My Genome, My Self?

theodp writes "After baring his DNA for the world to see, Steven Pinker follows up in the NYT Magazine with his take on the coming era of consumer genetics. Pinker comes away less wide-eyed than Time Magazine about the current predictive ability of $399 genetic tests, but is convinced enough to opt out of learning whether he has a gene that increases the risk of Alzheimer's and believes that genetic-testing-for-the-masses may hasten the arrival of national health insurance ('piecemeal insurance is not viable in a world in which insurers can cherry-pick the most risk-free customers'). Pinker believes that personal genomics is just too much fun to ban, but for now suggests: 'if you want to know whether you are at risk for high cholesterol, have your cholesterol measured; if you want to know whether you are good at math, take a math test.'"

Comments

Isn't it, though?

[FooAtWFU]

The thing is, piecemeal insurance is the most viable in a world where insurers can cherry-pick the least risky (or most risky) individuals. Insurance, after all, is about mitigating risk, and a fuller knowledge of one's exposure to risk is a good thing.

The thing is, people don't really want health insurance, when you get down to it. Maybe they want a little. But what they really want is some sort of health plan, and often one that other people pay for.

Re:Isn't it, though?

[0xdeadbeef]

The thing is, you seem to parse the words and glean some meaning, but the thing is, you miss the point entirely.

Re:Isn't it, though?

[Anonymous Coward]

Health insurance is a way of sharing risk, a form of solidarity. It is based on the insight that nobody is at fault for certain ailments, so in a society which wants to give the same basic opportunities to everybody, it is our duty to help those who, through no fault of their own, are burdened with sickness or injury. Making people with unfavorable genetic dispositions pay a higher price for health insurance is the opposite of the purpose of health insurance.

Re:Isn't it, though?

[forkazoo]

The thing is, piecemeal insurance is the most viable in a world where insurers can cherry-pick the least risky (or most risky) individuals. Insurance, after all, is about mitigating risk, and a fuller knowledge of one's exposure to risk is a good thing.

The thing is, people don't really want health insurance, when you get down to it. Maybe they want a little. But what they really want is some sort of health plan, and often one that other people pay for.

Sure, health insurance as a business model is viable when businessmen can eliminate risk from the insured pool. It just isn't viable as a way to care for a society. I think that's the point that was being made. Costs are distrubuted in insurance because you get a very wide pool of people involved, and everybody pays in. OTOH, if you get genetic segregation of health insurance plans, you have only very risky people in a particular pool, and they all have to pay very high rates. If they can't afford that, then you wind up with a bunch of people dead, which is a higher cost to society than a few extra dollars for insurance.

I agree that most people aren't interested in "health insurance." People want health. Health care, medical care, to be healthy. Health insurance is just a particular way to try and reduce the potentially extreme personal costs of getting health. And, once you get a completely nationalised health system, you effectively have a system equivalent to insurance with the largest possible pool. You pay taxes instead of premiums, but the risk is distributed through the entire society, so the people with the lowest risk probably pay slightly more as tax, but the people with the highest risk pay substantially less. (Of course, that assumes that the *for profit* health insurance companies don't actually make a profit any higher that the cost of government stupidity, while in practice the profits of doing health insurance tend to be enormous. This is likely an invalid assumption, no matter how cockheaded the government implementation is.)

Re:Isn't it, though?

[Creepy Crawler]

Perhaps what you said is true for a co-op, in which everybody in the co-op does for each other.

However, if we talk about the USA Medical Insurance companies, they exist for pure profit and nothing else. If they fail to treat you within the allotted time, you die. Shucks... guess we keep your money you paid for insurance services.

Re:Isn't it, though?

[FooAtWFU]

That's a lovely thought! However, Solidarity and the like is not the equitable transfer of a risk of a loss from one entity to another in exchange for a premium. (that is to say, insurance). It is, however, some expression of socialism. Whether or not this is a desirable thing is a function of your political philosophy on such matters.

Re:Isn't it, though?

[int69h]

In theory insurance is about customers sharing the burden of risk, not insurance companies raising their profits by mitigating risk. In practice, it's exactly the opposite.

Re:Isn't it, though?

[Anonymous Coward]

Helping the sick is the purpose of a health plan, such as a national health plan, exactly as the OP writes. The purpose of health insurance is, for the person buying it, to reduce health-related risk, and, for the person selling it, to make money by charging people more than the average payout and to have enough customers so that they will never all get sick at the same time. In other words, health insurance is about helping yourself (no matter whether you are buying or selling). It is a win-win arrangement.

A national health plan can also be about helping yourself, though now at someone else's expense, as the OP points out. It can simply be a way of transferring health costs from you to someone/everyone else, or from someone you like to someone/everyone else. This makes it a win-lose arrangement.

Of course, you could also be wishing to have a national health plan even though your total expected benefit from this is negative.

Re:Isn't it, though?

[Anonymous Coward]

Socialism is the concept that the means of production are owned and controlled by the state (communism: by the people). Solidarity is the individual or collective desire to help someone with their problems. The concepts couldn't be more different.

Health insurance is a result of solidarity insofar as the sick and injured couldn't institute and sustain a health insurance system on their own. The system depends on people with good health mixing their low risk with the high risk of other people. If you separate the low risk people from the high risk people, health insurance can no longer serve its primary function.

Re:Isn't it, though?

[philspear]

Insurance, after all, is about mitigating risk, and a fuller knowledge of one's exposure to risk is a good thing.

MEDICAL insurance is, to most people, actually all about being able to afford medical treatment. Knowing your "risk" in this situation unfortunately can often only lead to you being denied coverage and subsequently NOT afford the services you need more.

Re:Isn't it, though?

[radtea]

It is, however, some expression of socialism.

Now that the Republican Party is passing out of power in the US we can expect that there will be a good deal less socialism, so whether or not it is desirable (I believe mostly not) there is going to be a good deal less of it now that the more liberal Democratic Party is in control.

I've never been clear exactly WHY Americans call their Socialist Party "the Republican Party". This is the party that has overseen massive growth in government both in responsibilities and costs, intrusive imposition of the federal government into areas normally reserved for the states or the people, and huge transfers of risk "in solidarity" from private individuals and organizations to the public.

It has capped all of this by actually taking ownership of significant parts of your financial system, which must in today's world be counted as firmly amongst "the means of production." Now that the liberal Democratic Party is replacing the socialist Republican party perhaps free market solutions will be prescribed for some of the things that ails the US, like allowing badly-run businesses that make products no one wants to FAIL.

Re:Isn't it, though?

[Dice]

OTOH, if you get genetic segregation of health insurance plans, you have only very risky people in a particular pool, and they all have to pay very high rates. If they can't afford that, then you wind up with a bunch of people dead, which is a higher cost to society than a few extra dollars for insurance.

How are a bunch of dead high genetic risk individuals costly to society?

Re:Isn't it, though?

[Anonymous Coward]

The prospect of high, possibly unbearable, health insurance costs leads to eugenics and reduced diversity. Go watch Gattaca if you don't understand how that is a problem.

Re:Isn't it, though?

[sam_v1.35b]

The thing is, you seem to parse the words and glean some meaning, but the thing is, you miss the point entirely.

Not entirely unlike human genomic research :)

Re:Isn't it, though?

[radtea]

And, once you get a completely nationalised health system, you effectively have a system equivalent to insurance with the largest possible pool.

Actually, no, because there is virtually no risk involved: EVERYONE gets sick, and EVERYONE dies, and about half of EVERYONE's health care costs come in the last six months of life.

Although costs vary, they don't vary by that much, although the tail of the distribution is long. See figure B1 in this report on Canadian health care costs to see the actual distribution. For something over 70% of the population the average cost of a single hospital stay is less than $10,000, and virtually everyone has a couple of those stays in their lifetime (I've had one despite being in extremely good health generally.)

This is utterly unlike true insurance models--auto, home and term life--where the majority of people who pay premiums never collect a claim.

It is interesting to note that both the Canadian and American health care systems use insurance models, and suffer from similar problems of access and spiralling costs. I believe this is due to the inherent inappropriateness of an insurance model for a service that everyone will need and everyone which has a relatively low variance of total payouts.

A reasonable model of health insurance would deal with catastrophic costs only, say in excess of $10,000 per hospital stay as indicated by these data. As not everyone falls into that category, one could actually use insurance to spread RISK, which is not really possible under an "everyone pays, everyone benefits" model because the tails are not that relevant to the overall cost of the system, so you basically have a situation where there is very little risk to be spread (closer analysis of the numbers could contradict that, but that's my impression from a first look.)

Re:Isn't it, though?

[Anonymous Coward]

A national health plan can also be about helping yourself, though now at someone else's expense, as the OP points out. It can simply be a way of transferring health costs from you to someone/everyone else, or from someone you like to someone/everyone else. This makes it a win-lose arrangement.

