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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.'"
..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.
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.
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."
[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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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.
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
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.
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
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?
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.
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!
"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.