Bill Prohibiting Genetic Discrimination Moves Forward

An anonymous reader writes "The bill to ban genetic discrimination in employment or insurance coverage is moving forward. Is this the death knell of private insurance? I think private health insurance is pretty much incompatible with genetic testing (GT) for disease predisposition, if said testing turns out to be of any use whatsoever. The great strength of GT is that it will (as technology improves) take a lot of the uncertainty out of disease prediction. But that uncertainty is what insurance is based on. If discrimination is allowed, the person with the bad genes is out of luck because no one would insure them. However, if that isn't allowed, the companies are in trouble. If I know I'm likely to get a certain condition, I'll stock up on 'insurance' for it. The only solution I can see is single-payer universal coverage along the lines of the Canadian model, where everyone pays, and no one (insurer or patient) can game the system based on advance knowledge of the outcomes. Any other ideas? This bill has been in the works for a while."

Comments

Genoism...

[Adambomb]

they call it.

But no one takes the law seriously.

Re:Genoism...

[Adambomb]

heh just for clarity's sake, that was a quote from the movie Gattaca

Re:Genoism...

[LifesABeach]

Job discrimination based on one's DNA? The job interview in the movie Gattaca sums it up pretty clearly. The plot did ignore one aspect of DNA therapy. Genetic therapy to repair aging cells, and enhance aspects of the body, and that includes its Neural Net are coming into being. As an example, one can see the excellent muscle repair on the body of cyclist Lance Armstrong. Refining techniques, and better understanding of the Mechanica DNA will produce a healthier body, and a healthier mind. When considering Stem Cell therapies, they are but a single step. The goal is a healthy Mind, and a healthy body.

On a more sardonic note. I submit this tensor, "Living people buy more things than dead people."

what?

[Mr. Slippery]

We've had private insurance with no genetic testing for a long time how.

How is keeping the second condition going to mandate the end of the first? It's ridiculous.

Re:what?

[Mr. Slippery]

Because insurance companies manage their rates based on trackable probabilities and their claims history.

Yes, of course. But what does that have to do with the submitter's claim that banning genetic discrimination means the end of private insurance?

We've had private insurance for a long time without genetic discrimination, because genetic discrimination wasn't possible. This legislation bans genetic discrimination, thus keeping the status quo on this issue. How does that mean the end of private insurance?

Re:what?

[Adambomb]

Because if you reduce the margins enough, you end up with a scenario where ones premiums equal exactly the cost of ones expected medical treatment. If your premiums for insurance are equal to your cost of medical care, what the hell is the point of insurance?

at least thats the way i see it as a medical insurance salesman.

Re:what?

[bunratty]

It's just like counting cards in blackjack. If you the dealer is not allowed to change strategy on knowledge, players that place their bets according to the cards left in the deck can make a killing. Likewise, if the insurance company is not allowed to charge you according to how likely to you are to get a disease, people who buy insurance with full knowledge of their genetic predispositions will tax the insurance system by making sure they are fully insured for the diseases they will likely get.

The proposed solution of universal coverage would remove this problem.

Re:what?

[evanbd]

It's not the end, but it is the first step on that road.

How long until we see companies that offer policies that don't cover specific highly testable conditions? Sure, they can't test for the condition, but you can -- and choose the policy accordingly. Then the "generic" policies cost more because all the people *with* the genetic markers buy those, and the people without buy the other policies. If the consumer has access to the information, they will try to use it to reduce their insurance costs. You can't put the genie back in the bottle, useful information like this *will* get used.

I predict the next law will be one mandating that any health insurance policy cover certain sorts of conditions, specifically to prevent the above. The collection of patches to the insurance system will grow and grow, until it finally becomes untenable and something major changes.

Re:what?

[ajs]

We've had private insurance with no genetic testing for a long time how.

How is keeping the second condition going to mandate the end of the first? It's ridiculous.

It's not ridiculous, it's just that the summary really, really sucks. What the summary author is trying to say is that if the consumer can use GT to decide if/when they should buy insurance, but the insurance companies can't use it to determine rates/coverage, then the insurance companies will no longer be able to keep their margins up, and will ultimately fail.

