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Privacy Fears Send DNA Tests Underground
biobricks writes "The New York Times is reporting that people who could benefit from genetic testing are too afraid their health insurance companies are going to raise their rates or deny them coverage to find out the health information contained in their own genes. There is a growing "genetic underground" where people pay for their own tests so they won't have to share the results with insurers, and beg doctors not to divulge their genetic status in medical records. A bill that would ban genetic discrimination by insurers and employers — and presumably make people feel safer about taking care of their health — is stalled in the Senate. We've discussed these types of personal DNA tests in the past."
can they change the colour of this thing in my hand?
bomb the us up set someone
An insurance is a way for the insured to get an acceptable cover for risks and an insurance company also has to take a reasonable risk. Even if a certain genetic predisposition exists doesn't mean that it actually is triggered in an individual.
If builders built buildings the way programmers wrote programs, then the first woodpecker would destroy civilization.
was that the results are mailed ONLY to the test subject. The paper the patient gave me with the lab address to mail to specifically stated that they will not release the results to anybody else, not even the doctor unless there is a signed document declaring that this is the patients decision. Granted this is only one lab, but Im hoping its the same for all labs.
People already do this with tests other than genetic ones. I have heard many times: "Don't write this in my record but..." with regard to 'stealth' health care problems. In most states you can order labs without a doctor's prescription through direct to consumer labs, so you can find out all sorts of things that can effect your insurability. Heck, go to a pharmacy and you can check your BP for free.
The solution of course isn't congress passing a bill that makes such discrimination illegal, but rather to pass a bill that establishes universal health insurance (preferably single payer, but lets be honest, the US is far too much a classist society to adopt that... sigh.) Though what's particularly stupid about such a bill is that it would outlaw discrimination from insurers if I noted in your record that you had a blood test that said you were predisposed to diabetes or hypertension, but it would not outlaw the same discrimination that would occur if I noted in your chart that your BP was 160/100 or your fasting blood sugar was 160. If we diagnose your hypertension or diabetes with a $2000 test, you are safe, but if I diagnose it with a $3 lab test or by taking your BP several times, you are hosed.
Brilliant.
There's an easy solution here:
Whoever pays for the test should legally own the result. So if you pay for it out of pocket, you own the result and it's up to you whether you want to share it with any third party.
If your insurance company pays for it though, then they have a perfect right to see the results.
Layering still more legislation on top of medical record privacy law is just going to add complexity to a system which is already drowning under its own administrative overhead.
as then they can just keep you from working if you have predisposed to be sick have have to miss work for a long time.
*sigh* So now we have to hide information in the fear of the privately owned companies, who operate for profit and nothing else - as well they should; that's how the system works - increasing our rates. How bad are things going to have to get before we let our taxes take over where insurance companies currently operate? Yes yes, it's "taking away our freedoms." Y'know what, though? I'm willing to give up my right to die from a treatable wound or illness.
More and more aspects of that movie are becoming reality. I am not comfortable with this aspect of our future, guys. This is not good.
"The agriculture ministry is not in charge of Gundam" - Japanese ministry official.
The movie Gattaca. Not the best movie out there, but definately not a horrible movie. It is about the future when people are discriminated against because of their genes. Looks like we are getting closer to the sci-fi world that we dreamt about 20 years ago...
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There has been a phenomenon of individuals researching their suspected Jewish ancestry who are undergoing genetic testing for this express and exclusive purpose. This process has been used to confront the denials of living family members about their family history. Nowadays, more and more people are questioning America as a viable place to raise a family that could be targeted for their ethnicity by the results of changing demographics (Thank Hart-Celler for that). Such people now have the fear of having this information diverted for such nefarious purposes. Imagine the irony: "Without my knowledge, I have obtained an Israeli passport at the price of private health insurance coverage" or even worse "This pursuit has left me with no claim to an alternate citizenship AND, by reason of this process, I have found myself being denied private health insurance coverage altogether."
Downmodding constitutes antisemitism.
Submission as evidence constitutes plaintiff and/or prosecutorial misconduct.
I agree (as an evil socialist canadian ). The whole concept of "Health Insurance" is stupid. If you get car insurance, there's a chance that you won't get into an accident (especially if you are a good driver). If you get house insurance, there's a chance that your house won't burn down or be broken into. But with health insurance, you are guaranteed to collect 100% of the time. At this point health insurance is no longer an "insurance" business, and is now a "denial" business. It's sad to see.
Would they lower rates due to a clean genetic test compared to the normal now?
How long before insurance companies proactively raise rates, but then offer a discount back to normal if you provide genetic test results?
Is the bill worded such that neither penalties nor bonuses can be given out due to a genetic screen?
How much different really is it from family history, just a more accurate measure?
Insurance is all about modeling the risks for an individual based on available medical data. In *theory*, if genetic screening can increase the accuracy, then people with clean genetic situations should get decreased rates from what they pay now, while those with the dispositions carry the burden of the risk. If all goes according to the hypothetical, neither way is particularly feels 'fair'. On one hand, your rates go up because you got stuck with some genetic predisposition for heart disease that you couldn't control, that may never manifest. On the other hand, someone with a genetic disposition that will never suffer a particular ailment, will have to pay for the risk of that ailment anyway.
Of course, the chances insurance companies would *lower* any rates is slim, just jack up rates with the excuse of apparently increased risk individuals without ever acknowledging the class of reduced risk individuals.
XML is like violence. If it doesn't solve the problem, use more.
From a health insurer's perspective you'd be foolish to cover a disease for an individual if they have the bad gene. This isn't discrimination. It's facts and statistics, common sense from a business perspective. Arguably they could charge higher rates to those individuals (like they do to smokers). Health insurers already "discriminates" against you if you've prior disease. They can continue to do the same and it will be no more wrong than it is now. Discrimination is unjust. Medical facts are not discrimination.
Of course, testing is only the first step. Expect to see those with expensive, insurable genetic conditions simply denied care, much as those over 70 are denied health care for many ailments in the UK because it's not "cost effective."
Nationalized health care is, by definition, rationed health care. DNA testing will just be another way to make it more "fair" and "rational.'
Lawrence Person (lawrencepersonh@gmailh.com (remove all "h"s to mail)
http://www.lawrenceperson.com/
Its quite simple - as genetic tests become more powerful and reliable, either you either introduce mandatory state-funded free healthcare or you have Gattaca.
