means, the insurance model breaks. If Pat lived inland with a .1% chance of flooding per year and Chris lived on the beach with a 1% chance of flooding per year, and they agree to share the risks, then Pat's mean jumps from $100 to $550. Pat won't take that deal!
Of course, you could fix this by sharing the risk at 1:10 for Pat:Chris -- Pat pays 1/11 of any damages that occur, and Chris pays 10/11. Then Pat's mean stays unchanged -- but so does Chris's. So you haven't saved Chris any money on average. Pat, and people generally, will happily buy insurance if it reduces their standard deviation -- but not if it increases their mean greatly. So you can only sell insurance to people when it does not change their mean cost by more than they value the reduction in standard deviation.
You are assuming that DNA is a random distribution. Not true
TWW
"Encyclopedia" is to "Wikipedia" what "Library" is to "Some people at a bus stop"
Things will not follow in the US, at least for now. The results of the presidential elections will change the lag period. If the G.W.Bush wins, you may expect the US to follow within 5 years or less. If Gore wins, it may take 10 years or more and only after we start using gene therapy more effectively.
There are two reasons:
first, there are no patient rights in the UK. If you have a medico-legal problem, most likely you will lose and if awarded any damages, it is a very low amount. You may expect things to get worse in the UK!
The NHS is an example of the government priorities in the UK. If you haven't lived in the UK or if you do not have some insider details of it, you can imagine it as an OLD LARGE RUSTY MACHINE waiting to cash down.
I am saying this out of practice and personal experience.
Second, in the US, it is quiet the opposite. Now we are seeing the return of the patient bill of rights and a drive to restrict the influence of large companies (HMOs) in patient management. This can be noticed in the recent Mc Cane "phenomenon". Furthermore, medical insurance is and will be a major topic in the next presidency term; even Bush(!) will not dare support such a legislation.
In summary, if you are planing to visit the UK, put sickness in the bottom of your list!
The very concept of insurance is legal betting.
I'm betting a company that I'll possibly get sick, take ill, need medicine or health care.
The company is betting that I will stay healthy.
I pay into the pool, for the stakes of the bet.
If I get sick, need care, they lose and have to pay to cover the care.
Genetic testing just gives them an extra edge they don't need or deserve, it unbalances the gamble.
A host is a host from coast to coast, but no one uses a host that's close
First off,
anyone who claims this is good for the consumer either works for the insurance companies, or hasn't read enough.
The insurance company wants to test me to find out if there's a chance I may be genetically inclined to suffer a disease later in life. Then they will triple my rates.
For now, I can decline these tests, but watch that option be taken away after the large number of sheep become acclimated to these tests.
When that option is taken away, I will either have insurance, or not. If my insurance is among my benefit package at my place of business, why then, my employer AND my insurance company have my genes on file.
Only a matter of time before the insurance company sells my data...
And they'll make it tough to say no- either take the test and get insured, and employed, or dont take the test, and have no job and no benefits.
I love to take things apart as much as anyone, but aren't there some things we weren't meant to tamper with??
"We're all sons of bitches now."
--Robert J. Oppenheimer, on witnessing the first test explosion of the atomic bomb.
A host is a host from coast to coast, but no one uses a host that's close
Ok, here's a simplified example:
1000 people buy insurance with company X, each paying 500 quid a year. The turnover for company X is 500000 quid
The company requires 100000 quid for administrative and all other costs
The total payout for claims is 350000 quid, leaving X with a net profit of 50000 quid.
Now, genetic screening comes into the picture and ten procent of the clients turn out to be a higher or high risk. The good citizens they are, they keep those clients, but raise the premium for those folks to 1500 quid a year. So now X makes 600000 gross.
The PR department jumps in and makes management aware that the premium for the other customers have to go down, otherwise there will be public outcry. So for the other 900 customers the premium is reduced to 490 quid.
Suddenly X makes a yearly turnover of 591000 quid, a net profit of 141000 quid given that the other parameters stay the same.
Oh yeah, and in a side move they fscked over all principals that apply to health insurance, being to evenly distribute the risk between the insured.
