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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."
they call it.
But no one takes the law seriously.
Ice Cream has no bones.
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.
Tom Swiss | the infamous tms | my blog
You cannot wash away blood with blood
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
* Carthago Delenda Est *
Wasn't there a movie about this?
Because genetic planning, or whatever, exists it doesn't really matter whether genetic discrimination is allowed or not. It is simply the fact that genetically better people are more suited for things than genetically worse people. It's no more a matter of discrimination or not, but simply a matter of objectively looking at the attributes of each person.
The health insurance I pay is probably based more on phenotypic differences rather than genotypic. I don't smoke, but I do ride a motorcycle. Maybe I have the genes for some disease or another, but it's far from certain that I will develop it. OTOH, the fact that I don't smoke (or work in a popcorn factory, etc) means I am virtually assured of not getting lung cancer, and if I continue to ride often I am virtually assured of sliding down the highway at least once. The way we choose to live our lives will probably weigh more heavily in the way we continue to pay for health insurance than a nascent science whose findings will change year to year.
Tic-Tac-Toe, Global Thermonuclear War, and relationships all have the same winning move.
those that can and know, do.
pricey capital investment though.
Ice Cream has no bones.
The Insurance Industry really wants this because it will eventually destroy them, IMHO.
Let's say the insurance industry has free reign for genetic testing. First, they deny all the people that has "pre-existing" conditions. Now, the folks who are accepted know that they're free and clear and do not buy the insurance (OK, they'll buy the accidental death stuff). Therefore, the insurance industry loses all those folks as customers. Of course, I'm over simplifying but I think you get the idea.
Ban insurance completely.
It's a protection racket, under guise of a protection racket. No better than mobsters did in the early 20th century.
P.S. I work in the insurance business.
Shiny. Let's be bad guys.
Increase their mental capacity? If I had enough money to be 'rich' I'd be fiddling with the genes to increase the capacity of something else. Porn-stardom, here I come!
"Quote me as saying I was mis-quoted." -Groucho Marx
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!
Without the risk of discrimination, increased genetic testing could be a boon to both consumers and insurers. The earlier we know about a condition, the less expensive and more effective it is to treat, with likely a higher quality of life. Genetic testing would allow us to better assess who to monitor to attain this early detection. Moreover, with increased knowledge of risk factor, a patient could choose lifestyle changes that are preventative. (Even cheaper for insurers and further improved quality of life for patients!)
Take skin cancer: if you know you lack a key tumor suppressor gene that makes you more sensitive to UV damage, you'll be much more likely to use sunscreen and avoid peak sunlight hours (lifestyle/preventative); you'll also know to keep closer tabs on your freckles and moles for melanoma (monitoring).
With a level, non-discriminatory playing field, both patients and insurers benefit from the knowledge, rather than just insurers who want to drop any patient they can. -- Paul
OpenSource.MathCancer.org: open source comp bio
They don't have to mandate it, just make everyone eligible and the private insurance companies won't cover you as a primary -- just like Medicare.
There already exists "universal" insurance plans for two segments of the population, Medicare for everyone 65+ and one for military personnel (I can't remember what it's called).
There was a great special on Frontline called Sick Around The World about 5 capitalist democracies (United Kingdom, Japan, Germany, Taiwan, Switzerland) and how they provide universal healthcare. The show focuses on if the US can learn lessons from these countries.
It must have been something you assimilated. . . .
Just remember, the 'P' in HIPA stands for Portability not Privacy or Protection.
-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
Yeah, a study showed that obese people and smokers generally cost less in lifetime health care because the diseases killed them younger.
"The question is what do we allow? Discrimination against obese people, smokers, alcoholics?"
I don't see how it is a hop/skip/jump away from afflictions of -choice- (obesity is debatable, as that can have medical and heck, genetical, factors) to afflictions in which you, at least, had no particular choice. Perhaps your parents did (did your mom booze up during her pregnancy - d'oh?), but you yourself didn't get a whole lot of say in that and shouldn't become a victim of it.