You can't prohibit insurance companies from minimising their risks and still call it a free market. If you did there's bound to be some offshore haven from which insurers can offer preferential deals to the genetic elite.
In a survey of 100 programmers, 111111 thought that duck-typing was a good idea.
No. Because no one is subject to random economic events. Yes, people unexpectedly lose their jobs, but anyone who is well prepared won't be subject to significant risk because of that. They will have savings set aside and they understand that they will have the (federally mandated) option to continue their current coverage for up to 18 months if they chose to pay.
Health insurance companies already have a term for this: pre-existing condition. If you don't report your genetic deficiencies to them, they'll simply deny you coverage on that basis.
Consider that the National Association for the Self-Employed offers the following on their policies: you pay a monthly premium from now until you're 65. Your premium never goes up. When you get there, they say, ok, lets look at your claims against the insurance. They add them up. Then add up the premiums you've paid. And they give you the difference if anything is left over. Apparently, they invest the money because i was told that if I started today, i would have about $800k in premiums paid. Then they would deduct the claims and give me the difference. They are the first company I've heard of that does this. Had I know about this, I would have done it a long time ago.
The diversity and expression of human opinion is essential to human survival.
Don't sweat the small stuff, people. At the moment, the insurance companies can't accurately enough correlate your DNA to your future expected healthcare costs - Your familial history and general current health indicates that far more accurately.
So don't worry about taking your curiosity underground, the evil bastards simply don't care yet; and when they do, you'll simply get your test date in the mail (or the option to drop your coverage).
Knowing who is at risk and who's not doesn't make the health care cost for treatment go up. It is not that suddenly more people get heart attacks if you know who is at risk and who is not.
Instead of making the cost go up, it could make the cost go down (insurers would spend some money on preventive medicine like statins and save a bundle compared to the expense if the disease actually develops). This remains true even if you take the cost of the actual tests in account, because only those tests would be performed for which the cost of testing results in a net surplus.
All that needs to be done is legislation that requires any insurance company to accept anyone, and that the rates for individuals may not differ more than by a factor of 3. More legislation to help drive the cost down: Set a max to the amount of money in case a person dies because of a medical mistake at $100,000 and for invalidity at $500,000. Of course, expect to lose a couple of more quarters for ambulance chasers turned into beggars.
Oh, and there are health insurance organisations without profit motive (like Unive in the Netherlands).
Bert
without a Constitutional ammendment guaranteeing our right to privacy.
And it's not just on the level of DNA testing. We're already hearing about the dangers that data-mining companies like Acxiom are posing to privacy through their purchase and aggregation of previously unrelated databases.
Universal healthcare in the United States would fix one part of the problem, which is that you could be denied insurance coverage based on factors over which you manifestly have absolutely no control.
However, discrimination from employers would persist.
There's an additional danger: loss of reputation. Imagine the damage you could do to a political rival if you could access their DNA and learn that they are genetically predisposed for cancer.
Do what you can, with what you have, where you are.
Wait until someone's genome is copied without their permission from when they donate blood, and the privacy backlash leaves blood banks dry, patients dying.
Individuals should get the same explicit copyright protection on our personal data, including our genetic and other health data, as corporations get on recorded products. Personal data must be destroyed once the transaction for which it was initially transmitted is complete, with short timeouts, unless explicitly permitted into some specified other scope. Violations should be criminal violations of our privacy rights.
Probably we need a Constitutional Privacy Amendment to make indisputable the force and clarity of this protection of our rights. The Fourth Amendment already protects our private data, but the government hasn't been enforcing it. Since the 4th is itself redundant to the Constitution's lack of a created power to invade our privacy, it's clear that the fundamental line between private and public that is the basis of our liberty must be reiterated strongly or be ignored.
As our entire world becomes defined by the Info Age, the people better get our government to properly protect our privacy soon, or there will be blood.
--
make install -not war
All of that not withstanding, we still rank 37th in overall health care. Not good enough for supposedly the #1 country on the globe. Health industries in general should be focused on HEALTH, not on profits. For me, I eat healthy, don't smoke and get exercise. I do my part.
I think this is pretty interesting, because 100% of the time, I have to fight to get a solid copy of lab reports on blood work, and half the time the staff at the doctor's office (across several offices) will look at me like I'm some kind of freak because I want copies of my own medical tests and doctor's notes. I can ask that copies of whatever's produced by a test be sent to my home address as well as the ordering doctor's office and they never, ever come. Not once.
The only effective way I've found to actually get records is to tell them I want records faxed to another doctor... at a number I receive at.
If my experience is any indication, most patients don't have *access* to their own medical records, let alone control over them.
Tweet, tweet.
The dangers of discloser of your DNA to potential insurers and employers would seem to create an opportunity for people to self-test.
At the moment for a fee you can send a swab to a lab, and they'll return the results to you. That's reasonably private until Acxiom buys a copy of their database or the Department of Homeland Security decides it wants to know your genetic code for whatever reason.
But if you had an affordable device you could drop a swab into and have it return results, there would be no need for anyone else to ever be the wiser.
In the meantime, the only way I can think of to get the results of such a test without risk of others finding out is if you have access to the necessary lab equipment and ran the tests yourself. I know if I had, I would.
Do what you can, with what you have, where you are.
You begin living as frugally as you can, but the bills keep mounting. Your insurance has a $2,000 deductible per year, then you have to pay 10% of costs up to a maximum out of pocket of $6,000 per year. So the first several months, you pay out $6,000, but then the first of the year hits and you again have to pay $6,000 in the first few months of the next year. So your $50,000 in savings is now down to about $25,000 just with your out of pocket costs and paying 18 months of EMTALA coverage.
The chemo and radiation you receive gives you profound weakness and nausea/vomiting. Unfortunately the inexpensive antiemetics phenergan, compazine, and reglan all give you a severe dystonic reaction. So the only one you can take is zofran, which your insurer refuses to pay for because its non-formulary. You only use it for the worst days after your rounds of chemo and split pills when you can, but its the only thing that will help. Even ordered online at the cheapest Pharmacy you can find they cost $10 a pill. So you end up spending an extra $300 per month for medicine in addition to the $15 per month copay each for your other half a dozen medicines. So your out of pocket drug costs are $400 per month. That plus your bare minimum living expenses (food, utilities, tax on your house, travel to and from the hospital) are about $2000/month. So by the middle of the year, your savings have dwindled to almost nothing.