Don't get me wrong. I don't think that an insurer has to take a 70 year old male, smoking three packs of Gauloises a day and quaffing two quarts of Makers Mark. But those are factors within (a certain amount of) control within an individual, but genetic disposition IS NOT
What a bunch of sad, greedy, corrupt wankers
ich bin der musikant
mit taschenrechner in der hand
kraftwerk
This will be redundant, troll or something else: but I am at an absolute loss...
wtf are they thinking? the world is going to . What they should start doing is testing embryos in the womb - and charge different rates for birth, or better just terminate the ones without blonde hair and blue eyes (excluding the left-handed babies... you know what kind of trouble it is to stock left and right handed child scissors in pre-school... you can send your left handed child, but alas you must pay more...)
Read the article, this crap is why Ralph is running - then tell your friends/neighbours/coworkers to:
Here in Canada, and in the US and UK, we live in liberal democracy. The question of whether of not the insurance companies should be able to do this, based on a shared-risk analysis of the system, doesn't look at the real underlying value.
The question should be: Can anyone (government agency, or company, or private individual) treat someone differently from someone else based on that person's possible genetic disposition for a disease. It's important to remember that unlike other pre-existing conditions, genetic traits do not guarantee that a person will develop a disease or syndrome.
In Canada, we have something called Equality; it comes in two main types. There is Equality before the law, and Equality under the law. The difference is this. According to the first, everyone is treated the same when being faced with criminal charges. Everyone gets a fair trial; everyone has the right to counsel, etc. The second one is significantly different. It proposes that some people should be treated differently (better) than others because of who they are. The government is required to spend more on building access for handicapped people than it is for "normal" people. That is to say, the government has to go out of its way to improve the standard of living for handicapped people, so that they can have equal chances in life. So that they have Equality with the rest of us "normal" people.
The suggestion made in the UK, seems to say that the normal people have to be protected more than the people who may get sick. This is not the way things normally work in a democracy. The people who face having to deal with a disease, should have extra guarantees of protection by the government, who in turn should either force insurance companies to carry the weight, or do it themselves through taxes and publicly funded health care (as is, happily, the case in Canada). We need to remember that governments are not about protecting "normal" people, and not even just about protecting the majority. In fact, governments should go out of their way to protect minorities, while at the same time respecting the will of the majority. (At times when the two are in conflict, you hope that you have either good morals, or a solid Constitution with a built in set of basic rights, that not even a majority can take away from anyone.)
"You must do the thing you think you cannot do" E.Roosevelt
That way, if we detect the Troll Gene in them or in their families background, we would know they have 50% chance of suffering from the First Post syndrome and the like. If they don't disclose that information, we could refuse to give them access to the comments.
...and the world has reached a new low.
Who's ready for a revolution?
I'm dead. No, really. Ok fine, you got me, I'm a newt.
Ahh, but should we require such a moral system to be built in to our economics? Or should we let morality and capitalism, church and state, operate independent of each other?
Thus arises the conflict of interest.
On one hand, "It is not a punitive step. This will actually benefit very many people seeking insurance. The only people who are likely to have taken a test for Huntington's disease are people with a family history of this disease." But on the other, insurees "would be expected to disclose the results of any genetic test for Huntington's disease they had taken in the past" and "insurance companies would have the right to refuse to offer insurance if a customer refused to reveal details."
Additionally: "a person at 50% risk of developing Huntington's often found their insurance premium loaded by as much as 300%." And this is only if you're at risk, which is different from being certain of it.
Is this fair? Probably. If you, personally, are likely to contract a certain medical condition, then why shouldn't you pay your own rates for that instead of expecting it to be evenly distributed, Medicare style?
On the other hand, this is definitely a slippery slope. I'll be one of the first to cite "Gattaca", and the instance where a day-care center wouldn't take a certain boy who was at risk for assorted genetic "defects", all because "the insurance won't cover it". Will our medical insurance one day have factors for our likelihood of cancer, Alzheimer's, and depression, the same way our homeowner's insurance now factors in our neighborhood and the age of the plumbing?
Come on everyone, we know that the insurance companies will just pocket any savings. Do you actually think you'll ever see a news article like "Insurance companies have announced a general rate decrease because of savings from exclusion of high-risk people." Not a chance in hell.
British lawmakers swallowed this one just like the U.S. Congress swallowed the RIAA line and produced the DMCA -- it's all about corporate profits.