Not necessarily. If the government pays for preventive maintenance and certain corrective procedures for a young worker, there will be a larger amount of taxes paid than if that person dies. The key is to determine the point where an individual is no longer worth maintaining. Cutting off health insurance at age 55 would probably be the most economical thing to do. Certainly, preventative medicine and complete childhood medical coverage should be the priority. Things like heart transplants, cancer research, and neurosurgery would have a limited public benefit.

Re:Isn't it, though?

[BrainInAJar]

How are a bunch of dead high genetic risk individuals costly to society?

If one is predisposed to Parkinsons or something, which wouldn't manifest itself until late middle age, a car accident ( as early 20 year olds are prone to ) could make the difference between a successful multi-billion dollar CEO of something that benefits society ( who later dies of parkinsons ) and a bankrupt service sector wage slave ( who later dies of parkinsons )

Re:Isn't it, though?

[trolltalk.com]

"A reasonable model of health insurance would deal with catastrophic costs only, say in excess of $10,000 per hospital stay as indicated by these data."

That wouldn't work, because it takes away the motivation to reduce risk to everyone for the lower-cost events. Less reason for the "insurer/halth care system" to encourage people to do preventative care that has a low risk of falling into the "catastrophic" category.

As we're seeing with the GM bankruptcy, a single health-care system has unforeseen side benefits, one being that GM wouldn't be in its' current position if it didn't have $110 billion of unfunded health-care liabilities.

Re:Isn't it, though?

[DigiShaman]

The Dirty Little Secret is this. Everyone has a price tag. Be it from the private sector, or public Government.

Tell me, would both of these entities spend $1,000 to save your life? Cool. What about a Million? How about a Billion? Would they dare spend a Trillion on your life?

The moment you start negotiating the price for a single human being (in whole or in part) is the moment the argument still stands. We ALL have a price tag on our life.

So, what's the big deal about Insurance companies making a profit. Immoral yes, but also to be expected.

Re:Isn't it, though?

[Anonymous Coward]

So the people with huge medical costs steal from me to pay their bills.

That is what this sounds like to me.

Re:Isn't it, though?

[evanbd]

I am young and in good health. Right now, I could not afford a $10k hospital stay -- yes, eventually I could save up for it, but right now I can't. I can, however, afford an insurance premium that will cover it. As mentioned, I'm young and in good health, so that premium isn't terribly pricey. What would you have me do?

Re:Isn't it, though?

[Anonymous Coward]

So the people with huge medical costs steal from me to pay their bills.

Yep. And if you're on an Aetna health plan, thanks!

Re:Isn't it, though?

[Anonymous Coward]

If they can't afford that, then you wind up with a bunch of people dead, which is a higher cost to society than a few extra dollars for insurance.

Are you sure that this is true? Those "few extra dollars" must by definition add up to trillions to keep those people with bad genes alive. Beyond the sentimental value of "human life" I am not convinced at all that it's worth it.

Re:Isn't it, though?

[Anonymous Coward]

In theory

In practice, insurance as it currently exists is a failure in every sense of the word.

Tell me, how many drugs has Aetna developed so that it could reduce its costs to treat its patients? How many studies on the best way to treat a heart attack has United Healthcare undertaken?

The level of fail is consistent across all insurance agencies. How about that AIG bailout? How many home insurers support fire departments in order to reduce response times? What have auto insurers done to improve car safety? They have all become lazy leeches that soak up money with no real value produced, smashing the world's largest windows over and over.

Re:Isn't it, though?

[Anonymous Coward]

How are a bunch of dead high genetic risk individuals costly to society?

If one is predisposed to Parkinsons or something, which wouldn't manifest itself until late middle age, a car accident ( as early 20 year olds are prone to ) could make the difference between a successful multi-billion dollar CEO of something that benefits society ( who later dies of parkinsons ) and a bankrupt service sector wage slave ( who later dies of parkinsons )

Are you assuming that the person predisposed to Parkinsons couldn't get insurance that covers car accidents? If so, why? If not, then what was your point?

Re:Isn't it, though?

[Anonymous Coward]

OTOH, if you get genetic segregation of health insurance plans, you have only very risky people in a particular pool, and they all have to pay very high rates. If they can't afford that, then you wind up with a bunch of people dead, which is a higher cost to society than a few extra dollars for insurance.

More to the point, the insurance business collapses either way.

Give me the test. If it says I die in 20 years of Slashdotitis, my expected medical costs over my life are $100K, and my insurance company is going to charge me $150-200K in premiums. Otherwise it goes out of business. I don't need to buy gold-plated medical coverage, because my genes have priced such coverage out of the market. I may as well just save a few hundred bucks a month towards treatments for my genetically-linked condition out-of-pocket when it eventually manifests itself. (Just as the insurance company refuses to cover me unless I do the same damn thing in the form of higher premiums.)

Give me the same test. If it says I die in 80 years of old age, my expected medical costs over my life are $10K, and my insurance company is going to charge me $15-20K in premiums. Otherwise it goes out of business. I don't need to buy anything more than minimal medical coverage, because my genes tell me that the only thing I have to worry about are a few stitches from car accidents. (Sure, the insurance company will offer me a cheap rate on insurance, but it's only because the genetic tests have shown me that it's insurance that I no longer need.

The point everyone's missed in this debate is that as soon as this sort of data becomes available (to insurers, patients, or both), everyone has a financial incentive to leave the insurance market. The business model ceases to work.

Re:Isn't it, though?

[timmarhy]

it's not immoral until they place a quick buck before a persons health. here in australia our private health funds aren't too bad, they pay back about 98% (MBF 2005) percent of their contributions. if i stay in my health fund for the rest of my life, it's likely i'll get back 98% of what i've paid into it, and i'd say that 2% is worth it as a safe guard.

so while i'm young and healthy now i have to view the money i'm throwing into the system as an investment in what i'll need later in life. my only fear is that our aging population will suck my investment dry so there is nothing left when i need it. aka bastards who never paid into the system but want it all when they are old.

personally i think our model is the best - since i've been in private health from a young age my premiums are lower and any increases will be less for me, vs someone who is 50 and just joined up and will need expensive care within 10 years.

Re:Isn't it, though?

[symbolset]

So, what's the big deal about Insurance companies making a profit. Immoral yes, but also to be expected.

It's a violation of human rights when they have a monopoly on medical care. We have a right to "life". Even felons are entitled to medical care, but not free people without coverage, and no-one is obligated to cover you, but for most health issues noone will treat you in the US without coverage. Catch-22.

If you don't believe they have a monopoly, perform this experiment: write out a bogus identity on a sheet of paper. Then dial every dentist in your area and try to get an appointment to get an infected tooth extracted sometime in the next six months, but lie and tell them you have no coverage. The result will be instructive. An infected tooth is a life threatening situation you can't get treated in an Emergency room. I know - I've tried.

We need to break the monopoly on coverage for care if we are to have a chance at a humane system.

Re:Isn't it, though?

[TooMuchToDo]

I always thought that was funny. Most actuaries value a human life between $750K-$3 million. In the event the shuttle is stranded at the ISS, NASA is willing to spend $500 million for another launch to rescue everyone. I'm NOT saying it isn't worth it, just because if it's me stuck on the ISS, I want every dollar spent to bring me home alive. I am saying you just have to be worried about who is doing the valuing of your life.

Re:Isn't it, though?

[TooMuchToDo]

Perhaps you can explain how the countries in this documentary (Germany, Japan, Switzerland, etc.) are able to keep healthcare overhead at around 5% (it's around 24% in the USA) while also providing a great deal more services. It's sick really. The US spends the most on healthcare, but ranks 37th out of the 190 on a list of countries based on quality of healthcare.

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

Countries with rockstar healthcare systems: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/

Re:Isn't it, though?

[symbolset]

As mentioned, I'm young and in good health, so that premium isn't terribly pricey.

I think the point of TFA is that if insurance companies discover you have some genetic predisposition towards expensive treatments, you'll find coverage unavailable at any price. Then what? You can't get treated for cash in the US for anything except emergency care. Don't believe me? Try. The insurance companies have a monopoly on care.

We should all be very afraid.

Re:Isn't it, though?

[symbolset]

Knowing your "risk" in this situation unfortunately can often only lead to you being denied coverage and subsequently NOT afford the services you need more.

It's worse than that. For most people with no coverage, care is unavailable at any price. If you can't endow a wing of a hospital and you have no coverage, you're not getting a new kidney.

Re:Isn't it, though?

[Lord Kano]

So, what's the big deal about Insurance companies making a profit. Immoral yes, but also to be expected.

There's nothing immoral about it. If anything it's amoral.

