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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 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?)
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 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 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
..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.
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
Yes. That's exactly what it means. Well actually, it doesn't mean you're a worse driver, just more 'likely' (whatever that means) to have an accident and make a claim.
Discriminating against (or in favour of) an individual based on what similar individuals have done in the past is actually fundamental to society, and I'm surprised people don't notice this.
For example: a university offers a maths degree. After a few years they notice that people who didn't get an A grade in maths at school tend to fail the course. Not all of them, but most of them. Then two students apply for one place - one of them got an A in his exam and the other a B. Assuming other factors are equal, who gets the place?
Maybe 'student B' would actually do better at the course than student A - he could be a mathematical genius who just didn't get on well with the limited school course. (Everyone knows about Einstein's school maths achievement.) It is grossly unfair to judge this one student just based on what other people happened to do in the past - people he is totally unrelated to except by getting the same grade. It's by no means certain that the B-grade student will fail the course - but I'm sure you'll admit it's more likely.
-- Ed Avis ed@membled.com
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.
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 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.
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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As copyright owner of this comment, I authorize everyone to defeat any technological measure which limits access to it.
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.
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
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"
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.
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
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
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
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
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.
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
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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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.
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!
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.
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.
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
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.
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
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.
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.
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
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.
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
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.
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
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.
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
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?
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.
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.
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.
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...
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.
"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.
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.