Insurances already 'discriminate' against so many things. Didn't wear your seatbelt? There goes a good chunk of your payout, if not -all of it-. Over here in NL, smokers -do- pay a higher premium as well.. why not? Not only are they at a higher risk of cancer (insert "my grandfather smoked 3 packs a day and lived to be 94!" anecdotal evidence here), but they're putting everybody else at that higher risk as well (or, if nothing else, afflict those with asthma and generally stink up the place).
On the flip side - There's a life payout company in NL that gives a -higher- payout to smokers. Why? Because smokers do pay a higher premium, while they live less long. So they figure they should get a higher payout each month than non-smokers. Makes sense to me.
Why should people with genetic predisposition to health problems be entitled to affordable insurance? Let them die, and get those inferior genes out of the gene pool. Darwinism at work.
Better yet: Perform mandatory genetic testing at birth, and if they have problems, kill them. Then insurance companies won't have to worry about them.
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?
Try not to take me more seriously than I take myself.
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).
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.
Visual IRC: Fast. Powerful. Free.
> 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.
Democrat delenda est
> 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.)
Democrat delenda est
Would it actually be possible for consumers to 'game the system' if insurers weren't allowed to use testing?
/if/ testing exists, insurance-visibility doesn't affect gamability that much.)
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
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.
There are some who cannot afford health insurance, and there does need to be a solution for them. However, do not forget that a sizable percentage of those that don't have health coverage choose to forgo that expense, figuring that they don't need it. A third of those without it live in households of $50K or more annual income. It's possible that certain situations lead to some of those genuinely unable to afford coverage, but that's still millions that could afford it and choose not to.
In addition, there are millions eligible for government-sponsored health care intended for low-income people but who simply never sign up for one reason or another, be that lack of knowledge, laziness, or even pride at not being supported by the state.
No, apparently all that matters to you is how well the system works for the wealthiest individuals, and to hell with everyone else.
My parents were far from the wealthiest individuals when I was growing up. Dad worked in SoCal aerospace which paid well -- when he was working. It was very cyclical, and he was often driving trucks for $6 an hour in the late 1980s. A few years ago, he was hurt badly enough to go on permanent disability, leaving only my mom's income as significant. Mom worked at a hospital as a ward secretary, eventually moving into working for health insurance companies. She now works for a homeowners association management company. Despite what they've been through and what she saw from the inside of the health care system -- and it often wasn't pretty -- they still don't want a nationalized health care system.
There are about 300 million people in the US. A rough average of uncovered residents is about 45 million. That means that 255 million are covered. I'm fairly certain that 85% of the country includes a lot more than just those that are wealthy.
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.
Until recently, when I flipped to a PPO for flexibility (and ironically lower paycheck cost to me), I was on HMOs for most of my life. My brother and both parents needed arthroscopic surgery, which they were able to get within a couple of months of diagnosis (my brother actually got it within a few weeks, and before my mom started working in the health insurance field). In Canada, the median wait time for such surgeries is a significant fraction of a year, even in more heavily populated provinces. Neurosurgery patients can wait for six months from seeing a GP to getting their actual surgery. Life-threatening situations are treated much more quickly, of course, but those kinds of waits go beyond a nuisance for someone whose life is being affected by a given condition. I would find it simply outrageous to have to wait such times.
I have also read and heard anecdotally -- and this may be a misunderstanding -- that Britain's NHS has denied surgery to certain aged or extremely sick patients on the basis that they may not survive despite the treatment, or that others have a higher chance of survival and so the surgical slot is assigned to someone else. If I've been paying into the system for, say, thirty years, I'm going to have some serious concerns if coverage is denied on that basis. Yes, these things happen stateside, too, but the idea that they're unique to for-profit insurance companies in the US may be flat wrong.
On top of this, the overhead for a nationalized system is not necessarily better than in a corporation. Its budget has ballooned from £65.4 bi
You can never go home again... but I guess you can shop there.
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.
>> 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.