Of course, that's only true in a world where insurance companies don't adjust rates to reflect their actual profit/loss AND the primary reason that people get insurance is for genetically predisposed diseases. In fact, the primary reasons that most people get insurance is in case of serious and unforeseeable events such as communicable diseases and accidents and of course simple aging-related conditions.

Ask 10 people if they would not get insurance if they had a guarantee that they would never get a heart attack or diabetes. I'm quite certain they'll say that they still would.

So, the summary makes sense as far as it goes, but almost certainly doesn't map to reality.

Re:what?

[hurfy]

As long as you are not in the 5% whose premiums go up $12000 per year to make up for giving everyone else their $600 discount. A reverse lottery where losers go bankrupt?!?

(quickie math, feel free to fix if you are so inclined )

Obviously that means most of those people will not be insured for it, even if anyone is even willing to at any price. They will be the charitable cases that hospitals cover by overcharging those with insurance so your insurance goes up $50 to cover the increased costs.....

Re:what?

[aardvarkjoe]

Your comment illustrates exactly what is wrong with the medical insurance system we have today: the idea that the purpose of insurance is to save everyone money.

With a properly functioning insurance system, you would expect to probably pay a bit more for your premiums than you would for the medical care that you actually receive. In return, you would be protected from having to foot the bill for an unlikely catastrophe.

Instead, modern medical insurance has degenerated into a sort of payment plan for routine medical expenses.

Re:what?

[Wyatt Earp]

Never assume that you won't need it because you are young and fit now.

Cancers like Leukemia or Lymphoma can strike anyone at any time. Look at the Hockey players and most recently the American Football player from the Minnesota Vikings who've come down with Leukemia.

I say this because I was young (8) and fit and I got Leukemia. Later I relapsed, and even later I've had a Cavernous Malformations of the Brain and a non-cancerous tumor of the nerve sheath.

Sometimes there is just a health bullet with your name on it.

Re:what?

[molarmass192]

i'm young and fit and i hardly have any need for health cover ...

It only takes 1 uninsured driver not paying attention long enough to change that for you. Young and healthy is not mutually exclusive with accidental injuries.

Re:what?

[Anonymous Coward]

Sure, they can't test for the condition, but you can -- and choose the policy accordingly.

Just one problem for the insurance companies: People don't buy insurance, companies buy insurance.

That's why the law is targeting both insurance companies as well as the employers. Otherwise what will happen is that the insurance company will tell the employer that if they don't get rid of all of the employees with the getsick48 gene, their rates will go up, and the employer will fire them all.

And then we'll have to listen to all the inane prattle from the right-wingers strutting around and insisting that the people don't have jobs because they're lazy welfare leeches or some bullshit like that, so it's best to nip this off at the bud before it gets that far.

Re:what?

[tilandal]

The basic fallacy of your premise is that you want to win at blackjack but you don't want to get cancer. Preventative treatment is far cheaper then major surgery and aftercare. Many major disorders are easily treated if found early but life threatening if caught late. The other major fallacy is the premise that people but insurance based on the likely hood they will need treatment. The main driving force with insurance has always been cost. Most people who are uninsured tend to be so because they can not afford it. People who are predisposed to certain conditions may still be unlikely to get them and people who are not predisposed may still be likely to to get them. For example, 1/8 of US women are diagnosed with breast cancer. No one who can afford insurance would want to turn it down just because they are not disposed to breast cancer. On the other hand MS afflicts roughly 1/1000 people. Even if you were twice as likely to be diagnosed with MS it is unlikely that that would be the driving decision in you buying insurance.

Re:what?

[bunratty]

No, universal coverage would be analogous to everyone having to play and not being able to change their bets according to the cards already shown. No one could unfairly benefit from card counting in that situation.

Re:what?

[v1]

I don't see this as significantly different than say, a car insurance company jacking your rates for getting a ticket or causing an accident. Yes they're calculating odds and trying to predict how much a given customer is going to take in on claims, and it's nothing new. If my average accident payout is say, $70/yr, and then some schmuck that can't drive sober has more of a $2000/yr payout, I don't want to help pay his $2000, I want to chip in for my $70. Let HIM pay the higher rates, as it should be. I'm certainly the more profitable customer for the insurance company, AND I want lower rates so I think it's fair I get them.