Every company exists to make a profit. If there was no profit involved, no insurance companies would exist. Profit is the incentive that allows anyone to be covered in the first place.

Re:Isn't it, though?

[psychodelicacy]

"Bad genes" aren't anything like a 100% predictor of the development of medical conditions. It's not like letting these people die will wipe out sick people, leaving us with a perfectly healthy society. So an awful lot of people who would have lived to a healthy old age will die or go bankrupt because of appendicitis, or injuries sustained playing sports, or any other condition that has nothing to do with their genes. Meanwhile those with no genetic predisposition keep developing cancer and keep getting treated for it despite the fact that this will cost more with much less likelihood of a successful outcome than the kid with the sports injury.

When it comes down to it, allowing people to die in agony without medical treatment is barbaric - I don't believe that's a particularly sentimental position.

Re:Isn't it, though?

[DigiShaman]

It's a monopoly only if the single provider is Government. At least in America, the private system provides choices in the market place.

Personally, I don't care which system you go for be it government, employer provided plan, or what not. The key issue is having choice. I don't want to be forced into only having one option.

Re:Isn't it, though?

[Rue C Koegel]

we simply need non-profit co-operative insurance agencies, that can insure everything... and have a basic oath of conduct saying that no person will ever be denied insurance or care because or genetic disposition, et cetera (AKA non-governmental universal healthcare).

i suggest having statewide agencies... not national ones; so, like credit unions, they can join together as a national association and share their knowledge and abilities as a group but retain their individual charms and local seats of administration.

Re:Isn't it, though?

[symbolset]

You have some strange definition of monopoly I've not heard before.

Re:Isn't it, though?

[istewart]

The front companies provide the illusion of choice, but the American Medical Association holds a monopoly on licensing for conventional care, the drug companies are focused mainly on securing patent monopolies above anything else, and the insurance companies themselves have an army of lobbyists to keep them in their places of privilege.

Note also that neither Clinton nor Obama seriously advocated for a single-payer system during the recent election. Both proposed federal subsidies for existing insurance companies, touting it as the more politically realistic choice. I don't support state-monopolized medicine myself, but I can't see such a proposal as anything other than crackpot realism, which is the first refuge of scoundrels.

Re:Isn't it, though?

[evanbd]

Oh, yes, that's absolutely true. But the parent posts assertion that simply because my premium saved over long enough means I can save up for a $10k hospital bill I can afford to not have insurance against said hospital bill is horribly self-centered... not everyone is in the same financial position he's in.

Re:Isn't it, though?

[Anonymous Coward]

The right to life is only part of the declaration of independence which is not recognized as law in the United States.

Also, the common interpretation of this is that the government cannot pass laws to deny you these rights. In no way does it obligate the government to provide a service.

That said, common law changes to meet the needs of the times. If there is a problem with the way citizens are receiving health care and the government can do something about it, it's A-OK for government step in as long as it's within the limits of the constitution. That includes regulation and providing of services.

Re:Isn't it, though?

[jhol13]

Hint: government is not there to make profit.

Re:Isn't it, though?

[raduf]

My mother is a dentist in Eastern Europe. They have emergencies like everybody else, when they can't refuse a pacient and most rules about insurance don't work. Back when she worked for the state they had mandatory emergency service 24/24 (I remember she often complained it was very tiring, but better paid). They still have it at bigger hospitals.

I don't know how it is in US, of course.

Re:Isn't it, though?

[bwalling]

Actually, no, because there is virtually no risk involved: EVERYONE gets sick, and EVERYONE dies, and about half of EVERYONE's health care costs come in the last six months of life.

Yeah, and that's already paid by government health insurance: Medicare. Once you hit 65, you're on Medicare, not private insurance, so the argument that massive costs occur at the end of life is not really an argument against nationalized healthcare - we already have that portion of it.

Re:Isn't it, though?

[Anonymous Coward]

Funny, I thought the congress writes laws. Apparently, it's the president's party. You're a fucking retard.

Re:Isn't it, though?

[Jorophose]

Double-hint: The government can be elected, moulded, and destroyed, by you.

Re:Isn't it, though?

[SwedishPenguin]

A reasonable model of health insurance would deal with catastrophic costs only, say in excess of $10,000 per hospital stay as indicated by these data.

And what happens to those who cannot afford $10,000. Do they deserve to die because they were too stupid or too poor to save up $10,000?
And what if you had saved $10,000, broke your leg and used those $10,000? Now you don't have the $10,000 you need to survive a serious illness for instance.

Re:Isn't it, though?

[MobyDisk]

It is based on the insight that nobody is at fault for certain ailments,

The problem is that medical insurance covers ailments that ARE the fault of the person. And those ailments are often very expensive. I have a relative who smoked a pack a day since they were a pre-teen, never paid for health insurance, but spent years getting free chemotherapy then free hospice care.

Re:Isn't it, though?

[JesseMcDonald]

Given that you claim to be young and in good health, the obvious answer would be to take out a loan. Under any reasonable circumstances the terms on a personal loan are bound to be better than the expected return on your monthly insurance premiums.

Insurance has its place, but only in the context of pooling risks. If everyone is expected to endure a $10k hospital stay at some point it isn't really a risk, but rather a known cost, and the tools to deal with known costs are savings and loans.

As for the other common objection, "pre-existing conditions", the solution is to take out insurance before they become "pre-existing". Essentially, you're stuck with making one wager -- that you (or your dependent) might end up with some unforeseen disease or disability -- so you balance it out with a bet on the opposing side, trading risk for cost.

Re:Isn't it, though?

[E 99]

I disagree with your fundamental concept of insurance. Insurance is a product for risk management. It allows you to pay directly for your risk, in the form of a premium instead of paying for actual damages from the risk. For this to work... that is for the product to be valuable to consumers, and profitable to insurers, each customer needs to pay for his risk. e.g. in home insurance, if you have a $2mil house, you have a higher risk, because you have a higher potential loss than someone with an average valued house; if you live in a flood zone, you have a higher risk because you have a higher probability of sustaining damages. It has nothing to do with fault. Maybe your house in the flood zone is a family homestead you inherited. It's not your fault you have a higher risk. But you pay for your risk. That's all.

Re:Isn't it, though?

[E 99]

It's a violation of human rights when they have a monopoly on medical care. We have a right to "life".

BULLSHIT. The right to life, is the right to not be killed without due process. It is not a right to free medical services.

Re:Isn't it, though?

[symbolset]

The right to life, is the right to not be killed without due process.

The right to life I'm talking about in my post above is more about the natural right each of us is endowed with by our creator, and less about those rights enumerated in the US Constitution, which protects only those of us who live under it, and is limited in other ways. We have a Human right to life.

I agree with you about not entitling people to free medical services. That's not my issue at all. There is some basic level of immunisation and treatment that is for the public health and within the domain of stuff that should be automatic, but that's not what we're talking about here.

What I have a problem with is insurance companies creating a monopoly on care so that people who can pay cash can't get care. Doctors who want to practice for cash can't make a living. "Negotiated group discounts" prevent reasonable for-cash prices for medical practices that also accept insurance. That's just wrong in many different ways. If you aren't covered, you can't get care. If you don't belive me: try. You will find the attempt informative. Call around to your local health providers, and try to get care while pretending to not have coverage. In almost every case, they will not talk to you at all.

For what I pay in annual premiums for medical care in some countries I could have my own doctor to wait upon my every sniffle. It's over $1000/month between me and my employer. Are there any doctors in the third world out there who want to live in my basement? It's warm, and we have cable and food. It pays $12k/yr and you'll work maybe 12 hours/yr and the rest of the time is your own. Bring your whole family, I don't care as long as when my family is sick you'll treat us. Maybe I can hook you up with a clinic to work in when you're not busy with your main job, and you can clear $100k or better with $0 overhead. Sure, you're busy in your village or whatever, but hey, could your extended family maybe use US$6,000 a month? Wouldn't that buy a lot of whatever it is your village needs? How is your time better spent?

Re:Isn't it, though?

[meringuoid]

I've never been clear exactly WHY Americans call their Socialist Party "the Republican Party".

Most Socialist states are republics, but few are democracies.

Re:Isn't it, though?

[radtea]

And what happens to those who cannot afford $10,000. Do they deserve to die because they were too stupid or too poor to save up $10,000?

This is exactly the kind of insurance-centric myopia I was trying to point out.

I was giving "a reasonable model of health insurance" in a post that said the insurance model was a lousy fit for health care. I was saying the insurance model is the WRONG ONE.

So rather than asking smug rhetorical questions it would be more productive to suggest a better model for health care provision than the insurance model, which is pretty clearly broken, in part for exactly the reasons you point out.