This may also hurt public health by encouraging people never to get a genetic test for fear of finding something they can be made to pay for later. No tests means people may not find out information they should, such as having a high genetic risk of breast cancer necessitating the need for more thorough and frequent breast exams.
Of course, that will go away in 10 years when the genetic tests are mandatory.
Another one, if a lab at a hospital I was in tests me for this genetic trait without my permission and shows me the bad results, can I sue them later because I was denied health insurance?
If insurances were handled by one official office, this may be what you get (such as pensions and the money you get from social welfare if you become disabled).
Instead, insurance companies are financial institutions. What do you think they use the money for? How can they make money? You know they want to make money, right? Actually, insurance companies are among the largest investors in the market. Their main activity is really buying and selling, making profit on your premium. If something happens, you will get a return pay. I think Terry Pratchet has a good description of this in the beginning or the Ringworld Saga when one of the main characters describes the concept of insurance to someone who has never heard of it. This other guy realizes that they are going to bet on whether his house will burn or not, he will place a small wager that it will burn and get a very large return if it indeed does. He pays the money and sets fire to his house, laughing as he does so. Unfortunately, the entire city goes up in flames, but that is a different story :-)
Anyway - insurance is not "public service". You can't insure a high-risk object. Try. These days even trying to insure a car will evoke a response of "we're not really interested" from your insurance sales rep. That's what you're going to get in the future if your genes are bad - you are too risky to insure; of course you are going to cash in.
What is the sound of one hand clapping?
cat
It is a little bit like trying to start a new auto company to compete with GM - good luck on trying to raise venture capital; call us when you do. Nobody even tries to compete with insurance companies; what could you sell the Venture Capitalists on? "We'll run our insurance company honestly and pay our claims quickly? " I think you can see there is little chance of that raising the big bucks. To raise venture capital it is necessary to show that you can do a particular job better than those already in an industry - so that you will have a competitive advantage against them. That is a very difficult thing to do in insurance; all the companies in the industry are already very efficient.
Nobody in the industry wants to upset their scam - they all profit from it - so nobody rocks the boat. They just count on nobody noticing what is going on.
Why is this a scam? An example will show you the trick. Suppose fire works are legal in your area. The "Fire Safety Institute" or some similar insurance industry backed group starts a big push to outlaw fireworks. "Look how much fire works cost you in extra fire insurance premiums" is one of their main arguments. The Push is successful - fire works get outlawed. So your fire insurance premiums drop - right? Somehow the Insurance companies 'forget' to pass on the savings to you that came from their risk being lowered.
Nice scam, and one that people have been falling for repeatedly for 70 years or so. Cars today are far safer than they were in the 1950's. Your chance of being injured in an accident in a 2000 model car is a lot lower than it was in one from 50 years ago, but your insurance rates are a lot higher. (That is not all scam, there are a lot more cars on the roads than there were in 1950, and like chemical reactions, accident rates go as the square of the density of the reactants. double the number of cars and the number of accidents goes up by a factor of four - given nothing else changes.)
In any case the basic scam is: "Make things safer by pointing out that X costs you money in higher insurance premiums, forget to lower the premiums when X disappears". Quick test, did anybody have their insurance rates drop when helmets for kids on bicycles got mandated? How about helmets on motorcycle drivers, did anybody get lowered premiums for that? How about when mandatory seat belt laws went into effect, did your auto insurance costs decline? No, but you can bet insurance company costs went down when those laws went into effect.
I once heard someone say "One more time through and the banks and the insurance companies will own everything." He wasn't very far wrong.
On one hand, it's worthwhile for countries to offer a minimum set of services to everyone. This is for a variety of reasons including financial, political, and social. This is the best way to ensure equality as it can incorporate many cost savings beyond normal insurance, such as reduced drug costs.
On the other hand, in the realms beyond minimum services, I'm all in favour of life and health insurance companies dividing up the risk pool according to statistical data. I don't want to share my health insurance premiums with smokers, my life insurance premiums with terminally ill people, or my car insurance premiums with people who speed and have collisions. I don't owe those people anything. When I go shopping for insurance, I want a product that is a good reflection of the risk/payout ratio for me.