This works for health insurance too. Unfortunately, people seem to flip out if you try to charge them higher rates if their odds are higher. I can't say I blame them though... if I had a condition that I knew was going to cost me a fortune in medical bills then of course I'd want to try to get it insured, knowing that it would save me a ton of money in the long run. Sadly, that means that someone else that is otherwise healthy is subsidizing my medical care. I don't think that's fair.

It's easier for me to take this position because I'm a good driver, and I'm healthy. I suppose if I had serious driving problems, or cancer or a bad genetic trait I might be tempted to climb the fence, but I hope I would hold my ground here. I just see a lot of people that want me to help subsidize their health care.

Even if you're not healthy, or do have a bad genetic trait, if you put forth effort to see an unbiased position you'll have to realize this is the fair way to go. Sure, it's not fair that you have a bad genetic deck, but why should that be my problem? I can appreciate that it's not fair, but that doesn't mean the world has to force the bad roll on the rest of us. Just as unfair as it is that you have bad genes, it's more unfair that I am having to pay for it.

Re:what?

[FooAtWFU]

Because insurance companies manage their rates based on trackable probabilities and their claims history. Everyone should have genetic tests so they can see what sort of diseases might affect their health, and plan to prevent them.

So, if you take your genetic test and come up with some potential condition, you may have to pay more, because - hey - you're an actual risk. Presumably the savings will be offset by people who don't have to pay more, because they came up clean. (If not, then the insurance companies are in an uncompetitive industry and that is an entirely different problem that patching up laws about genetics can't address).

If you can save money by remaining ignorant about things that could affect your health in the future, then that's a serious bit of Moral Hazard for the insured, and a terrible set of incentives for society in general. This is a sign of Something Badly Wrong.

Some people will claim that this is not fair, that it will leave them without health insurance for future health conditions. They're right, but it is Life that is not fair, and life that placed them in the position, not insurance companies. When you get down to it, really, what people want is not insurance so much as someone else pays for my medical care . If that's the case, we should be up front about it instead of playing charades and calling it "insurance" when it really isn't. Moreover, don't fool yourself by thinking that you're sticking it to the Big Evil Insurance Companies; you're sticking it to every working man (/woman/family) who has a need for health insurance, and it's essentially a regressive tax.

Re:what?

[Rich0]

But the problem is that what you propose isn't financially viable.

Let's take diabetes. If you get it you're going to cost a fortune to treat over many years and you're going to probably get all kinds of nasty diseases like heart disease that are even more expensive to treat.

Right now nobody knows if they're going to get it or not (sure, you can control this to a degree but it isn't really a sure thing). So, everybody who can buys insurance "just in case". Most don't get back what they spend, but a few get back a LOT more than they spend.

Now, suppose you can find out with 100% effectiveness whether you're likely to get any number of serious diseases. You find out that you aren't likely to get sick - so you don't invest in an insurance policy that covers those diseases - you either get just an accident policy or nothing at all. Insurance companies aren't allowed to discriminate, so they issue policies to all who apply. However, only people likely to get sick bother to apply. Now instead of having 90% of customers paying more than they receive they now have 90% of customers receiving more than they pay. That just doesn't work financially for privately funded insurance.

You assert that insurance is both for things that CAN and WILL happen. That really isn't true based on the historical definition of insurance, although this is becoming true of socialized medicine (where the word "insurance" is used for both traditional insurance (the CAN part) and social welfare (the WILL part).

Normal private insurance is just a way for a group of people to share their costs with a broker making a profit on the trade (maybe).

Let's look at it another way - take an office lottery pool as an example. Suppose you could predict whether a lottery ticket was going to win with some kind of an oracle. Now, suppose you determine that you have a winning ticket. Would you join an office lottery pool? Of course not! You're sharing your guaranteed winnings and getting nothing back. Pools exist because people want to achieve something closer to the true statistical likelihood of winning rather than just taking their chances. (Granted, that is dumb with the lottery since statistically everybody loses.) Insurance is the same thing in reverse - a group of people choose to bear their statistical average medical costs rather than taking their chances.