I would argue that a pooled-cost model rather than a pooled-risk model is the appropriate one, which carries with it the implication of some kind of triage within the system of the kind that over-taxed emergency rooms and long waiting lists provide in Canada. Acknowledging that we are dealing with a pooled-cost system rather than a pooled-risk system might allow us to design a better means of doing this.

The coefficient of variation in health care payouts is only 10 or so, as opposed to insurance models where it is easily over 100. If I have $1 million term life insurance and am paying $1000 per year for it and there are 1000 people who have the same plan with the same insurance company, and on average just one of us dies per year, the coefficient of variation is going to be nearly 1000 (999.49), as the mean payout is $1000 but the standard deviation is basically $1 million.

Insurance schemes work where the coefficient of variation is large. This is not the case for health care. Ergo, insurance schemes do not work for health care. If one wanted to make an insurance scheme for health care, it would have to have a high minimum payout per hospital visit to create a high coefficient of variation, which would introduce the rhetorical issues you raise.

Now that we have that cleared away perhaps you could present an actual argument rather than asking smarmy questions and pointing out the trivially obvious, because doing those things does exactly nothing toward determining the best way of paying for universal health care services.

No nationalized insurance without eugenics!

[Baron_Yam]

If we're testing everyone for everything, and covering their health costs...

I don't want my tax dollars supporting the breeding of people who will put an unfair load on the medical system.

Re:No nationalized insurance without eugenics!

[Baron_Yam]

Harshly worded, perhaps, but I didn't mean it as a troll.

Why on earth should society deliberately hobble itself supporting people with severe hereditary disease? Never mind the fact that people with these diseases who have children are exceptionally (and unacceptably) selfish.

Just because the dawn of eugenics saw racists trying to justify their views doesn't mean the concept itself is bad.

Besides, once germline genetic engineering is A) possible and B) permitted to fix genetic disease, the problem goes away anyway.

Re:No nationalized insurance without eugenics!

[philspear]

Why on earth should society deliberately hobble itself supporting people with severe hereditary disease?

Because this is Earth, and that's what civilized people on Earth do.

Never mind the fact that people with these diseases who have children are exceptionally (and unacceptably) selfish.

Judging from your comic-book villain logic, you're no model of human evolution yourself.

Re:No nationalized insurance without eugenics!

[Baron_Yam]

Yes, because if you have cystic fibrosis, or thalasemia, or huntington's... it's perfectly acceptable to deliberately have children knowing they have a 50% chance of a shortened lifespan with some terrible suffering.

I know people on both sides - one couple that was unaware they were carriers of a nasty resessive gene who both got 'fixed' upon the diagnosis of their firstborn, and another couple where the wife had a 50% chance of being a carrier (she was not old enough to be past the point of the first symptoms) who had the money to get tested but had children WITHOUT getting tested because she didn't want to know she shouldn't have kids. Nice, eh?

I'm not suggesting that kids not get coverage, but that anyone with a nasty genetic disease who has kids get cut off. Insurance isn't for those who deliberately cause their own misfortune, it's for those who get caught unaware.

Re:No nationalized insurance without eugenics!

[bornwaysouth]

Hoo boy! You didn't read the article, did you. Reading the 8 long pages takes a while, given that the language isn't designed for the illiterate. I'd recommend page 5.

The basic message is simple - the DNA tests are slightly better than horseshit, and nowhere near as good as talking to some gossipy individual (prejudices and all) who knows you and your family. He quotes horrible stats like a study of 16,000 people for DNA contribution to IQ which managed to explain 2% of the variance. So if you are going to spend $400 to $100,000 per individual on outcome info, the best way to do it is to pay dear old ladies to babble to someone typing into a database. Saying things like, "Yeah, that family were often off to the library and that's why he had to get glasses aged 14." Such a database would be a huge heap of social venom but it would work better than genome testing.

The downside is that it would lack the aura of technology and be difficult to persuade funding for.

There are a few rare conditions worth testing for, but those are in the main an irrelevancy. They are rare, and usually the family history is already really informative.

If you don't want your tax dollars going to needless medical costs, then genome testing is not a good approach. Try persuading people not to eat high salt fatty food. Pay for TV ads for this. It will be a total waste of time, but so is playing with eugenics. At least you will know in advance that you are wasting your dollars.

Re:No nationalized insurance without eugenics!

[im_thatoneguy]

And what happens when everybody with the name of Bob is deemed statistically dangerous to society?

These sorts of thigns aren't viable because it's difficult to draw a line as to when it's safe to remove rights of an individual. Therefore we default to giving everybody equal rights.

I mean statistically speaking Black Men should be put under far more close surveilance than white women. They're going to statistically cause more crime. But once you decide something like that you've also said that we shouldn't allow men to drive cars because they're more likely to crash. This goes far beyond 'slippery slope' this is a non slope. You can't find a slope the moment you begin assigning different rules to different groups of individuals based on innate and highly suspect reasoning.

Part of the reason our mental health care is sooooo terrible in this country is because of the abuse it received not very long ago. Unhappy with your wife and want her 'gone'. Inform the court that she's mentally unstable and in need of psychiatric care. She'll deny it but that's just part of the paranoia lock her up! The burden of proof for psychiatric lock up in extraordinary because it involves removing the rights of an individual that has commited no crimes or threatened society.

In schools should we offer a genetic test for intelligence and success and give resources to students based on the probability they're going to succeed?

Re:No nationalized insurance without eugenics!

[Baron_Yam]

Wow, because you called me illiterate, I'm convinced of your opinion!

Just a suggestion, if you're really trying to convince people, name calling is a pretty good way to get them to tune you out, and thus isn't recommended. Another hint... people participating in a text-based format can probably read and write and are therefore literate by definition.

Family history is a good way to choose what tests to perform, but if the tests are inexpensive enough, you might as well test for everything. And family history can tell you you're at risk for having a specific genetic flaw, but only a DNA test can tell you that you actually inherited it.

Article or not, most of your opinion is just dead wrong in the context of the discussion at hand.

Re:No nationalized insurance without eugenics!

[azenpunk]

"shouldn't have kids?"

do you think your friends with cystic fibrosis should not have been born? who are you to impose your judgments on these people?

it's not immoral to have kids knowing they *might* have a disease, nor is it immoral to not have kids for the same reason. if the second couple had gotten the testing and it turned out positive, should they then have been barred from having kids? your assumption is that such offspring can have no contribution to society, that because someone has a disease and will live a shorter and more painful life that they have no worth. sure you save them all that suffering but they'll also never have joy. and if the fact that they wont be born makes them not ever knowing joy a moot point, well then it also makes the pain and suffering moot. does all that suffering outweigh any joy they might have during their lives? would they even view it as suffering?

you'd advocate people lose their insurance simply for procreating, not even with a check to see if the child was born with the *costly* disease first. costly, that's really what you're arguing. you realize that, right? for you to argue that a life filled with lots of suffering has to be meaningless is just insane. i have a friend who has cystic fibrosis (well not exactly but it's something very close) he's got one of the most fulfilling lives i can think of. he has no fear of doing anything he thinks would be fun because he realizes how little time he's got to cram it all in. would you ask someone like that if they should not have been born if his parents knew he *might* be born with this disease?

if you think people should not be born into a life of suffering, lets start with abusive homes first. parents who are going to senselessly beat their kids, or sexually molest them. these families have a much greater cost to society than people with genetic diseases.

Re:No nationalized insurance without eugenics!

[Baron_Yam]

Your argument is based on someone magically existing even before conception. It's kind of a wacky argument because the logical conclusion is that all possible sperm should be used to fertilize all possible eggs - after all, each fertilized egg is a potential human and we should allow them all life, right?

I'd never say to someone with a nasty disease that they shouldn't have been born. They're real people, getting as much out of life as they can just like everyone else. If they don't exist yet, I'm certainly OK with the concept of preventing the conception of a human with a nasty disease.

The two positions are NOT mutually exclusive.

Re:No nationalized insurance without eugenics!

[bornwaysouth]

Actually, I wasn't calling you illiterate. The original article was a really long read with quite complex language at times. It was slow going with a mix of stats and university level English. I had the problem. So my apologies for an inadvertent insult.

On full scan DNA testing: Yes it should be possible within 5 years to get full scans at a reasonable price. If there is a specific DNA fault tied to a particular problem, it will probably find it. (Full I expect to mean mean 1% of the DNA, the 'exome', which I understand generates all the proteins.) Worth doing, I agree, if you can afford it, or if there is a likely (familial) fault and it is worth it for a society to help you avoid propagating a serious problem.

Pinker argued that whilst there are these specific and valid cases, the interpretation of the genetic fitness of an individual is just plain too difficult in the majority of cases. My opinion is that a generation from now it should be different, but the snake oil merchants are not going to wait that long. The valid cases will not pay for them; they will prey on fear and the misunderstandings of statistics. If someone pays $1000 for a test, telling them they do not have any one of 20 rare cases just means they have blown their money. If you go on to elaborate on probabilities and possibilities, then you catch their attention, and they recommend the test to their friends. I dislike what I see as a probable social outcome.