Insurance should be used for its original purpose: unpredictable financially catastrophic problems. When the probability is well known people should insure themselves. When its a matter of equality public policy should be enacted, but not by enforcing consolidation of risk by private insurance companies.
Careers should combine three things: what you can do, what you want to do, and what you can get paid for.
It is fair that if you do certian things to reduce your risk, like install a sprinkler system, that you should pay a lower premium.
As you say, you can't change your genes.
What the genetic testing does, is eliminate the uncertianty. Now the insurance company can know with 100% (or some percent) certianty that you will get Disease XYZ and charge you higher accordingly. It seems to me that whether you know or not, from genetic testing, that the risk should be for the entire (insured) population. Any individual person has risk X of getting disease Y. Now that fact that I may get a test and find out that I'm way more likely, shouldn't change my premiums, but it is information that I can use, which benefits everyone, including the insurance company. The idea with share the risk is that X % of the population will get disease Y, not that YOU will get it.
Back to changing things you can change; it certianly seems fair, that if I don't smoke I should pay less. If I don't jerk off, I should pay lower premiums for eyecare, etc.
I'll see your senator, and I'll raise you two judges.
Way back when I was in high school, I was taught that the concept of insurance was to "share the risk".
My house may not burn down. Your house may not burn down. But somebody's house is probably going to burn down this year. This is a terrible thing. Devistating. An asset that costs an entire lifetime's savings is gone in a few hours.
With share the risk, we all share in the risk by paying a little bit, and then when disaster happens, the money is available to "make us whole" again. If the cost of fixing burned down houses goes up, then everyone who wants to be covered under the plan needs to pay a higher premium to meet the cost of the outgoing claims.
It seems like insurance companies increasingly want to avoid risk. They want to collect premiums from everyone. But when disaster strikes someone, they don't want to pay out.
They increasingly want to cherry-pick. Especially in health insurance. We won't insure you unless you're in perfect health.
I know (health) insurance companies are not a bottomless pit of money to spend on outrageously expensive treatments. But insurance companies will no longer play the "share the risk" game, which is what I though insurance was supposed to be all about.
When it comes to health, there are lots of risks. Different people will have different problems. Problems will increase with age. You'll have more difficulty getting it up, etc. But our genetic diversity is a good thing. It is what helps make us resistant to nasty things that would easily wipe out a race of genetically identical creatures. After all, somebody is going to be more resistant to the black death, even if it wipes out a sizable fraction of the population.
Following from the genetic diversity, everyone is going to have different problems. So maybe nobody should be eligible for health insurance (no risk) -- but everyone should still have to pay premiums. I think I better switch careers to be an insurance executive. (Or maybe recording industry executive.)
Hmmm. Shades of Gattaca.
I'll see your senator, and I'll raise you two judges.
I'm gonna pass all the genetics tests, get loads of life insurance, and step out in front of a bus. That'd serve them right.
If you're a jock, inflict some pain / If you're a nerd then use your brain - DAPHNE AND CELESTE
My proposal: Let government create an "individual health-care account" for each citizen, at birth, containing a fixed amount of money. Each individual could make a decision over his lifetime as to how that money is spent on health-care services, but if they want to exceed that quota, it has to come out of their own pockets (or that of friends, family, employers, churches, cooperative organizations, whatever).
Because the money is coming out of the individual's own account, he'd have an incentive to be judicious in his expenditures and to take care of his health to the extent possible. People who could afford to pay for routine health-care costs out of their own pockets would be smart to do so and save their account for catastrophic expenses, but those who today can't afford routine health-care costs could dip into their account to get coverage. People could make individual lifestyle choices: If they want to smoke and eat fatty foods and never exercise, they should go for it, but they shouldn't expect anyone else to subsidize those habits beyond their basic allocation. (They're not being left completely out in the cold, of course, they're just not being given "cost is no object" health-care coverage either.)
This approach would, I think, have an effect similar to insurance in that it's pooling risk -- in effect you are being taxed (rather than paying premiums) for benefits that go both to you and to everyone else. However, there's no issue of genetic or lifestyle discrimination here, because everyone is getting an equal amount of money to start with. You could make the taxation scheme progressive so that higher-income individuals (who will always be able to spend their own money out of pocket for enhanced coverage) contribute more to these universal accounts (but having a job would not be a condition of having an account).