So you begin borrowing by taking a loan out on your home, this gets you through the end of the year and into the beginning of the next. Unfortunately, as a result of the treatments, you suffered a mild stroke and now have to walk with a walker. So you begin the laborious process of applying for disability. You are initially denied, and hire a lawyer who works on commission, but he tells you it will probably be a year or more before you get disability (and hence medi-medi coverage as well.)
I'm getting tired of writing this, and depressed because its all too common. Over half of people in the US in 2006 who filed for bankruptcy did so because of health care bills. Over half of those were employed and insured when they became ill. Don't fool yourself into believing that you can render yourself immune from this should you lose your health and hence your usefulness to a capitalist society. We discard 'useless people' like yesterdays newspaper. And the only reason it hasn't happened to you is you are still producing.
Do you happen to be a Fox News pundit?
Step back a minute and use your brain. Under what health care system would mandatory genetic testing be more likely to be misused? A system where insurance premiums and profits are maximized by reducing or refusing care; or a system where everyone pays, everyone participates, and everyone benefits?
In the current system, mandatory DNA testing would be used to refuse coverage or care - to maximize profits and weed out costly/sickly individuals.
In a universal system, it benefits the system to give you preventative care - that reduces costs for all. In that situation DNA testing benefits all.
I'm so sick of hearing everyone claim the United States is the greatest country in the world, yet we can't care for our sick or elderly, and we sure as hell can't educate our young (the parent post illustrates the education problem).
What the hell makes us so great? Military hardware?
If we are to be a great nation, we need to find a way to provide health care and education for all. A sick and stupid population is not the way to greatness.
-ted
Insurance is all about modeling the risks for an individual based on available medical data.
No, Insurance PROFITS are all about modeling the risks. Insurance is actually about distributing unknown risk among a large number of people. If I had a time machine and could look into the future and see if I'd ever need insurance, the whole thing would become completely pointless, as I'd know exactly what was going to happen. If the insurance company had access to my "time machine test results", they'd either cancel my health insurance if I was going to get sick, or I'd just sock all that money away in a bank account if I wasn't.
In *theory*, if genetic screening can increase the accuracy, then people with clean genetic situations should get decreased rates from what they pay now, while those with the dispositions carry the burden of the risk.
I think what people are really concerned about here is that certain individuals will just not be able to get health insurance. We don't really worry about that for car insurance, or flood insurance, or whatever, since you can always choose to not drive, or live somewhere else. Without health insurance, the only real alternative if you get gravely ill is death, or bankruptcy and losing your job (then maybe medicaid will take over). I think most people would say those aren't very good alternatives.
AccountKiller
Why all the /. love for universal health care? The US has the best health care system in the world, and /.ers want to destroy it in favor of an inefficient government controlled program?
Please stop drinking the Michael Moore kool-aid.
http://gregmankiw.blogspot.com/2008/02/should-rich-get-better-health-care.html
I would like to point out that I think there should be at least some reward for people who take good care of themselves. I guess one can only hope that sensible ideas will prevail.
The diversity and expression of human opinion is essential to human survival.
taking care of you.
They are in the business of evaluating risk and spreading that risk to all of their share holders while charging a premium based on the risk in order to MAKE A PROFIT.
You, as an individual, don't matter. In fact you, as an individual, don't exist.
If you fall into the cost side of the equation, they will try to eliminate you as you are reducing their profits.
You can't run health care for profit.
The United States is the LAST hold out in the civilized world where people think it can be. (Actually, they DON'T but the major shareholders, being anonymous pools of capital, DON'T CARE about the suffering of individuals.)
You aren't even a line item on a spreadsheet somewhere.
The only way to actually run a health care system (as opposed to the health-don't-care system currently in place) is with socialized medicine, just like we have a socialized military (you don't want a bunch of militias running around after all.)
Health is a social responsibility.
Insurance is an actuarial game played for profit. (As long as you don't need it, you don't mind losing a little bit since it is spreading risk around to all the players. The problem comes when you DO need it and the companies DON'T WANNA PAY. [With health care, you might very well DIE!!])
MSBPodcast.com The opinions expressed here are my own. If you don't like 'em... Think up your own stuff.
Why should I be forced to pay for someone else's health care? Fuck, lets get right down to it:
Why the fuck should I be forced to pay for my own insurance if I don't want it? Simply turn me away at the doctor's if I can't pay it is how it should be. The federal government has no place in this matter, should be left up to the states.
Let's say hypothetically that these genetic tests are done by people, and insurance companies offered a la carte rates (i.e. could insure for blood cancer specifically, welcome all comers willing to pay for that coverage). In this case, the customers naturally discriminate themselves, as people who have reduced risk of blood cancer would more often waive the coverage, and in aggregate the percentage of people who buy that insurance plan are quite likely to be afflicted. Either way, whether driven by the insurance companies or by the customers, rate hikes would occur. So a la carte premiums for certain prominent genetic conditions might be a way to drive the rates without technically discriminating or even knowing as companies. I wonder if the bill also prevents a la carte plans...
There are naturally given risks (genetic predispositions) which are unfair and in an certain idealistic vision, the ones covered equally at equal cost across the population (i.e. assumes equal risk of prostate cancer and everyone pays without caring about likelihood, screening used merely for early treatment), and there are voluntary lifestyle risks, like smoking, drugs, and physical activity, which could be abusive of a completely flat non-discriminatory system.
It's a whole set of rough questions, and health/life insurance companies from the very nature of dealing with life and death situations from a business perspective inevitably come off as either sinister by effectively choosing death or a poor business by doing the 'right' thing, it seems. Even if forbidden from denying coverage, they can always price the rates such that they aren't significantly cheaper than the treatments, so I see a rough path ahead regardless as tools for accurately knowing the likelihood of genetic conditions emerge.
XML is like violence. If it doesn't solve the problem, use more.
that you can get along without him and his perspective on the universe so, in order to not endanger your potential right to buy [stick in some Wal*Mart import] you're going ot kill his lame ass.
Go on. I dare you...