My opinions may be dead wrong, but I am not bothered by that. I express them as a way of having them open for examination, and discarding if need be. Piss on them by all means. But if 'eugenics' is worse than talking to a gossip, I think this comparison should be made clear. Telling people that there is some convoluted statistical correlation that implies they have a potential health problem then they will worry, or alternatively, not employ or insure someone. Say you talked to the local gossip and then trot out the same conclusion and you will be despised. I think there is going to be too much money invested in 'eugenics' to allow people to make rational decisions.

I've been in science, and had to try and explain technology to policy makers who were ignorant of my area, and pretty shaky on even simple stats. In the end, simple comparisons are all that worked. "Eugenics is not as good as talking to your family." That message may undermine billion dollar investments, but I still think it is valid.

On the other hand, I do have a genetic fault that has resulted in a heart op. The DNA link is unknown at present. Long term, yeah it would be nice for family members to know if they have the problem, as it can be better managed than I did in my ignorance. At least when it comes to being dead wrong, the emphasis is still on the wrong.

Re:No nationalized insurance without eugenics!

[Anonymous Coward]

And what happens when everybody with the name of Bob is deemed statistically dangerous to society?

Well, my life sure as hell gets a lot more interesting...

Re:No nationalized insurance without eugenics!

[ultranova]

It's kind of a wacky argument because the logical conclusion is that all possible sperm should be used to fertilize all possible eggs - after all, each fertilized egg is a potential human and we should allow them all life, right?

I think I see a plot for a japanese hentai manga here :). After all, all the eggs of those young schoolgirls which go to waste need help, so enter... The Fertilizer !

Seriously, it would make more sense than most of those plots ;).

If you want to know...

[Anonymous Coward]

...if you've got too much money, take a DNA test.

How nice for the US

[Anonymous Coward]

believes that genetic-testing-for-the-masses may hasten the arrival of national health insurance

Nothing like cutting edge 21st century technology to bring the US roaring into step with 20th century social attitudes. Way to keep up guys.

Re:How nice for the US

[philspear]

Nothing like cutting edge 21st century technology to bring the US roaring into step with 20th century social attitudes. Way to keep up guys.

It's funny, you say that like we all got together and foolishly decided that private health insurance was the best way to go, rather than special interests setting up camp directly opposed to what is better for everyone else.

Since we're going to play that game, good job on setting up the government corruption in (insert your home country here).

Re:How nice for the US

[Anonymous Coward]

Since we're going to play that game, good job on setting up the government corruption in (insert your home country here).

Good job on setting up the government corruption in the United States of America.

Oh wait, did you think America doesn't have corruption in its government?

Re:How nice for the US

[philspear]

Woosh. Every country does, and it's not that the citizens choose it, just as we in the US didn't decide to go with for-profit health insurance.

Re:How nice for the US

[Anonymous Coward]

Every country does, and it's not that the citizens choose it, just as we in the US didn't decide to go with for-profit health insurance.

And if your country was truly an oppressive dictatorship that shit might fly. But for a country that spends most of its time telling anyone who'll listen about how it 'invented' democracy you sure seem to spend a lot of time blaming those mean politicians for not doing what you want.

Id venture

[Creepy Crawler]

That this article will be tagged GATTACA.

All reasons aside, if you get a genetic test right now, you're screwed. Why?

There is no genetic rights. Businesses can exclude you from working for them due to it. Health insurance can disclaim all the "bad gene" illnesses, that is if they accept you at all. The government can pidgeonhole you in some god-awful plan in which you cannot escape.

And if you hide the fact that you were tested, or hide the test results, you are committing insurance fraud, or can be dismissed, with prejudice, for withholding vital employer facts.

And you thought poppy roll buns and drug tests were bad...

Re:Id venture

[Anonymous Coward]

http://en.wikipedia.org/wiki/Genetic_Information_Nondiscrimination_Act

Re:Id venture

[lee1026]

On the other hand, if you have some gene that would make you healthier then average (which must exist, or else there could be no genes that make you less healthy then average), then you might be able to get insurance at a discounted rate. Like wise for business hiring - if you have the genes that makes you an excellent worker, then you are more likely to be hired.

By definition, the expected value for you in the test results breaks even. Thus, it is not a bad idea to get tested if you are curious about what you have or not have.

Re:Id venture

[Anonymous Coward]

There is no genetic rights. Businesses can exclude you from working for them due to it. Health insurance can disclaim all the "bad gene" illnesses, that is if they accept you at all. The government can pidgeonhole you in some god-awful plan in which you cannot escape.

Actually, there is: http://www.reuters.com/article/politicsNews/idUSN2143439320080521

Re:Id venture

[Anonymous Coward]

"There is no genetic rights. Businesses can exclude you from working for them due to it. Health insurance can disclaim all the "bad gene" illnesses, that is if they accept you at all. The government can pidgeonhole you in some god-awful plan in which you cannot escape."

Not (legally) in the US, because of the Genetic Information Nondiscrimination Act. (http://www.genome.gov/24519851)

Re:Id venture

[Anonymous Coward]

Businesses can exclude you from working for them due to it. Health insurance can disclaim all the "bad gene" illnesses, that is if they accept you at all. The government can pidgeonhole you in some god-awful plan in which you cannot escape.

Not where I live, no. We're a civilised country where this kind of shit is illegal.

(And in case someone's going to ask, I live in Germany.)

Re:Id venture

[E 99]

Compare it to the auto insurance market, and you'll see how the free market would ACTUALLY respond to such available information: You'd have niche insurers with the tagline, "same low prices, even for those with a less-than-perfect genome," and other insurers who can deep discounts to customers who can document a low genetic risk profile. We already have such a system in place. One type of insurance (group plans) needs to know absolutely nothing about you. The other kind, which which can be cheap if you're very healthy, requires in extremely detailed health history. Having genetic information available might just allow some people to afford insurance who otherwise couldn't -- because they could demonstrate that they were lower risk that the norm.

Re:Id venture

[Anonymous Coward]

Parent is NOT +5 Insightful. It's WRONG.

http://en.wikipedia.org/wiki/Genetic_Information_Nondiscrimination_Act

Add the danger off false positives...

[trolltalk.com]

For example, what good would "normal" cancer test be if it detected 100% of cancer cases, but also, for every one detected, falsely marked 3 others as having cancer when they didn't.

Now apply it to this.

Re:Add the danger off false positives...

[Creepy Crawler]

That's a non-starter.

For one, there's more than 1 test for each ailment. Some tests are cheap with high error. Then you get to mid-grade with acceptable error. Then comes top of the line with low error. And tests are getting better as the cheap ones are getting cheaper and better ones are being made.

Back in '84, even a high-error-rate AIDS test would have been accepted with open arms. Now, some company is putting Rohypnol (sp?) in swizzel sticks.

As per your test of 1/3 false positives, we'll use that test for the over-the-counter el cheapo test so you come to a doctor for a better test/scan. After all, if you dont have it, there's a 67% chance it will not alert you.

Re:Add the danger off false positives...

[trolltalk.com]

Your math skills might need some work ... "As per your test of 1/3 false positives, we'll use that test for the over-the-counter el cheapo test so you come to a doctor for a better test/scan. After all, if you dont have it, there's a 67% chance it will not alert you.",/i>

If 1/4 of the tested subjects actually have cancer, and the test yields 3 false positives for every true positive, there is a 100% chance it will alert you.

Now let's consider something more prosaic - a test for drunk driving. Would you like to be convicted of drunk driving when you were stone sober, by a test that "only" has a 1% false positive rate?

Or death row inmates - where we now see that there's a 20% false positive rate there, AFTER all the "safeguards".

How about a marital fidelity detector? Is 1% false positives on supposedly-cheating spouses "acceptable?"

Or lie detectors in general. After all, "if you have nothing to hide, citizen ...", which completely ignores the false positive problem.

False positives are a real, and serious, problem, and it will be at least a generation before we can make any of the claims in the article. It's like artificial intelligence - 20 years ago, it was 20 years in the future. Now it's STILL 20 years in the future.

Re:Add the danger off false positives...

[Anonymous Coward]

His point was that genetic risk tests are nothing more than tests with high false positives, but very few false negatives.

In reality, how you treat your body is more important than the genes you have.

Re:Add the danger off false positives...

[Creepy Crawler]

My mistake. I thought you said a 1:3 false positive. You actually said 3:1, which then shows there is test... well isnt.

And I love your little list of "what ifs".