Now I know that you could say, hey, what if you're unfortunate enough to be born with "bad" genes that predispose you to disease? Or you get unlucky and develop a freaky cancer? Aren't you getting shafted because the amount of money you are given to treat your condition is limited? True, but the reality is that any system must ration people's access to health care in some fashion, because the amount of money that a society -- and I don't mean just government, I mean all individuals in aggregate -- is willing to spend on health care is necessarily bounded. (If you had a fatal disease and discovered it could be cured, for you and you alone, by spending a billion dollars, would we spend a billion dollars? Or would we decide that billion dollars could better be spent on more widespread health-care initiatives or even something else entirely, say education?) So the question is not whether expenditures are bounded and therefore rationing will occur, it's (a) at what dollar amount does the rationing occur, and (b) who determines who benefits from that rationing -- is it the government and insurance companies, or is it individuals in consultation with their doctors?
This is just the kernel of an idea, so I'd be very interested in thoughts, comments, feedback.
"Biped! Good cranial development. Evidently considerable human ancestry."
If you actually read the article, then what you find is that there is a definite advantage for consumers in allowing this kind of test. Remember folks, it's not mandatory, and you'll still be able to get insurance without having a DNA test, so it's not any kind of Big Brother conspiracy.
The fact is that if you've had a DNA test and there's no problem then you will be getting an advantage - companies will be more likely to insure you at a much cheaper rate. And seeing as anything that brings down those premiums is good, I don't really see how this can be construed as a negative move on behalf of the UK government.
As long as it's voluntary, then we all win - you can either take the test and get cheaper premiums, or you can not take the test and satisfy your urge for privacy. It's a win-win situation.
But what happens if you are in perfect health, and you take a genetic test and they turn up some high risk factor? Then you can never again get health insurance, or if you can, it will be very expensive and have clauses excluding any disease related to your risk.
But very few people will have the genes which put them in high risk groups. These genes are generally recessive and so it won't express itself in you because you don't have the correct combinations to cause the disease to become active. Only a small percentage of the population will be adversely affected.
Suppose you're a young adult whose parent begins to deteriorate mentally for no apparent reason. You seek many cures. H/she gradually goes insane, develops tremors and becomes uncoordinated. Finally a doctor suggests it may be HD, which is passed by a dominant gene. But there's no family history. One of his/her parents lived to be very old, and the other died of a heart attack at age 38. Other relatives died of TB or were killed in wars before they reached middle age. You can't find medical records on their grandparents. Your parent dies after many years of insanity and institutionalization, and finally a brain autopsy reveals that he/she had HD. By now you are married and have kids yourself. You have a job, you have insurance. Now you realize that you have a 50% chance of developing this disease yourself - and you may have already passed it on to your kids. You know from your parent's experience that it's a very slow death, and there is no cure. Most people who aren't faced with this decision might automatically say they would want to take the genetic test. That's because they are not at risk, and they imagine they would test negative. Could you face finding out that you will soon begin to lose your mind, personality and coordination - and you may have doomed your children as well? To make matters worse, you know if you flunk the test, your insurance could be cancelled, and you could lose your job, even though you haven't developed any symptoms. Not only would you be unable to support your family, but you could become a drag on them economically, emotionally and socially.
All this happened to someone close to me. I wouldn't wish this disease on my worst enemy.
You've broken it down well. Only a blanket health care system makes sense in this context.
Providing health care only to people who are healthy or wealthy is not a very moral system.
If you were offered a ride in a time machine that allowed you to skip forward and see who won the next superbowl, betting shops would demand you disclosed that information, if you had it, before placing a bet. Otherwise, logically, you would only ever bet if you knew you'd win.
For all this appears to be the first step on a dubious path, that is all that is happening. The health insurers are saying, "If you already know the results of the bet, shouldn't we be given that information too?"
What really needs to happen is for health insurance to be categorisable. So, if you do find out you're likely to get Huntingtons in thirty years, you can still get insurance for everything BUT Huntingtons for a reasonable price.
Genetic screening will benefit some people. The idea of shared risk is that no one in the pool of people insured knows who will require medical care and who won't. If you can find ways to screen out the "riskier" portions of the pool, you can make more money.