MSBPodcast.com The opinions expressed here are my own. If you don't like 'em... Think up your own stuff.
That's a very interesting statement. I would have said that the *theory* of insurance is that it is a mechanism to pool risk, not merely to calculate it. Payments are based on prior probabilities, allowing us to plan our lives, and payouts are made to compensate for surprises. After all, if it doesn't do this, why have insurance at all? You minimise your premiums by cancelling your policy, so on the libertarian analysis the best insurance is no insurance; you just gamble on remaining as lucky as you are today. On average, however, and that's the point, the ideal case would seem to be to have everyone pay the same premiums. It's less paperwork, too. And it's pretty much the economic insight behind universal healthcare.
The thing we should be working on is not screwing over the unfortunate at moments when our doctor happens to be giving us good news, it's developing management techniques that will allow socialist infrastructure to capitalise on its lower costs, so it can outperform capitalism consistently. A simple engineering problem that you would think would excite the slashdot crowd....
Amen, brother.
We need to remember that much of science is politically and or profit driven giving rise to pseudo science. Much of it built on the premise that life is an accident resulting from random mutation and no intelligence was involved. Furthermore it holds that nature is flawed in it's system design and needs to be fixed when in fact it is perfectly designed. We simply need to adapt and integrate with it.
When the new approach is implemented medical treatment costs will be very low reducing and perhaps eliminating the need for health insurance that covers disease leaving only physical injury repair to be insured.
Most people do not know this yet: About 50 human genetic diseases due to defective enzymes can be remedied or ameliorated by the administration of high doses of the vitamin component of the corresponding coenzyme, which at least partially restores enzymatic activity. From the Department of Molecular and Cellular Biology, University of California
http://www.ajcn.org/cgi/content/abstract/75/4/616
The reason you don't know this is that it is a very low cost therefore low profit approach that offers no monopoly or control.
Read about the end of disease protocols here. http://intelegen.com/nutrients/index.htm
"an infinite player that has lost his finite mind" ~Infinite Play the Movie (it blends with reality)
to being stupid but that didn't stop us from electing the current administration. (Which is largely composed of elements of a prior one.)
MSBPodcast.com The opinions expressed here are my own. If you don't like 'em... Think up your own stuff.
EMTALA? No. COBRA. I pay whatever my company pays for the same coverage. We're talking in the area of $200/mo. I'm not even going to try to answer the rest of your story because it has no substantial basis in reality. Is it possible? Perhaps. But you made it up. I've never had a job with the health insurance terms as bad as you've stated.
I am living in socialist Europe too, in Switzerland, which has a health care system much like what the US Democrats want: every employed person is required to buy a minimum level of health insurance from a private company. Every private company is required to offer a minimum level of health insurance to every person, with only age and sex affecting the premiums.
That minimum level is pretty bad (20% copay after deductible on everything; pharmaceuticals cost more here than in the US). Of course, the insurers offer plans for a little bit more money that provide what most would consider "decent" health care.
And yes, they do practice genetic discrimination on those plans.
Your country may differ, but not for long.
I am pitting my wife through college for two reasons:
1) To save her sanity. Being unemployed was driving her nuts and being too near a refrigerator was driving her fat.
2) When she finally gets health benefits working for a Catholic School board, its one less worry.
Personally, I hope the USA wakes the hell up and does what Canada did decades ago.
And the argument about socialized medicine being bad for health care is so bogus (as this article points out,) is not funny.
The USA would have achieved even MORE with socialized medicine, (just like they won in Afghanistan and Iraq with a SOCIALIZED ARMY. [I'm not saying that there aren't problems with KEEPING Afghanistan and Iraq, but the battle phases of the operations were remarkably effective.])
MSBPodcast.com The opinions expressed here are my own. If you don't like 'em... Think up your own stuff.
In the end, some people will require more care than others. Insurance is about providing a guarantee of care before it happens, without knowing whether it will happen. Financially it spreads the risk among all members, converting a big unknown into a small known regular payment. Perfect genetic testing would just make this known before it happens, rather than after. We could continue to allow care just as before. The only snag is that since we'd know who would be requiring care, those who wouldn't might not want to have to pay for those that would.
First, with more and more people who are uninsured or underinsured, the experience of finding oneself with a serious illness and no way to get help without bankrupting yourself and your family is becoming more common. This experience is also entering into the middle class (and even upper middle class) ethos because its not just a poor person's problem anymore.
Second, any idiot with a modicum of intelligence can see that the US health care system is failing the US population. Even those who are insured cannot be guaranteed care when they need it. The US is undergoing an emergency care and on call crisis due to the problems created by uninsurance. If you are a specialist and agree to be on call for a hospital, or you are a hospital who has an ER, or if you are an ER physician on duty in those hospitals, you are bound by the EMTALA law which says you have to provide care for all medical emergencies regardless of ability to pay. This unfunded mandate is pushing emergency care to the breaking point. From 1993 to 2003 in the US, 425 hospital EDs closed their doors; the number of ED visits rose by 26% during the same period (Institute of Medicine, 2006). Moreover try to find that on call neurosurgeon you need to drain your epidural hematoma or the hand specialist to reattach your finger in under 4 hours. Specialists are now refusing to take call because it makes them vulnerable to provide uncompensated care. So while years ago, it was only the poor who suffered, now even the insured are suffering because ERs are overcrowded and specialists are just unavailable. (See what's going on in LA's now as its emergency system implodes if you would like an example.)
Third, (and this is the only thing that has kept me from leaving the US to practice in Canada), I genuinely think the American people are good and want a system that provides people health care just like we provide every child an education and other services like EMS, fire, and police. When bad things happen to others, I think Americans really do want to help. I saw that when I was a chief resident in the ER at Brooklyn's largest trauma center on Sept 11, 2001. We saw it in the actions of individuals and organizations to help NOLA after Katrina when our government stood by with its hand up its ass. Most of us, at heart, are not hateful neocon hawks. However, the hateful neocon hawks have pretty mighty propoganda machines and they were able to fool a lot of people a lot of the time. But eventually we do come around. Witness the phenomena of Evangelical Christians who won't vote Republican because while they don't support abortion rights, or my right to marry my partner, they think that the US's inaction in Darfur, the war in Iraq, the fact that Americans are dying as I type this from preventable diseases, the fact that poor children are abandoned in drug and gun infested warehouses that used to be schools are far worse tragedies than the fact that I have buttsecks with the man I call my husband.