Drunk test: Hmm.. guess the cops dont also pay attention to demeanor, pills in the seat, or plenty of other tell-tale signs they can arrest you on Intoxicated Driving. Hint: Its intoxicated driving, not just alcohol. Breathalyers are an easy, yet error-prone way of getting a BAL.

Death row test: On what? To see if they're dead yet? If a test has that much error, why arent the lawyers attacking that?

Marital fidelity: WTF? now you're just making this shit up.

ObBackOnTarget: False positives suck. False negatives also suck. And if someone has some form of nasty disease already in the family, they should probably take the more expensive test that provides better error rates. Those genetic tests are the best form of "In the family", as they apply to YOU, but they have nasty side effects I outline in another thread.

Re:Add the danger off false positives...

[trolltalk.com]

Death row test: On what? To see if they're dead yet? If a test has that much error, why arent the lawyers attacking that?

The lawyers are part of the problem. It's journalists who have uncovered the problem, not incompetent lawyers. That's why Illinois, a pro-death state, became the first to issue a blanket moratorium on executions in 2000 based on wrongful convictions:

On January 31, Illinois Governor George Ryan (R), a death penalty supporter, put a hold on executions in the state after 13 inmates on death row had their convictions overturned. Since the state reestablished the death penalty in 1977, Illinois has released more prisoners from death row after proof of their innocence than it has put to death?13 overturned convictions and 12 executions. In recent years, journalists rather than lawyers in the system have been largely responsible for pursuing the exculpatory evidence. A Northwestern University journalism professor and his graduate students conducted investigations resulting in the overturning of three murder convictions, one of them days before the scheduled execution.

The moratorium has a number of supporters who back the death penalty, but want to ensure that it is justly applied. Crime solving using DNA technology has made tremendous strides over the past two decades. Many of the overturned Illinois convictions were supported by DNA testing and other evidence. Vermont Senator Patrick Leahy (D) has introduced legislation that would make DNA testing less complicated for death row inmates and improve the counsel they are afforded at the state and federal levels. On One Hand...

Executions must stop until all convictions are carefully reviewed to ensure there are no innocent persons on death row. The state of Illinois, facing exonerating evidence, has set free more death row inmates than it has executed. With numbers like that, there is little doubt the Illinois and other states have wrongfully executed many innocent people.

How do innocents end up on death row? Bad legal representation due to lawyers who have never tried a capital case or who show up in court drunk. Others are wrongfully convicted for lack of DNA evidence or corrupt witnesses. In Alabama, Judy Haney was convicted of murder and sentenced to death, even though one of her lawyers came to court drunk. In Chicago, Rolando Cruz was sentenced to death for the rape and murder of a 10-year-old girl, even though another man confessed to the crime. After 10 years, Cruz was set free, thanks partly to DNA evidence.

With a proven false-positive rate of over 50%, the legal process that resulted in wrongful convictions in Illinois was clearly unconstitutional, nevermind a travesty of "justice".

False positives can kill.

Re:Add the danger off false positives...

[khallow]

Marital fidelity: WTF? now you're just making this shit up.

That's what you think. But suppose the false positive rate on paternity testing were 1%. "There's a good chance the baby isn't yours. So we'd like to run some more tests to make sure. Should have an answer inside of a month!"

Re:Add the danger off false positives...

[jc42]

[W]hat good would "normal" cancer test be if it detected 100% of cancer cases, but also, for every one detected, falsely marked 3 others as having cancer when they didn't.

We do have a lot of data on how society in general (and the corporate world in particular) deals with such data. For example, ten years ago the two most common HIV tests had 10% and 5% false-positive rates. There was a lot of PR to reassure people that this wasn't important, but the data said otherwise.

Consider the math with a simple example: You have a test population of about a million, of which roughly 1000 have HIV. The better (5%) test would show 51,000 positives, 1000 true positives and 50,000 (5% of a million) false positives.

This in itself should make you cautious. But consider how many employers and insurance companies dealt with it. They had forms that asked whether you have ever tested positive for HIV. If you were one of the 50,000 false positives, and later tests showed that you didn't have HIV, this didn't matter. There's no place on the application form for that information. For the rest of your life, you have tested positive to HIV, and to not mention this is fraud.

Actually, in most cases, the 10%-false-positive test was the first used, so 1/10 people who had that test are now and forever among the group that have tested positive for HIV. Further testing with other tests won't decrease this number; it can only increase the percentage that have tested positive. So the fact that we have better HIV tests now is mostly irrelevant to those who tested positive 10 or 20 years ago. They still have it on their medical record, and they legally have to admit it, despite the results of later tests.

Now, it's true that there are corporations that are more responsible than this. But as long as a significant portion of the corporate world treats false positives this way, the sensible approach is to avoid any tests that have a nonzero false-positive rate.

And note that I haven't mentioned the possibility of fraudulent positive test results. This is a very real worry when the legal system is involved, as with blood-alcohol and polygraph tests. Those require a different sort of defensive approach.

Re:Add the danger off false positives...

[trolltalk.com]

Eureka! Finally, someone who "gets it!" As you point out, even a small false positive rate, among a large enough population, will screw things up.

We're seeing this in other areas as well - like the "Do Not Fly" lists.

Appearance is a genetic trait

[trolltalk.com]

It gives plenty of outward clues as to "what makes a person tick", which we internalize over a lifetime as "rules."

An example FTFA:

Millions of people are exposed to cognitive psychology in college but have no interest in making a career of it. What made it so attractive to me?

As I stared blankly, the interviewer suggested that perhaps it was because I grew up in Quebec in the 1970s when language, our pre-eminent cognitive capacity, figured so prominently in debates about the future of the province. I quickly agreed -- and silently vowed to come up with something better for the next time.

Stick him in a room with 9 non-Quebecers, and a native Quebecer will pick him out immediately. He "looks" like a michigan-hotdog+poutine-looer

So this gives a quick insight into his formative culture (since it gives information about BOTH nature and nuture - genes have regional variations), despite his rejection of the interviewers' observation.

That he rejected something so obvious just goes to show that we're all human, and want to believe that we're more complex than we really are.

Re:Appearance is a genetic trait

[toiletsalmon]

'He "looks" like a michigan-hotdog+poutine-looer '

Huh?!? What do you people DO up there during the winters?

Re:Appearance is a genetic trait

[trolltalk.com]

He "looks" like a michigan-hotdog+poutine-lover '

Huh?!? What do you people DO up there during the winters?

It's not the winters; everyone looks the same under 4 layers of coats and hats and gloves.

It's the summers. If you want to be polite, you address people in their mother tongue, which is usually either english or french, so you quickly learn the visual cues for determining, before they've said a word, what language group they're from, especially since, if you work wth the public, getting it wrong can sometimes lead to a certain nastiness from people who insist on being served in "their own language."

It gets trickier with other ethnic groups, so you again have to figure out, of the 2 official languages, which one are they going to be more comfortable in. Again, you learn to figure it out to the point where it's just instinctive.

Some people are better at it than others ...

Pinker is a media whore

[Anonymous Coward]

He's never done any hard science. Just lots of speculation.

Re:Pinker is a media whore

[Anonymous Coward]

Why the fuck is there a "Read the rest of this comment..." link when it already shows the whole damn 64KB troll?

Re:Pinker is a media whore

[Anonymous Coward]

It would be nice to have something in the prefs to
"display only [select number] characters in posts modded troll".
That way you know they are there, but you don't have a half mile of scrolling to do to find the next post...

Piecemeal never works.

[Bombula]

'piecemeal insurance is not viable in a world in which insurers can cherry-pick the most risk-free customers'

Piecemeal insurance is not viable under any circumstances. It's the profit part of the equation that borks everything: when your money depends on not paying out benefits, you're going to do whatever you can get away with to not pay out benefits. Private, for-profit health insurance makes even less sense than private, for-profit fire departments, police forces and armies.

If I have to pay for other people's healthcare

[Anonymous Coward]

...they better be genetically engineered to make that as cheap as possible.

This will actually reverse the cost of health care

[dada21]

Health insurance is a scam pushed on the masses through Federal tax loopholes. You don't need health insurance for MOST of your health care needs. I have health insurance for BIG stuff, hence me HUGE deductible (5 figures). I pay very little for health care, going to a cash-only doctor who asks for an up front fee annually for unlimited visits and some basic yearly lab tests. He doesn't even take insurance, Medicare, or credit cards. He's also available for house calls.

Genetic testing for predispositions will likely give people options to fight the parts of those possible diseases that nurture (lifestyle) causes, instead of just pure nature (genetics). As more people are prediagnosed, it is wise for insurers to drop them. Here's the thing, though: if insurers drop too many peoole, doctors will have to find ways to treat them, or the doctors will be out of work.