This is really an extension of current insurance practices. Insurance companies started skimming the healtiest people (young, non-smokers, etc.) off the top by offering them lower rates. Providers like Blue Cross, who insured a heck of a lot of people, got stuck with a higher-risk pool, and so their rates would be higher.
What insurance companies would like to do is to put everyone into a pool of one, i.e., they would have a reliable estimate of how much each individual person is going to cost them. Then they charge a bit more than that, and make money. Have a gene which guarantees a certain disease? We aren't going to have the people with good genes subsidize your care -- you have to pay more because you, as a single individual, are unprofitable otherwise. What would happen in the extreme, of course, is that there would be no shared risk anymore -- everyone would be evaluated on their individual profitability. Eliminate the uncertainty of the future, you eliminate the need to pool yourself with "riskier" people.
Some people would benefit with no insurance. Those who never get sick. The question is, do those that are not likely to get sick have a responsibility to those that won't? If the answer is no, then test away, and let the market decide the fate of those who are known risks. If the answer is yes, then we might have to limit the way people are pooled in health insurance. I suspect that many of the people would answer that question based upon their expectations of getting sick.
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The truth is out th- oh, wait, here it is...
'nuff said.....
and why not ? where would stephen hawkins have been today if insurers would have refused him ? there are so many people that contribute to humanity even though they're in need of some sort of medical attention. It's not a matter of right and wrong it's simply a matter of choice; do the healthy people want to pay for the sick people ? I can honestly say that I do, and i'm a healthy person with no family history on any special diseases.
what if you fall in love with someone, are you gonna get them take a genetic test before deciding to start a relationship ? off course you're not.... what if your child gets sick, would you pay the cost ?, your neighbor ? your countrymen ?
my genes tell me that i'm not gonna get sick ?
That's a snippet from a DNA sequence (AGTC) and a movie portraying an Orwellian society (gotta love the Sci-Fi channel's wide-screen version!). I wonder how many instances of "GATTACA" are in my genome.
"Ancillary does not mean you get to rule the world." --U.S. Circuit Judge Harry Edwards, speaking to the FCC's lawyer
Obviously, once this sort of testing starts, people with genetic risk factors for serious disease (meaning expensive to treat) will end up paying more for their health insurance, if they can get it at all. An interesting side effect will naturally enough be a huge upswing in abortions of "defective" (that is, expensive to maintain) embryos that would have been born as babies unable to get health insurance after a certain age (when many genetically-related diseases begin to manifest symptoms).
As other posters have pointed out, insurers can easily implement this sort of vicious health insurance discrimination by simply adjusting the base rates ever upwards while offering "discounts" to more and more people who "volunteer" to allow genetic tests "for planning purposes" and yet steeper discounts for "low-risk" individuals (meaning super-healthy). In this way, I've no doubt that the practice of "stealth" health insurance discrimination will spread fairly fast to the United States, and for just about every genetically related disease.
This nightmare scenario of "genetic outcasts" who can't get affordable or any health insurance, or even employment because employers don't want (for instance) to be sued for "negligence against the financial interests of the stockholders" has been well enough covered in many science fiction novels, although I leave it to the reader to find these novels (sorry, it's been years since I've had time to read anything much but technical or business material, and I've forgotten the names of even the ones I vaguely recall).
A truly excellent pizza parlor is a delight unto the heavens. Treasure the sauce and the toppings!
Christ. This is like an extension of the usual slashdot 'gimme' mentality -- 'Gimme life insurance even though I know I'm going to die early and require you to pay it all out'.
Which begs the question, what if you don't know? I have a couple of friends who were adopted. They don't know, and haven't been able to find out who their birth parents are; consequently, when they are asked by insurance companies if there is any history of cancer, or whatever, in their family, they answer that they don't know. And because of this, a couple insurance companies wanted to raise their rates, or deny them coverage... They got lucky, tho... They found an agent who was an adoptee himself, and he cut through the BS for them...
Not everyone has that advantage...
I like you, Stuart. You're not like everyone else, here, at Slashdot.
Possible denial of coverage over something the person had no control over... How lovely...
I'm not surprised, tho... I just wonder how long it will be before this hits the US.
I like you, Stuart. You're not like everyone else, here, at Slashdot.