I'm actually not a big fan of socialized medicine. However, I suspect that it will slowly become inevitable if genetic screening outpaces cures for diseases. The insurance industry simply can't work if people have strong knowledge about their risks - either it goes bankrupt by being forced to treat only the sick, or those who will be sick end up uninsured. Neither is really a good solution.

Good

[kurt555gs]

There are very few businesses that as a rule are genuinely evil, but insurance companies are one in that category. The whole idea of the entity that has to pay for your health only benefiting when they do not is morally flawed.

Health care needs to be a right, and the risk or cost spread over everyone, with no one excluded. This also means that any benefit in savings must be good for the whole. Private profit making business can not be part of this for it to really be fair to all.

We could have had really top notch health care for everyone for less than we have spent on this silly war in Iraq, and with the give away's big political donors in the name of 911, we could all have our own Doctor.

Health care just needs to come from general revenue, like the Military, and cover every one. We spend more on weapons than the rest of the world combines, and most of that is greedy contracters gouging us. Just the waste in the Pentagon budget could cover everyone.

I really think it is time to take our government back and have it serve us.

So There

Re:Good

[evanbd]

At some point, there is a fundamental problem. Even after you magically remove all the various waste, corruption, and frivolous lawsuits, you get to a point where we know how to spend more money keeping people alive in the face of nast diseases than we can afford to, at a national level. When that happens, you have to either start rationing healthcare in some fashion, or the country *will* go bankrupt.

That's not to say we shouldn't have national healthcare; I think it would be an improvement, and that we should do it. But it is in no way a complete answer to the problems.

Re:Good

[khallow]

Indeed. If life were naturally fair, then everyone would have the same disposition to illness and there'd be no benefit to genetic testing.

Re:Good

[techno-vampire]

Yes but isn't it the goal of organizing as a society to improve the lives of citizens?

Here in America, that's what the goal is supposed to be. Over most of the world, during most of history, the goal has been to improve the lives of the leaders at the expense of the rest of the people.

Re:Good

[digitalvengeance]

You would run into the same issues with socialized medicine as you are complaining about with the military.

Unless we nationalize every supplier needed to run a healthcare system, there is the chance (and I'd argue the likelihood) of private companies gouging the government for supplies, services, etc. In fact, I'd say that this is considerably more likely to occur with a government health care system because private institutes typically make decisions on who to purchase from based on profitability and price is a factor in that. In a government system, profitability is a non-issue and political weight becomes much more important. We as taxpayers will start paying $20 for a band-aid because ReallyBadBandaids, Inc. happened to back the right candidate at the right time in a recent election. We could legally mandate the low-bid system, but then we are essentially guaranteeing that we will all receive the lowest quality of health care legally allowed.

The alternative is to give the government control of huge sectors of the economy so that they don't have to depend on private contractors. This is, of course, the first step toward a socialist society and the loss of our rights.

I agree that its time to take our government back and have it serve us, but I have a different viewpoint on what the government should be. The government has grown far too large and controls far too much of our lives; we need to get back to the original intent of the founding fathers and focus on a small federal government that honors the constitution.

Re:Good

[j0nb0y]

Health care can't be a Right. How are you going to decide what treatments are included in this mythical "Right," and which ones aren't? What if there isn't enough supply of medical care to meet the demand? Are you going to force people to become doctors? Are you going to force doctors to work more hours? If there is a limited supply, how are you going to decide who gets treatment, and who doesn't?

Suppose that a new treatment was invented that allowed people to live healthy lives indefinitely, but the treatment cost a million dollars a year. Are you going to exclude this treatment from the "Right"? Simple economics dictates that everyone cannot have access to it. So will you ban it outright? That ignores the possibility that if you allow wealthy people to fund the treatment right now for the expensive price, that funding could allow further developments that decrease the cost of the treatment, thus allowing more people to have access in the future. Are you willing to stunt the development of new healthcare technologies in order to have this supposed "Right"?

Keep in mind that I have already heard pundits on financial oriented tv shows warn against healthcare investments for fear that a democrat will be elected and harm the healthcare industry. Arguably, the rhetoric has already harmed healthcare in this country by discouraging investment.