And I would damn rather work in an organization with one of those folks or have one as my neighbor than you. Because she and I would both be Americans who love our country and understand that diversity of beliefs are OK, but that first and foremost we have to ensure that there is social justice, that every child has an education, that every person has health care when they need it, and that our military and our political capital is spent on real problems like resolving the tragedy in Darfur and creating freedom in China rather than creating a profit for Haliburton.
Nick
Institute of Medicine. (2006). Hospital based emergency care: At the breaking point. Washington, DC: National Academies Press.
Let's go over the alternative in a country which has your blessed "universal healthcare":
You suffer kidney failure. You can't afford private treatment. You're put on a wait-list because dialysis is expensive and in short supply. You're over 55. You don't make the cut off. Your socialist system has decided that a 55+ year old person is not worth the expenditure. Since you depended on the state to support you, you have no private recourse. You die.
Sadly, this is exactly the case. I saw something very similar happen to my paternal grandparents (who were never in the best of health) as they reached the last few years of their lives, and they were reasonably prepared.
It may be kind of depressing to think about, and people often think that I'm kidding when I say that if I ever get sick, I plan to run up massive debt, and then die. I just think that's the only way to deal with the U.S. "health care" system as it is... just don't get sick, because if you do, you're screwed. Game over.
I don't suffer from insanity, I enjoy every minute of it! --Longbottle
Actually you are right. Thanks for catching that. EMTALA, COBRA, HIPPA, JCAHO, LOLINAD, etc. I just worked a long night in the ER... acronyms begin merging after an all nighter.
If you're basing your decision of who to vote for on that, then you, sir, are dumber then I.
I would prefer basing my decision of what structural changes a candidate would implement in order to deal with the reality and thus avoid a Gattaca scenario.
Getting the insurance companies out of health care is a very good place to start. (They are fundamentally dedicated to health-don't-care because caring about the fate of individuals would impact their bottom line.)
If we take care of the stigmatization (all based on potential costs) by eliminating it and even the need for it, a Gattaca scenario is a waste of resources and thus extremely unlikely to occur.
Implementing universal health care as a single payer system will immediately eliminate the kinds of multi-pricing scams that see different department in the same hospital being charged different prices for the same medication.
The scams only get worse with medical appliances.
On the whole, I really think we would benefit from a good sweep with an ethical broom, because the medical supply industry really need it and rather than appoint an oversight committee, (just one more structure to corrupt,) it makes a lot more sense to have a single payer system where a prescription for good *A* is the same regardless of who makes, who prescribes it, where it come from, where its going to, or how it gets into a patient.
MSBPodcast.com The opinions expressed here are my own. If you don't like 'em... Think up your own stuff.
I'm not sure where you work(ed?) but this is the exact opposite of my lab in California, which is part of a major national chain. The report goes to the ordering physician, and a copy to the patient only if the ordering physician authorizes it. Except for certain low-complexity tests, all lab testing has to be ordered by a licensed physician or an AP/NP under their direct supervision. This is regulated by the state Department of Health Services.
The problem discussed in the article has been a problem for us long before DNA testing was available. There are certain diseases that one might not want to have on one's medical record for one reason or another. So the patient asks to pay cash up front. But when the paperwork hits the lab computer system, the patient demographics get scanned against various health plan eligibility databases and automatically popped into their health plan, reported back, etc. More than once, we've had a patient in this situation call and ask why we sent them a refund check.
If you ever have a lab test that you want to make sure doesn't show up on your medical record, don't give the phlebotomist your SSN or health plan ID card, and make sure it's not on the paperwork your doctor gave you. (You probably won't be able to give a fake name; most labs absolutely require picture ID as positive patient identification for HIPAA compliance.)
"There is no way an HMO can properly function bound by such a rule," said PhysCare-Plus member-accounts departmental supervisor Toby Francis. "HMOs must be free to disclose patients' medical, personal, and financial information to insurers. How else can we determine what treatments a patient is or isn't eligible to receive? If someone needs a new lung and they don't have the necessary funds to pay for it, how are we supposed to know not to perform the surgery? I can't tell you how many cost overruns have been rung up as a result of doctors providing life-saving operations in accordance with the Hippocratic Oath, only to find out afterwards that the patients weren't covered. In a case like that, the surgery turns out to be for nothing. I get burned up just thinking about it."
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how can anyone expect to get good health care when the ''average'' ( read not all but most)Americans will gladly pay some actor an insane amount of money to play a doctor on TV, or some jock who throws a ball 2 - 3 times as much money as a real doctor... don't let the corporations fool you, if the drug companies put all the cash they spend on flogging the ''so called'' medicines into real health care ..there would be no need to even have a user fee
Though funny you should use that as an example, because all HD patients in the US are covered if they have no other insurance by Medicare-Renal. So we already in the US pay on public insurance for HD to age 116 if needed.
Of course the best way to save money and provide the most useful life to everyone is to prevent people from getting renal failure in the first place. In the UK, if you have diabetes and hypertension (the number 1 and 2 causes of end stage renal disease) you get care for those ailments, so fewer patients get to the point of needing HD. In the US however, if you are poor and have diabetes and hypertension, you are shit outta luck. We wont pay $2000 per year to treat those conditions, but when your kidneys fail we will swoop in and pay $40,000 a year to give you HD three days a week (not to mention the costs of line infections, shunt surgeries, etc.)
Its like buying a car and just putting gas in it till the engine falls out and then buying a new engine. Its stupid, wasteful, and will cost you a lot more money in the long run. And unfortunately its not engines that we are talking about, its people's lives.
health care.
As for the medical care system.
Just make it a single payer system. That would be the federal government's sole responsibility, not deciding on treatment or deciding anything else. (They already foot the bill for the military, let 'em foot the bill for health care and for the same reasons.)
It would eliminate most of the shenanigans and multiple price lists that are currently a major headache with spiraling health care costs.
MSBPodcast.com The opinions expressed here are my own. If you don't like 'em... Think up your own stuff.
The US "health care" system astounds those of us living in other countries. How come people put up with this?