Why stop with genetic tests for Huntingdon's? Why not do a full battery of genetic, ultrasound, blood, and urine tests. Hell, throw in some psychological profiling for good measure... it wouldn't serve the consumer to raise premiums to cover drug addiction or psychological counseling, now would it? Then the insurance companies can deny coverage if any problems of any kind present themselves.
Isn't it reassuring to know that one day you'll only be able to get health insurance if you don't need it?
I take drugs seriously.
I would suggest a viewing of the movie Gattaca. It would appear that it is not too far off.
I myself would be a victim of such "pre-approved" screening as I was born with a heart condition and missing tendons in my right hand. Both have been overcomed but the hand is still a hinderance.
A friend of mine is epileptic due to head trauma. As a result she has to pay something over $200 a month for personal health insurance that has, get ready to choke now, a $10,000 deductible!
I think/fear that these are the joys genetic insurance screenings will bring.
--
When you sympathize with stupidity, you start thinking like an idiot.
"Financially punishing you for being alive. Good for consumers and good for you!"
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end communication
"Huntingdon's chorea is one characteristic of Huntingdon's disease which is completely different from Parkinson's disease in ways which will be apparent if you read the article in conjunction with this."
Btw, That's A Link On What The Hell That Is.
Well, you see, it belongs to the same species of evil as racism. When you can classify someone, when you can dehumanize them and make them "the Other", that's when you can kill, torutre, and oppress them without guilt. This is something Hitler and Stalin knew very well; if you can make your victims look less than human, then the public will go along with whatever you do to them.
Remember, we had slavery in the U.S. before. And don't give me that "well we didn't know any better" crap. Everyone knew perfectly well that it was slavery, they just didn't mind because they had been taught that Blacks were less than human. And I can look ahead to a future where anyone with defective genes will be argued by scientific pawns to be less than human.
It's very important that we all act individually AND together to prevent this sort of dehumanization and classification, no matter where we find it. I don't care if you're black or white, a woman, genetically defective, still in the womb, or wearing a hood and white sheet - I think everyone is human, and everyone deserves equal treatment. When you can apply a label to someone, "Jude", "Fetus", "Hick", "Retard", and other hurtful and ignorant terms, that's when people turn into animals and tear each other apart, all the while being convinced of their own superiority.
If you think this is off-topic, you're wrong. This is just another way of describing some people as less than human so they can be controlled and abused. We need to ready ourselves to do something about this, instead of just sitting back and waiting for a faceless organization like the ACLU to handle it for us. Personally, the prospect of government controlled Eugenics scares me about as much as any dire warnings of military despotism futures.
I personally was scared much more by Brave New World than by 1984.
Kasreyn
Kasreyn: Cheerfully playing the part of Devil's Advocate to hairtrigger
This lowers the rates for the majority of us without too many genetic defects, and allows those with such defects to know considerably earlier and take action. I see it as win-win.
What action are they supposed to take once they have been denied health insurance, unless they're independently wealthy? Maybe they will turn out to be you as genetic screening improves, by the way.
-jimbo
"Hold me Bob!" "I would if I could man!" -Bob and Larry from VeggieTales
Insurance requires mutual ignorance. This keeps both parties from cheating. To those of you how have written that genetic testing is a good thing (fair) for consumers:
How do you know you are fit to survive???
IMHO, this is racism, plain and simple. After all, racism is nothing more than discriminating against someone because of some genetic property over which they have no control (usually, skin color). I feel fortunate to live in the U.S., knowing that the ACLU would never let a law like that pass, unless someone amended the U.S. Constitution first.
I had a very good friend die from Huntington's Chorea. I watched him go from a good-looking, wise-cracking, hard-drinking, Corvette-driving ladies' man (who'd give you the shirt off his back) to a lifeless lump whose mother had to spoon-feed him and change his diapers. Fortunately, he had a union job with good insurance, even after he was put on permanent medical leave.
Personally, the thought that anyone should try to exclude such people from the comfort of knowing that they are at least covered by insurance, just for the sake of profit, disgusts me. I'd gladly pay my extra share to make sure such people get the care they deserve. But then, I know such opinions aren't very popular these days.
Serving your airship needs since 1995.
OH GOSH, NO!!! I have some much love and respect for insurance companies...I would hate to rip them off. In fact, I would DIE for my insurance company.