The United States currently has the best healthcare system in the world. Why do you want to destroy something that at most needs a little tweak?

Remember that hospital in Cuba that Michael Moore visited in his film? Contrary to what Michael Moore would have us believe, that hospital is actually not available to the average cuban. That hospital is primarily involved in the business of health care tourism. Wealthy europeans escape the socialized medicine of Europe by seeking care in Cuba. If socialized medicine is so great, then why do europeans feel the need to leave the continent to seek medical care?

All of this without even getting into any of the problems that central control of any economic activity brings. Essentially, central control eventually leads to a single point of failure. Sooner or later, that point of failure fails, and bad things happen.

I find it telling that most of the people in favor of greater government interference have a great distrust of our current President. I have no doubts that Obama would do a great job running all the socialist programs he wishes to put into place. But it's not Obama I'm worried about. It's the moron who follows him. It will only be a matter of time before we have a terrible President. Do you really want to maximize the powers of the federal government that terrible President will have control of?

I'd rather trust the free market. Any governmental interference should be (1) minimal AND (2) targeted to fix a specific problem. Also, time limits on government exercises of power are generally a good thing. Otherwise government power tends to just grow and grow... ultimately the people pay the price...

Re:Good

[LunaticTippy]

I don't want a fire department. Why should I be FORCED to pay for it?
I don't want police. Why should I be FORCED to pay for it?
I don't want a standing army. Why should I be FORCED to pay for it?
I don't want schools. Why should I be FORCED to pay for it?

I don't want roads, clean water, clean air, FAA, FCC, or any of that other bullshit. Yet I am FORCED to pay for all of it.

There are lots of things that we as a society have decided are essential. I think that medical care is pretty important, and dealt with more efficiently by the government than the private sector. The US spends a lot for pretty poor results. Why not try something else? It can't be worse than the current elaborate fraud.

Re:Good

[Chris Burke]

Here in America, that's what the goal is supposed to be. Over most of the world, during most of history, the goal has been to improve the lives of the leaders at the expense of the rest of the people.

Yeah, and let's just ignore the part of the world that also has the same goal as America, but is doing a better job of it by providing health care for all of its people.

Yes, most of the world for most of history has been a terrible place for the commoners. That is not and should not in any way be our goalpost.

Re:Good

[Chris Burke]

I've never yet been accused of claiming that we've succeeded in that goal, or that other countries might have done better.

Nor are you being now. You're being accused of dismissing our failure to reach that goal by saying that life has been worse somewhere and somewhen else, akin to responding to a failing in our respect for human rights by claiming that at least we're better than China. Having to use such a comparison is in reality an admission of failure.

And surely those to whom we should actually be comparing ourselves, other modern democracies, are anything but perfect. Yet at the same time, I haven't heard any horror story of the Canadian or British that I could attribute to it being public, rather than them spending vastly less per capita on health care than we do. Considering just how much of our health care dollars are wasted paying the for-profit middlemen, I think a public American health care system that didn't reduce overall spending could be truly impressive and give us bragging rights over basically everyone.

Sharing risk

[kennykb]

Sharing risk is supposed to be the goal of insurance, going back to when it was a group of shipowners getting together in Lloyd's Coffeehouse to agree to cover each other if any of their ships sank (they all made a little less profit, but none had to worry about being utterly ruined by a single event. If insurers begin to stratify the clients on the basis of genetic testing, a market will arise to insure the never-tested against bad test results (pay us $xxx up front, and we cover your increased premiums). What the proposed legislation does is force participation in that market, by essentially bundling it with all policies. That may be a good thing, because it's otherwise too easy for the insured to game the system (get a test secretly, buy "testing insurance" only if the test shows that it would pay off). The problem with the whols system is that the market appears to have failed. You can't simply pay a little bit more to find an insurer who won't tell you, go ahead and die!

Re:Sharing risk

[nickhart]

The ones who "game the system" are the insurance companies. They refuse to cover people when they deem it unprofitable and they intentionally deny claims that they know should cover. They increase their profits by denying care. The entire business model of private health insurance is immoral, as they profit from the illness and misfortune of others. Then they buy politicians (like Clinton, Obama and McCain) to ensure their gravy train keeps rolling. The only solution is single-payer. We're all in the same risk pool, we're all covered, and physicians make medical decisions--not bureaucrats and legislators.