If genetic predisposition is predictive enough to kill health insurance, it would be fantastic. I;ve been trying to tell people for years that the problem with the health care system IS the insurance companies. You can follow the history quite clearly, as health insurance has become more am more prevalent, prices have risen. Unfortunately Big Insurance has a strong hold over government and media, and has everyone dancing to the same piper --i.e. mandate insurance and prices will drop. But it's a LIE! And they know it. The reason is b/c health insurance isn't insurance. Insurance is only effective for rare/emergency events. But health insurance covers every actively of health care and therefore is just payment scheme.
The only GOOD SOLUTION is to outlaw private health insurance, have the government provide life-and-limb coverage to all, and have charities shore up preventive care for the poor. This would remove the middle man and provide the best care per dollar spent.
:T:R:A:N:S:
Of course people wait. They wait to get that little problem looked at until they get a job with health insurance and the pre-existing condition exclusion period is over. Or they wait - wait forever - because they can't afford the services.
"Socialized medicine" really has nothing to do with whether you have an economic system based on the exchange of labor (socialism) or on the private ownership of economic resources (capitalism). It's entirely possible to have a health care system in a libertarian socialist system that would not be government run, and it's possible to have a capitalist government run healthcare system. (Such as Clinton's latest offering, which would make us all buy from private insurers. The worst of both worlds!)
A better term - and one less likely to trigger the conditioned reflexes of Americans who don't know what socialism is other than that it's the devil's work - would be "public medicine." Like public libraries, public roads, public parks, public fire service, public police...
Tom Swiss | the infamous tms | my blog
You cannot wash away blood with blood
Completely nationalize it? No. But the means of food production, distribution, et cetera, are very heavily regulated, from farm policy to food stamps. (And if a food emergency hit, yes, nationalizing the food supply might be the best option.)
But the poster wasn't asking about a situation with no possibility of failure. Just softening the landing of one does fail.
But yet, if said asshole sets up camp on your front lawn, you want to use the power of government to move him. (To where?) And you want to use the power of government to seize the product of my labor to make me pay for the police force to do it.
Paying for a social safety net is the ante you owe if you want to play the game of private property. If you want to border off some land for your home and keep others off, use government force to turn land into real estate, the price you owe is providing everyone minimal shelter. If you want to border off some land to make a farm and keep the harvest to yourself, turn the bounty of the earth into agricultural commodities - again, using government force - the price is making sure nobody starves. If you want the government to issue patents on drugs, use government force to keep people from making copies in order to secure profits to big pharma, you have to make sure no one dies from lack of access to them.
Tom Swiss | the infamous tms | my blog
You cannot wash away blood with blood
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.
For every problem, there is at least one solution that is simple, neat, and wrong.
Aw hell; I waited 2 freaking years with debilitating back pain before my HMO doctor would recommend a freaking MRI.
By then it was too late, the wear on my cartilege was irreversible, and the bones had begun to fuse. (constant pain? you bet!).
The criteria for an MRI was that I had to lose bowel or bladder function from nerve damage.
But they certainly got my monthly premium all that time.
These are my friends, See how they glisten. See this one shine, how he smiles in the light.
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.
Don't trust anyone under thirty.
So, if the insurance companies are allowed to dicsriminate based on genes they will exclude the weakest, who will then lose out, and they aren't, those with bad genes will abuse the system, and the insurance companies will lose profit. There are two things to say about this:
1. Universal, public healthcare will remove the problem - no one will lose out because of their genes, and no one will lose profit, because the system isn't geared towards profit anyway.
2. Insurance companies are businesses and are supposed to be clever enough to do business the given reality. If they aren't, they have no right to exist as businesses.
In most European countries this is much less of a dilemma - the public healthcare takes care of everybody, and private healthcare is simply a luxury option that gives you faster access to non-emergency treatments etc.
The solution is to sell health insurance like homeowners insurance. If you live in a flood zone, you'd better have flood insurance. Similarly, if you have a predisposition to heart disease, you should have to by heart disease insurance or you get no coverage for it.
My rights don't end where your feelings begin.