My neighbor and I each have a barn. I spent a pretty penny to make mine out of concrete, and I put in electric lights and have two fire extinguishers handy. My neighbor's barn is built out of wood and straw, and he still uses gas lamps. His hired help has drunken parties in the barn every weekend, and his son makes illegal fireworks in the barn for extra income.
Our health insurance company charges us the same premium, because it says we are the same age and live in the same county, so we have the same risk.
Well, last year my neighbor's barn burns down. The health insurance company wouldn't pay for a better barn, so he rebuilt it exactly the same as before, gas lamps, drunken parties and all.
I ran in my neighbor last week at a PTA meeting. I asked him if he was going to get any fire extinguishers. He said, naw, now that our health insurance premiums had tripled, he had no money left to pay for extinguishers. Beside, he said, the insurance company as going to pay for a new barn just the same whether he had extinguishers or not.
I called up my health insurance agent to see if I could get a better rate, seeing as I had extinguishers and concrete barn, and all. He said nope, and beside, the new law on barn privacy meant he wasn't even allowed to go out and inspect any barns any more.
I asked Hillary, and she said the solution was to force everybody to buy barn insurance, even if they didn't have a barn at all.
I'm thinkin' maybe I should just get out of the farmin' business altogether, but I was born with this here farm, so I'm not sure I can part with it that easily.
I will create a sig when innovation restarts in the U.S.
Americans are pathologically paranoid about anything to do with government. It's in their cultural genes. That's understandable because the US was founded in order to get away from autocratic, corrupt and tyrannical European governments in power at the time. But that's also why they are willing to put up with severe dysfunctionality caused by lack of proper government.
What we call health insurance in this country is actually a pre-paid health maintenance agreement. There is an insurance component, but by and large the costs are associated with routine care, not insured healt disasters. Right now, the closest thing we have is the high deductable health plans which work with a health savings account. In the HDHP, you pay every dollar of care out of pocket until you reach your deductable - about $2.5k for a single, or about 5-6k for a family. This excludes just about all routine care, which means that it doesn't kick in until you've hit a real stumbling block, healthwise. In return, the gov't lets you put away money, pre-tax, into an account (savings or investment) which you draw on to pay your health expenses.
Everyone on insurance already has a "single payer system," it's just that the "single payer" is the group of health insurance companies instead of the government, but they act and think with close to one voice. Right now we aren't covering everyone, though we could for about 1.2T/yr through the existing private system*. It would be a significant burden if the cost were borne by employers, as most businesses just can't foot the bill for $8-12k/yr/employee, especially when the coverage could cost more than the employee's salary.
Anyway, the point is that there may be two systems needed - one for health maintenance, and one for catastrophic coverage (which I like to call "hit-by-a-bus" coverage). As with all things, there are some gray lines at the boarder between the two. And this doesn't really address the DNA problem, though it would be reasonable to expect a test to get a rate for the catastrophic coverage, since that is a pretty straight forward way to more accurately determine risk, and no different than charging 22 year old males with sportscars more for auto insurance - even if the never drive more than 35 mph, and only take trips to church on Sundays. That's what probability and risk determination is about. If you don't like it, save your money yourself for that rainy day.
I will say that I would prefer cancellable "term" policies rather than the annual individual policies that are common today. Right now, if you're too expensive, you can simply not be renewed. With a term (say, 30 year) policy, you have a guarantee of coverage for your term with embedded annual escalation and whatnot, just like life insurance. You might even get a product similar to whole life insurance, which guarntees your coverage until you die. (Note: just like life insurance, health insurance has caps on your benefits).
As with all other things, there ain't no such thing as a free lunch, so the total money into the system = total money out of the system. There profit on gross in healthcare insurance is probably small, just like most businesses (2-8%). My point is that everyone can't just put in their $120/week, get routine healthcare (office visits, minor events, maintenance prescriptions, and some elective procedure) taken care of and then have a heart attack and run up a $280k tab, and expect the system to stay solvent. Healthcare is one area where manpower is necessary to get things done, and people who are competent and reliable cost a _lot_ of money to hire, train, and retain. Most people would be surprised to find that the job which pays them $25/hr requires billing them out at $75/hr to be worth while for the company (you know, that 2-8% profit margin). And hiring reliable people to work on the most basic parts of your health costs quite a bit more than $25/hr most places.
*extend the federal employee group for BCBS standard to count every citizen, paid at roughly 100M policies at 12,300/yr, per http://www.opm.gov/insure/health/08rates/2008non_postal_ffs.pdf
Is it just my observation, or are there way too many stupid people in the world?
This is beginning to happen already. Government refuses to let insurance companies exclude alcoholism because they don't want a lot of uninsured drunks clogging up the system. This hurts T-totalers like Mormons that could otherwise get a lower rate. Another example, if you are monomogous or celibate you might want to exclude AIDS, but government won't let you do that in many places with a politically correct disease, like AIDS.
At some point the amount of the exclusions potentially available, will be greater than the hassle and overhead of going offshore. That will be the tipping point. Past that point, large numbers of low risk people will buy their insurance offshore.
Of course, government will then make buying insurance offshore illegal. That will work, government would not be so dumb as to create a black market. :-) And of course people do not go offshore right now to evade taxes. :-)
Of course I hear the cries of outrage from people who think low risk people should share their good fortune with the high risk people.
According to the theory of evolution by natural selection, the struggle for existence has been going on this planet for at least 3 billion years. I don't think soft hearted sensibilities are going to stop it.
So where do I find a reputable offshore insurance company?
It's interesting that these programs already exist for flood and car insurance (which as you note are avoidable risks) but do not exist for health insurance (which while reducible, is not really avoidable).
And yet the attitude displayed in your .sig shows that you are a part of the problem.
I'm not even going to try to answer the rest of your story because it has no substantial basis in reality. Is it possible? Perhaps. But you made it up. I've never had a job with the health insurance terms as bad as you've stated.
Heh! You were just schooled by an ER Doc. Yeah, it wasn't pretty. Now don't you look (and feel) like an ass.
Yes, because people really want the government to have access to their DNA information?? You know, I can't understand how a lot of the slashdot crowd can be zealous privacy advocates on one hand, and on the other hand think nothing of having a health care system where we make the government accumulates all the power that insurance companies have now. For all the problems with insurance companies, we at least have some very minimal competition and government oversight. Whent the government is running the enterprise, who's the watchdog?