Who's going to keep it away?

[RingDev]

Just remember, the 'P' in HIPA stands for Portability not Privacy or Protection.

-Rick

Medical 'insurance' is an extended warranty

[jmorris42]

> Instead, modern medical insurance has degenerated into a sort of payment plan for routine medical expenses.

Exactly. What we call 'insurance' in the medical world is more like a maintaince agreement or extended warranty anywhere else.

Your homeowner's policy doesn't pay every home repair AND routine maintaince expense. Your auto policy, even 'comprehensive' coverage, only covers accidents and serious unexpected damage. Extended warranties for cars are a routine thing these days but nobody confuses it with insurance.

This sort of blurring of terms is dangerous because we are on the brink of doing something really stupid, nationalizing the entire medical industry. As if the outright socialism of it doesn't scare ya, or the drop in quality that has occurred EVERY time it has been tried around the world doesn't disuade you from supporting this BS then I got one last argument.

Look at the latest (but totally predictable) development in countries that have gone this way. Because they pay for your poor decisions they are claiming the power to totally control your life. Diet police ascendent. In AU they are actually sitting around and talking like civilized people (when they are nothing but, as this is pure fascism) about mandatory assessment of everyone and taxing people differently based on their results as a way to enforce norms of behaviour less stressful on their overloaded nationalized health system. Britain is talking about denying people access to medical care if their BMI exceeds government limits, they smoke, etc.

And the sick part is it actually makes perfect sense if one accepts the premise. If the government is responsible for your care then they should be able to tell you how you can live. The downside of being a 'dependent' is that you aren't Free.

Given a choice I'd rather live a short life as a Free man than a long healthy one as a slave but the whole idea is that Democrats want to make the decision for me at gunpoint. There won't BE any opt out, accepting payment for medical services outside of Hillarycare will be a felony. They already TRIED it in Canada, thankfully a few judges weren't quite ready to go there yet. Yet.

Re:Medical 'insurance' is an extended warranty

[Miseph]

You seem to be under the impression that the US has the best health care in the world. We do not. Not even close. Nearly all of the top countries in that field have socialized health care systems (the exception being Singapore, a micro-nation). Quality of care does not "always" decrease from socialization... in fact, it appears that the exact opposite occurs in most cases.

But hey, since when have stupid things like "facts" or "ethics" ever meant jack shit to conservatives?

Re:Medical 'insurance' is an extended warranty

[nevali]

So how come, in oh-so-socialist Britain, every time they try to privatise or outsource parts of the (publicly-funded) National Health Service, there's a clear and marked pattern of drops in quality of care, overall service, manageability and an increase in cost?

The point is: medical care is a fundamental necessity in any society--modern or otherwise. Denying it because of affordability (which is ultimately your "solution") isn't just ludicrous, it's positively Dickensian. Healthcare has to be, by nature, universal, or perfectly preventable deaths occur on a wider scale than most would like to admit. Sure, you're "Free", but is the guy who lives on the street "Free"? What about the the woman down the road who's barely holding down her job in the bar and earning a pittance?

Perhaps your thinking is that people who can't afford healthcare should just become victims of natural selection, in a manner of speaking, so that only the frugal survive. Or, perhaps you think the Government can skirt the issue by providing some voucher scheme or something which provides free healthcare to those who can't afford it themselves: which, thanks to the wonders of taxation, is more unfair than just a straight healthcare tax (or "National Insurance" as it's called over here).

Britain might be "talking about" denying people access to medical care under certain conditions, but that's about all it's doing. Don't believe everything you see on Fox.

And, for the record, the NHS isn't by any means perfect--in no small part thanks to the efforts of our Glorious Government to outsource critical areas to the private sector--and for that reason alone people are perfectly free to pay a premium to avoid waiting lists, get a private room or prettier nurses in a commercial clinic; the healthcare they get should be of an approximately equal standard in either case, but people who can afford luxuries are welcome to splash out on them if they wish.

(Also, while the NHS isn't perfect, I'll take it over the US "sorry, you don't have any insurance, come back on Thursday for the free clinic and pray you don't need surgery" crap any day of the week).