The number of doctors leaving the world of insurance and Medicare are growing. It's a good thing. They can treat you cheaply ($35 per visit, cash on the barrel), and can spend time with you helping you make choices to work towards a healthier life. It's not about taking drugs, sometimes, it's about fighting the diseases before they're serious. MANY diabetics could have prevented the disease had they known they had a predisposition. Not all, I understand, but many (see: fat diabetics). The same is true of other diseases.

As more people lose health insurance and find options for cheaper health care (it is out there, really), genetic testing will make it easier for us to work with our doctors to find ways to avoid the tragedies. We're not healthy people, because we rely on health insurance rather than preliminary lifestyle adjustments before we get sick.

Wash your hands after touching sick people. Cut back on excessive drinking and smoking. Wear a condom. Don't eat too many sugars or starches. Do some exercise. It's not so hard.

The big late-age diseases, Parkinson's and Alzheimer's, are great to diagnose risks early. Then you can SAVE YOUR MONEY when you're young to prepare for the care you'll need when you're old. Don't pass it off to insurers, save for it yourself.

Or are you too busy buying the latest video games or blowing it on a weekend of drinking that you won't remember in 6 months?

$399 for nothin'

[Anonymous Coward]

$399 is going to get you nothing these days. Wait a couple or three years, and you'll get your whole genome sequenced for $1K.

Why not wanna know?

[macraig]

Why would Pinker choose not to know whether he has the Alzheimer's gene or not? It seems to me that knowing the answer to that implied question is a win-win: if he DOESN'T have the gene then attempting to divine the answer to the question out of thin air will no longer keep him awake at night, and if he HAS the gene he'll soon enough forget that fact and every other sodding thing that isn't relevant to breathing.

That's what abortions are for ...

[trolltalk.com]

If you can test "in utero", you can have your cake and eat it too. If the fetus is going to result in a disaster, a quick D&C is preferable to a lifetime of crap.

Of course, this has social implications - the biggest one being that, over time, the average "genetic quality" of "true believers" - fundies who are against abortion, will trend lower than the population at large. Considering some of the mouth-breathing, knuckle-dragging moronics displayed in the last election, we've already gotten to the point where the effect is visible.

3-4 more generations ... it'll sort itself out. Just keep telling yourselves that God really wants you to breed kids that will live a shortened, painful, and meainingless life. Stupidity, like intelligence, is partly genetic.

Re:That's what abortions are for ...

[philspear]

Just keep telling yourselves that God really wants you to breed kids that will live a shortened, painful, and meainingless life. Stupidity, like intelligence, is partly genetic.

You have by far surpassed many fundamentalists and pro-lifers in terms of stupid statements by implying that your religious beliefs and position on abortion is based on inteligence, which is based on genetics. You also just proved they're not the only ones with a tendancy to oversimplify things to black and white.

Re:That's what abortions are for ...

[trolltalk.com]

Just keep telling yourselves that God really wants you to breed kids that will live a shortened, painful, and meaningless life. Stupidity, like intelligence, is partly genetic.

You have by far surpassed many fundamentalists and pro-lifers in terms of stupid statements by implying that your religious beliefs and position on abortion is based on inteligence, which is based on genetics. You also just proved they're not the only ones with a tendancy to oversimplify things to black and white.

I'm an atheist - I have no religious beliefs, you ignorant clod! :-)

Look, there's no proof whatsoever that there's a "person" in a 12-week fetus, so anyone arguing against abortion based on "it's a person" is making an argument based on wishful thinking, not the evidence.

So, tell us how you can justify people having kids that are going to have a grossly shortened, painful, and ultimately tragic life. My position on abortion is based on simple decency - I wouldn't let a dog go through what some parents put kids through by not aborting when they had plenty of time.

Same as euthenasia - I'm all for it. Why should people have to continue to suffer in pain because of someone else's religious beliefs? Anyone who put an animal through such crap would be stoned to death in a show of public outrage. But for people, "It's different - it's God's will!" Bullshit. If "God" wants people to suffer, I'd rather be in hell than sit at the same table as such an asshole. Let "God" clean up "his" act first, and get a decent set of morals and ethics.

But keep breeding those mouth-breeders - the RNC needs them. Just remember that every fetus that should have been aborted that wasn't potentially takes the place of one who could have been viable.

Re:That's what abortions are for ...

[Anonymous Coward]

Not every Republican is religious.

Re:That's what abortions are for ...

[philspear]

I'm an atheist - I have no religious beliefs, you ignorant clod! :-)

I guess that should have actually been "...implying that an individual's religious beliefs and position on abortion is based on inteligence, which is based on genetics..."

...how you can justify people having kids that are going to have a grossly shortened, painful, and ultimately tragic life.

By not having the arrogance to assume I know what's best. That also happens to be why I'm pro-choice.

Same as euthenasia - I'm all for it.

You're really getting off topic here...

...every fetus that should have been aborted that wasn't potentially takes the place of one who could have been viable.

You're going to have to explain that one. Be sure to explain why that matters in a discussion of medical insurance as well.

Re:That's what abortions are for ...

[im_thatoneguy]

Not every Republican is religious

No just 95.6% of them according to some of latest demographic data. (GSS)

Re:That's what abortions are for ...

[trolltalk.com]

...how you can justify people having kids that are going to have a grossly shortened, painful, and ultimately tragic life.

By not having the arrogance to assume I know what's best. That also happens to be why I'm pro-choice.

So you're okay with a parents' "right" to knowingly have another human being suffer for years and then die? That's just fucked up thinking from the time when kids (and wives) were regarded as property. We may not have ALL the information, but we have enough to make reasonable choices. People who knowingly bring guaranteed-risk pregnancies to term should have their tubes tied, and the fetus aborted on birth if it's been allowed to get that far. Maybe we could extend it further ... here's a thought - we could start with Sarah Palin, the "poster child" for "people - even children - should have children".

.every fetus that should have been aborted that wasn't potentially takes the place of one who could have been viable.

You're going to have to explain that one. Be sure to explain why that matters in a discussion of medical insurance as well.

Simple - if the parents abort the defective one, they can try again, and maybe the next mix of genes will be better. After all, a lot of the genetic disorders are 50-50.

Also, it's a lot cheaper on the medical system to get an abortion than it is to finance the care cost of the seriously non-viable - not to mention the additional psychological and time burdens on the parents, which also ends up costing in lost time and $$$.

Same as euthanasia - I'm all for it.

You're really getting off topic here...

Why - any talk of making the results of genetic screening available to insurance companies ultimately comes down to $$$ - and euthanasia saves money and resources. If genetic screening shows that the treatment options available won't work, you better believe that this info will be used to deny treatment, so you might as well at least be humane and not let people needlessly suffer when they don't have other options.

We're already a few billion over capacity. If we're going to have to limit the number of births anyway, might as well make sure that they're the best possible. The alternative is NOT to limit births and get down to some sustainable level of population, in which case the eventual culling (either human or natural disaster) will be much harsher, and the "defectives" won't have a chance anyway.

It's not eugenics. It's reality. We've over-bred, and the last thing we need is to preserve defective genes that are going to hinder our chances of long-term survival. One viable child per couple for the next 100 years, no exceptions, should do it. Either we make the choice voluntarily, it it WILL be made for us.

Re:That's what abortions are for ...

[foniksonik]

Ummm. There's really easy proof that there is a "person" in every single 12 week fetus. Let it go to term. If at the end of the 40 weeks the woman does not deliver a fully formed individual human being, then you can make claims. Only in the rarest circumstances is a child born without a brain or a beating heart or some other condition where they are not a viable human who will grow into your neighbor.

Otoh I'm not against abortion when there is a near guarantee that the child will live a life full of pain and suffering. In this case a person who is likely to pass on their genetic disease should use in vitro with testing of embryos.

Abortion isn't evil it's just not necessary as a means of convenient birth control. There are so many better alternatives.

Re:That's what abortions are for ...

[JebusIsLord]

A huge problem though is in deeming what is "defective". The fact that a gene exists in any significant part of the population beyond what you'd expect given random mutation, implies that it must have (or had) a reproductive benefit. For example, some jewish people have a gene that makes them slightly more succeptable to Tay-Sachs disease, which is an almost certainly deadly recessive trait. However, being a carrier for it grants immunity to Cholera, which would have been advantageous for a population that has been living in disease-ridden ghettos for millennia. Another deadly recessive trait is sickle-cell anemia. Being heterozygous for this trait still has non- life-threatening symptoms, but also the benefit of malaria immunity. Not surprisingly, sickle-cell anemia is prevalent in tropical african populations.

My point is, by weeding these genes out we create a monoculture of humans that will be less able to adapt evolutionarily to new diseases and environmental stress. Genetic diversity is a natural safety mechanism for species, as any agriculture expert will tell you.

Re:That's what abortions are for ...