----- Question authority, but not ours. Hate the man, but we're not him.
No, I was just told a story by someone who can't even take the time to lookup which laws are relevant to the situation. The story was no more reality than your average night of WWE.
Here's some problems with his story:
- $6000 year maximum? Not at any job I've ever had. Think $1500 for deductibles and then you're done paying. Everything beyond that goes on the policy.
- EMTALA is a subsection of COBRA and has nothing to do with continued coverage after termination. It has to do with refusing coverage and transferring patients. Another section of COBRA says is that after you leave your job, you can continue to pay the premium at the rate the company paid. No company pays $700/mo for their normal employees. The number is in the area of $200-$300/mo.
- Employers with medical coverage also offer short term and long term disability coverage. For about $10/mo you're covered in the amount of 70-80% of your salary for varying lengths of time depending on the specific program. You don't need to stop receiving a paycheck because you're sick.
- $2000/mo in expenses (not including a mortgage or rent)? I don't think so. My entire cost of living including rent, car payment, food, utilities, gas, auto insurance, etc. is about $2200/mo. Over half of that is rent. Someone who already owns their home (as posited in his story) will have living expenses in the sub $700 range. Add in his $400/mo meds and you're only at $1100.
- For a home owner you're looking at somewhere around $100,000 (minimum) in equity that can be tapped. More likely in the area of $250,000 and possibly as high as $500,000-$1,000,000 (in the north east/north west metro areas.)
He wanted to tell a story, and I'm fine with that. But don't think that his work of fiction is common. His story churned through $50,000 in 18 months. According to this the average cancer patient runs $36,000 in uncovered medical bills. The average seriously ill patient has $13,000. And these are the people who are declaring bankruptcy. Which is the point I was making. People who are prepared won't have this problem as they have been living prudently and have some savings set aside for a rainy day.
Using the corner cases to determine your health care policy is dumb as they will suck up 100% of your resources.
Diagnosis of a condition is a fundamental -- AND CRITICAL -- step in medicine. If I have a toe infection because of a brain tumor or because of HIV/AIDS or because my shoes are too small: this is relevent information.
Preexisting conditions will raise the cost of coverage. This is assessed primarily by an increase of treatment [costs].
Ultimately money is saved. Unnecessary treatments are eliminated, problems are headed off when they are little problems, before they become big problems. The manhours wasted by people who cannot diagnose a problem correctly are saved. Understanding increases.
Most of all medicine will be streamlined. No longer will there be a semantic discrepancies across the broadspectrum of the human form. "Healthcare" and "medicine" truly become as One.
All in all insurance is not a party to this. Make it a crime to suggest otherwise, by all means.
Because no one is subject to random economic events.
Bullshit.
So you don't think that poor, sick people on the streets wouldn't affect your way of life negatively? A large underclass of people that can't pay for doctors would create all kinds of problems for everyone. A dying man that is dying just because he doesn't have enough money knows he has nothing to lose.If he has a year to live, and can't afford chemotherapy, why not take it from someone else?
Marie Antoinette wasn't all that worried about the extreme poverty that surrounded her, but that didn't save her head. Letting your neighbors die because they can't pay for a doctor would lead to the exact same place.
Ha - Just $200-300 a month on COBRA right?! Well forget about that!
I lost my job last year and my initial COBRA payments where a fairly reasonable $400, but the company decided to up it in the new year to a whopping $800 (just $42 of that amount was for dental - the rest was all medical for just ONE person).
They made sure that the premiums didn't go up for their existing employees - they took it out on the ones they had dumped instead!
You're absolutely right. The numbers in the original story don't quite work.
Glad you showed us the error of our ways.
Now, how much money does a short-order cook or welfare mother have to tap into in her rented property to cover that new leukaemia diagnosis in one of her children?
None to very little? Really? How is she going to make ends meet and try to save the life of her child? Really? I thought the US was the largest economy the world has ever known, with the most multi-billionaires as well?
But as long as you're sitting pretty because of your financial situation, good for you.
I'm optimistic that our electoral process would work and pass effective legislation to prevent genetic discrimination.
thing they seem to be any good at, paying.
As for the corruption in the military industrial complex that Eisenhower warned us about...
No need to bother your father. I wholeheartedly agree that its the must corrupt thing (What do you want? They're dedicated to blowing thing up and people down.) In delivering the goods, the level of corruption is as astonishing as it is expensive.
But what is important here is that they are a nationalized defense force.
We have state militias but they are subservient to the national militia.
We should organize the spending for our health care in the same manner. (And keep the feds OUT of the loop when it comes to deciding what treatment is necessary.)
Health care should be a national agenda priority and the province of a national single payer because it affects the well being of the entire nation.
It is fundamentally not amenable to "sharing the caring" for the same reason that we don't have 50 state currencies.
MSBPodcast.com The opinions expressed here are my own. If you don't like 'em... Think up your own stuff.
That's the thing though, isn't it? Except for a miniscule number of people who really get the short end of the straw and are afflicted with some terrible illness at an age less than 20, there's no reason for a person to not have money socked away. You can go ahead and tell me how hard someone's life is, but honestly anyone can put some money away. Oh, and for your hypothetical short-order cook or welfare mother? Try medicaid.
Once again we see why commercial health care doesn't work. The profit motive provides HUGE incentive to deprive people of coverage. A universal system, funded either by a universal flat levy or a tagged portion of tax, would make such exclusions both irrelevant and contrary to the PRIMARY goal of providing appropriate and sufficient health care to people who need it. The young and healthy of course subsidise the care of the very young and the old and the injured. That is what insurance IS: spreading risk across a broad enough group to make the final cost an average of the wellbeing of EVERY person. The US health care model is deranged and dysfunctional...and the big profits that generates sees it stay that way...and the propaganda that money pays for has for decades tricked Americans into thinking there is no better way. If they stopped warring with the world, the cost of meeting health care requirements would be easily funded by7 what is currently wasted on "defense" spending. Obvious enough to pretty much everyone everywhere.......
Only boring people are ever bored.
Genetic Discrimination Saves Lives.
Drugs are one of the few places where patents make sense. Due to the lengthy approval process, competitors could have the copy ready before the inventing company gets to market their drug at all at all. Removing patents would probably kill commercial drug research.