Re:Medical 'insurance' is an extended warranty

[Mr2001]

We do [have the best health care in the world] by every metric that matters. In other words, it doesn't matter to you that millions of people are unable to afford routine preventive health care, and are forced to wait until their problems become emergencies (because the ER can't turn them away for non-payment), driving up costs for the rest of us.

It doesn't matter to you that medical expenses are the leading cause of bankruptcy in the United States, and for millions of Americans, getting sick or injured at the wrong time can destroy their savings and ruin them for the rest of their lives.

It doesn't matter to you that millions of people are unable to move to better jobs, even when those jobs are available, because they're dependent on their current employers for health insurance.

No, apparently all that matters to you is how well the system works for the wealthiest individuals, and to hell with everyone else.

In America people do not wait months for basic services. Actually, they often do. Private health insurance (especially HMO) doesn't guarantee that you'll be treated any more quickly than people in Canada or the UK.

If your private insurer won't pay for a facility that can provide those "basic services" immediately, I suppose you can shop around and find a facility that will, but you can also do that under the national health care systems that Obama and Clinton are proposing.

Re:Medical 'insurance' is an extended warranty

[jmorris42]

> medical care is a fundamental necessity

Boo hoo. Food is a fundamental necessity. So I guess the only solution is to nationalize the means of production, distribution etc of foodstuffs?

Shelter in much of the country is a fundamental necessity and pretty damned useful everywhere else. So do we nationalize housing and ration it too?

Outside of cities with mass transit, a car is now a fundamental necessity. See where your reasoning goes?

> Sure, you're "Free", but is the guy who lives on the street "Free"?

Yup. Freedom that doesn't include the possibility of failure isn't Freedom. Freedom includes the right to do things you (and me) think are dumb/wrong/etc. or it isn't Freedom.

If some guy uses their freedom to screw their life up I see no reason for you (using the power of government) to seize the product of my labor to help the asshole out. Now, being a civilized person, I might help the guy out if he is in my neighborhood (and he is ready to BE helped) but that is MY decision.

NO karma is granted for 'helping' with other people's money. Since the victim (taxpayer) didn't give it willingly they don't get any either. And since the target usually doesn't actualy get helped when some nitwit social worker tries to manage their life it is a loss all around. If you guys would get that fundamental truth into yer heads the world would be a better place.

The problem with wanting stuff for free is TANSTAFL. Somebody pays. And any system of distributing goods and services beyond voluntary exchange quickly leads to lowering production and thus to rationing.

Our current mixed free/socialist medical system offers ample examples of this in action, comparing and contrasting it with full socialist systems and with the historical record of a fully free system should be enough to convince any person capable of rational thought as to the more desirable direction we should be attempting to seek reform toward.

Re:Medical 'insurance' is an extended warranty

[jmorris42]

> Others might say "you can be the crazy old coot out in the woods who's
> afraid of society, but we recognise that humanity is a family - we take
> care of each other and recognise that we're interdependent".

In other words YOU are deciding the crazy old coot is WRONG and by virtue of your superior morality/reasoning/whatever you claim the right to make another your slave and force him to obey your will.

By MY moral code that crazy old coot has every right to give you a 2x4 response applied directly to the forehead when you try it.

The right to be wrong is THE fundamental human right. It's fair game to reason with someone you think is making a bad decision but the second you use force to impose your will on them you have lost the argument. (Cases of extreme mental illness being an obvious exception. The moral argument being that the person isn't a free moral agent and will probably be grateful once they are sane.)

Re:Medical 'insurance' is an extended warranty

[John Whitley]

It doesn't matter to you that medical expenses are the leading cause of bankruptcy in the United States, and for millions of Americans, getting sick or injured at the wrong time can destroy their savings and ruin them for the rest of their lives. Not to mention the litigious bullshit that this induces on the US. Why? Because many folk have NO CHOICE but to attempt to sue to cover their uninsured medical costs, or better still, their insurance company initiates the liability suit on the insured's behalf.. but with no control or say from the insured. Maybe the whole thing is better written off as an accident... instead of suing some elderly person on a fixed income into oblivion.

Travel around parts of Europe for a time, for example. The subtle and not-so subtle attitude changes that come when people aren't deeply afraid of economic debilitation from injury or disease are remarkable. And these changes smack of freedom.

As to the earlier poster's argument about the risk of gov't trying to control your life: a) have you been paying attention to the US political climate? You call this new? and b) that's what the old saw about "eternal vigilance" is for, eh? In this case, it's a matter of the controlling power of corporations (insurance companies) vs. the controlling power of government. At least we have elected voices in one of those groups.

Re:Medical 'insurance' is an extended warranty

[Improv]

Deciding someone else is wrong is part of these discussions - you think I'm wrong, I think you're wrong, and we both are proposing the other live in the system we describe. To you, I'm imposing on you by telling you to bear the costs of society taking care of all its members, and to me, you're imposing on me by saying I must accept that the benefits from such a system will not be had. There is no moral high road here, just a disagreement on how things are managed and whether peoples fiscal autonomy is more important than public health (plus a completely independent question over whether socialised health care is better or worse for society, and for what parts of society).

Government is based on taxes, and hopefully it provides good value to its society for the taxes it collects. Where it fails, I want it to do better. It cannot function without a source of funds though, and that usually means taxes. If taxes to you are theft, then I am advocating that form of theft in order to benefit society. I don't think of it as theft, but if you do, then the phrasing is an accurate description for what I think can lead to good things for society from our government.

Pre-existing anti-gaming strategy in long run?

[Cartotype]

Would it actually be possible for consumers to 'game the system' if insurers weren't allowed to use testing?

I mean, in the short term, sure, I can see a surge of consumers (who, via private testing, know they're at higher risk) getting risk-appropriate insurance which (via a lack of test information) is offered at a lower-than-appropriate (appropriate to the relevant risks) rate... but after a few decades of accumulating data, wouldn't the basic metrics change? Wouldn't the insurance companies essentially be able to see "While the risk for disease X is 5% in the population, the risk for the same disease among those who buy our disease X insurance is 70%, so we will price our disease-X insurance with the expectation we'll have to pay out for 70% of our clients, rather than 5%"?

It just seems like, in the long run, the lack of testing for insurance companies would make no significant difference. In the short run, the system could be gamed, and whenever a new disease cropped up, insurance for that particular disease could be gamed (if 'highly overpriced insurance' didn't become the norm for new things), but in the long run you'd get about the same results from second-hand testing (see who applied for your policy because they got a positive private test) as from doing first-hand testing.

Granted, I don't like the idea of such data being a standard part of my medical history... I'm not advocating that insurance companies should get to do testing... I'm just not convinced that (in the long run) the situation would look that much different with and without insurance-testing. (I certainly admit, though, that the situation where testing exists at all is different from when testing doesn't exist... just that /if/ testing exists, insurance-visibility doesn't affect gamability that much.)

Fundamental Necessity

[nick_davison]

>> medical care is a fundamental necessity

> Food is a fundamental necessity.

Actually, humans survived for millenia without medical care. They rarely survive more than a few weeks without food.

Arguably, medical care isn't a fundamental necessity. Of huge value if you'd like to live comfortably for longer and have greater odds of surviving to maturity... but not actually a necessity for the species.

The problem is we mistake medical care for being a fundamental necessity. Then, when idiots choose to make payments on a bigger car or TV, instead of their health insurance, we wring our hands and give a damn when the consequences of "I'd rather have more money now and accept the increased likelihood of suffering or dying later." come back and bite them. Instead, "Wow? You made a really dumb choice, didn't you. Hope the TV was worth it." becomes "Oh, that's tragic. Look how the system failed to provide you with your basic necessity. We must do something!"

Medical care isn't a fundamental necessity - just damn nice to have and pretty sensible. If people would own their own dumb choices, it wouldn't be such an issue. Instead, we're in a society where we make stupid short term choices then whine about how unfair it is when the consequences hurt us, expecting others to help mitigate our stupidity.

Ummm... this is already being done.

[haakondahl]

Insurance companies charge me higher rates based on my Y chromosome and its supposed predictive effects on my behavior. This is a far weaker link than other types of genes-to-outcomes linking.