So if you remove patents for drugs, you also need to step up public funding for research (which then goes into the public domain). This may actually be worthwhile, considering the huge amount of money going into drugs today. But you need to be aware of it and think it through.
C - the footgun of programming languages
When you give all the authority to the private sector, then it essentially is the government, but with less accountability and with a mandate to make money.
I am entirely against entitlements, be it welfare, free healthcare, anything which is paid for by myself and others unwillingly, taken at the point of a gun, but if it's going to happen it should ONLY be done at the state level. The federal government has no place in the matter.
It's also a fact that anything our government does turns to shit. When we see how badly they fuck up what they're already doing, naturally we're reluctant to give them MORE to fuck up.
Slow down, cowboy! It has been 4 hours since you last posted. You must wait another few hours.
I picked up cobra for a short stint between gigs last year. We paid $1100 for just over 1 month worth of coverage. And my wife had a knee surgery during that time. The "cost" of the knee surgery was $8000 all together, we paid $1600 of that, in addition to the premium.
So if you were getting single coverage for $200, you likely had one hell of a deductible.
-Rick
"Most people in the U.S. wouldn't know they live in a tyrannical state if it walked up and grabbed their junk." - MyFirs
I own my own house, my mortgage is about $500, taxes, insurances, etc... bring my monthly mortgage check up to $750. The car is another $300. Probably $200 a month in diesel. Another $300+ for gas, water, and electric. $100 for cable and internet. Another $70 for cell phones. $100 a month for car insurance. Probably $200 a month for house maintenance. Another $400+ a month in food. Maybe $300 a month in entertainment/hobbies. And that's not even getting into the horses or any of the medical costs! For a home owner you're looking at somewhere around $100,000 (minimum) in equity that can be tapped. More likely in the area of $250,000 and possibly as high as $500,000-$1,000,000 (in the north east/north west metro areas.) Not sure which metro you are talking about. I live in a suburb about a 30 minute drive from down town Madison, WI. I picked up my house under market value, and the last appraisal put it at ~$120,000. Of course, I still owe $79,000. So at best, we're talking about 40k equity. I would venture a guess that the majority of home owners have less than 50% equity in their properties, especially considering the housing sales in the last few years. So even with inflated house values, it doesn't mean that people have any equity. And if you look at the way properties have been dropping in price, some people may even be in the hole for equity right now.
My wife and I live inside our means. I cram money into a ROTH 401k every month, we keep a decent nest egg tucked away (no wheres close to $50,000 though!), and we keep the budget balanced so that each month we come out a tiny bit ahead.
-Rick
"Most people in the U.S. wouldn't know they live in a tyrannical state if it walked up and grabbed their junk." - MyFirs
Except for a miniscule number of people who really get the short end of the straw and are afflicted with some terrible illness at an age less than 20, there's no reason for a person to not have money socked away.
Maybe they put their savings into buying a house that is now worth a lot less than they paid. They can't sell the house in this market. They can't find a job because they live in Michigan.
Maybe they are divorced and all their cash is consumed by alimony or child support.
I make six figures and don't have trouble saving. But your suggestion that everyone should have a big bag of cash on hand is just absurd and very far removed from the reality of the working world that so many people face. What color is the sky where you live? What planet?
Folks! We have an opportunity to prevent the insurance companies and employers from discriminating against people who have had their DNA tested and have health issues. The Genetic Information & Non-Discrimination Act 2007 (GINA) was presented to both houses of Congress in Jan 2007 and passed the House 420-3 in April 2007. The Senate has yet to vote on it because Senator Tom Coburn of Oklahoma has put a "hold" on the bill and is sticking to his guns on this. He has put holds on over 80 bills in the past. This guy either wants his 15 minutes of fame or is in someone's pocket. Who's to know, but the point is: The Majority Leader of the Senate (Senator Harry Reid of NV) can call for a vote if he allows 30 hours of debate first. Although this can take away from other duties the senate has lined up at this time, this bill is VITAL to ALL Americans since it protects us from insurance companies and employers refusing coverage or employment based on genetic testing. EVEN President Bush and his Administration are in favor of it. The Senate has enough votes to pass it, but Coburn is clogging up the works. What can be done? Write your Senators, write Coburn and write Reid telling them how important it is to get this bill passed now and not wait until another Congress has to start from scratch. Medical science and geneticists will continue working on how DNA affects our health, but we need protections against the insurers and employers to protect our privacy. Do NOT be among the 90% of the people who do not write their Congress men and women. There are documented cases were 20 letters have changed a Senator's vote. See this link, not only for a contest to win a free DNA kit, but for all the links to contact your senators, read more about the bill, etc. www.isogg.org/savegina.htm Please ACT. Emily Genetic Genealogist and Speaker
I'm talking about the described individual in the poster's story. The one what owns the house, not the one that has a mortgage on a house. No mortgage payment. I can't speak for your family, but $400/mo for food seems pretty high. And, sorry, but the rest of society has zero interest in offsetting your health care (or aspect of your personal life) so you can put $300/mo into hobbies and entertainment. And your $100/mo cable and internet bill? You sound as bad as those who apply for food stamps because they don't make enough money for food (and alcohol and tobacco.) The ones who do their grocery shopping at Seven Eleven and have to separate their items into two piles so they can use their cash to pay for their "necessities" (beer, smokes, junk) and their food stamps card to pay for their food.
And you are also incorrect. Society as a whole has every interest in offsetting my health care costs, just as I have an interest in offsetting everyone else's. It's called the economy, and having a body of healthy, able, and educated employees. It is in my interest for everyone else to remain healthy, and it is in everyone else's interest for me, just like everyone else, to stay healthy.
Oh, and I ran to the store just yesterday to pick up about a week and a half worth of groceries. Nothing to extravagant, a nice blend of easy dinners, fruits, vegies, milk, eggs, the usual. I think the total was right around $150. And that was shopping at a Piggly Wiggly with a discount card. Any time I go for a big shopping trip though, I usually head to Woodmans or the Super Walmart where I can get better prices (enough to offset the $4 in diesel I burn getting to and from the store). To be fair though, I am shopping for myself, my wife, and the bottomless pit we call our son.
-Rick
"Most people in the U.S. wouldn't know they live in a tyrannical state if it walked up and grabbed their junk." - MyFirs