[trolltalk.com]

Ummm. There's really easy proof that there is a "person" in every single 12 week fetus. Let it go to term. If at the end of the 40 weeks the woman does not deliver a fully formed individual human being, then you can make claims.

The same "logic" was used in times past to argue that sperm contained fully-formed homonuclei - little people.

A person is more than just a hunk of meat. According to your argument, we should never bury someone who is dead, because they are a "fully formed individual human being."

You mistake the form and the functionality.

A "person" is a sentient, self-aware being. Neither the dead, nor the brain-dead, nor the grossly mentally retarded, nor 12-week-old fetuses, qualify. Filling up space when there's obody home, a la Terry Shiavo, is just a waste of oxygen and an example of superstition overriding common sense and ethics.

Re:That's what abortions are for ...

[azenpunk]

i know a guy with cystic fibrosis. his life is far from tragic, he's one of the most fun guys you could spend time with. even suggesting he shouldn't have been born just to 'save him the trouble' is just arrogant and uninformed.

everyone has their cross to bear, but if that cross is too heavy they should not be born? what's the threshold, where do we draw the line? should we abort someone who'll have autism? aspergers? cystic fibrosis? what's the list?

i can stalemate you easily on that abortion point too. we have no proof that it *isn't* a person at 12 weeks. there's really not much proof either way, it's all purely the realm of philosophy.

and: the phrase is 'mouth breathers' implying that unintelligent people often leave their mouths open when not speaking instead of closing them like us smarties.

but what's really sick is how you mix the beliefs that someone should be saved the suffering of their genetic disease with the idea that if they are born they're worthless as human beings. simply because they have a degenerative disease there is no reason to allow them to be born.

at best having a kid with such a disease is really just a crapshoot. but so is having a kid with when you have no known risks of passing on such a disease, it's just a crapshoot with better odds. and the gamble isn't whether or not the kid will have the disease, the gamble is whether or not the suffering will outweigh the joy in their lives if they should be born.

the lapse in morals and ethics is to assume that you have all the answers and that anyone who disagrees is wrong with such a topic.

it's the suffering that gives perspective to everything else.

Re:That's what abortions are for ...

[azenpunk]

the fact that you can boil a person down to 'non-viable' is fucking disgusting.

Re:That's what abortions are for ...

[trolltalk.com]

i can stalemate you easily on that abortion point too. we have no proof that it *isn't* a person at 12 weeks. there's really not much proof either way, it's all purely the realm of philosophy.

No, you can't. Since the 12-week fetus doesn't have a brain that is capable of the functions of a person, such as self-awareness, your claim is totally wishful thinking. Actually, it's an example of willful ignorance in the face of scientific fact. Superstition rather than observation and reasoning. It's an extraordinary claim, and as such requires extraordinary proof. There is nothing even approaching "proof"; quite the contrary, the brain growth spurt commences in the 6th month.

Heck, even a sheep or a pig has more brain cells than a 20-week fetus - which is closer in complexity to an aardvark, if you want to put things into perspective. At 12 weeks, even a shark, cat, alligator or rabbit has more brains.

Flush it. Use it for medical experiments. See if it blends. It's just tissue, not a person.

Re:That's what abortions are for ...

[trolltalk.com]

the fact that you can boil a person down to 'non-viable' is fucking disgusting.

A fetus is not a person. The brain at 20 weeks is smaller than a pig or a cow. At 12 weeks, you're on the level of an aardvark, at best, but without the survival traits.

The fact that you insist on calling a clump of cells a "person" when there's no evidence that "anybody's home" is more a testimony to wishful thinking or knee-jerk rejection of evidence in favour of indoctrination is what's disgusting.

But I will go further, though not to the extent you imply. While I won't boil people, I'd be happy to add schizophrenics to the "non-viable" list. Mandatory sterilization once it manifests. The human race has had enough problems with people who claim to "hear voices" telling them what to do, or what is right, rather than making decisions based upon observation and testing. It's time we grew up, and put away childish things.

Re:That's what abortions are for ...

[Eli Gottlieb]

Yes, but the idea isn't to create a monoculture of humans who carry no copies of these genes. The idea is that fetuses found to actually have double-copies of the disease-causing genes should be aborted (or simply never made in the first place), while ordinary recessive carriers should be allowed to come to term.

Re:That's what abortions are for ...

[Eli Gottlieb]

But I will go further, though not to the extent you imply. While I won't boil people, I'd be happy to add schizophrenics to the "non-viable" list. Mandatory sterilization once it manifests. The human race has had enough problems with people who claim to "hear voices" telling them what to do, or what is right, rather than making decisions based upon observation and testing. It's time we grew up, and put away childish things.

If your definition of "schizophrenic" includes religiousity or leadership of religious people you really need to moderate yourself. Remember that even the craziest religious people tend not to display any other symptoms of schizophrenia (including "hearing voices"... they read books).

Re:That's what abortions are for ...

[trolltalk.com]

But I will go further, though not to the extent you imply. While I won't boil people, I'd be happy to add schizophrenics to the "non-viable" list. Mandatory sterilization once it manifests. The human race has had enough problems with people who claim to "hear voices" telling them what to do, or what is right, rather than making decisions based upon observation and testing. It's time we grew up, and put away childish things.

If your definition of "schizophrenic" includes religiousity or leadership of religious people you really need to moderate yourself. Remember that even the craziest religious people tend not to display any other symptoms of schizophrenia (including "hearing voices"... they read books).

Really? Look at all the wars throughout recorded human history. One bunch of retards fighting another because "God told them to." We don't need any more of that shit, and the quicker we purge it from the gene pool, the better. If someone claimed to hear God telling them to steal cars for Jesus, we'd refuse to give it any credence. If someone claimed to hear God telling them to rape people, we'd refuse to believe it (though the people in the Bible acted on exactly that "command from god" when they'd rape the women after killing the men). If someone claimed to hear God tell them that it was their duty to shit on your living room carpet every morning at 7AM, you'd kick their ass.

So why would be believe them because they say "You must kill these people!" Simple - it aligns with the mob's secret desire to violence - not any rational thought process. Same as the rabid death penalty supporters who can't wait to execute an 8-year-old. Better yet, read some of the comments here and here.

"God says put them to death!" Yeah, riiiiight. Got any witnesses to that? No? Just a voice in your head? God sent me an email saying you should give me all your money. And that abortion is okay. What, you don't believe me? Send an email to god AT trolltalk DOT com asking if it's true.

Re:That's what abortions are for ...

[BotnetZombie]

One bunch of retards fighting another because "God told them to."

I think "God" is often framed when people say this, no voice-hearing necessary to explain that.

Re:That's what abortions are for ...

[trolltalk.com]

One bunch of retards fighting another because "God told them to."

I think "God" is often framed when people say this, no voice-hearing necessary to explain that.

Exactly. Further, there's no proof that EVERYTHING people do "because it's God's will" is a put-up job.

They could at least send God an email asking for confirmation.

Re:That's what abortions are for ...

[WCguru42]

You know that it usually takes 18 months after birth for a child to recognize itself in a mirror and before that they just assume it's another person in the mirror. Can you prove to me that an infant is self aware, because that would be pretty impressive. By your logic it seems like one should be able to abort their child in the first year and a half after birth.

Re:That's what abortions are for ...

[Golddess]

It's a tricky subject to be sure. Just for the record, before I go into my diatribe, I am pro-choice.

At what point does a fetus begin to qualify? 15 weeks? 30? 40? Do they continue to remain unqualified for weeks, months, or even years after they've escaped the womb? After all, birth is just some arbitrary action, the creature within the womb became able to exit some time ago.

Again, I am pro-choice. This is just me playing Devil's Advocate.

Re:That's what abortions are for ...

[trolltalk.com]

You know that it usually takes 18 months after birth for a child to recognize itself in a mirror and before that they just assume it's another person in the mirror. Can you prove to me that an infant is self aware, because that would be pretty impressive. By your logic it seems like one should be able to abort their child in the first year and a half after birth.

... there are a lot of parents who would love that ...

I've mentioned this before in other contexts, and people get all in a jam about it. If, for example, someone is so brain-damaged that they no longer have a sense of self, a sense of others, etc., it doesn't really matter if they can do some sort of somnambulistic imitation of "someone being home" - there's no person, so why not just pull the plug.

I don't know that it's a full year and a half - animals (dogs and cats) catch on quite quickly that the "other" is really them, and ISTR playing peek-a-boo with my daughters via a mirror before 6 months, so they certainly understood that even a reversed image was the same person, and they didn't try to play the game with themselves ...

I think they pick up cues from the eye motion. It would make sense, since there are mirror surfaces in nature (water surfaces, for example), and it would be in every species' interest to be able to discount their own reflection when looking down (unable to see attackers directly). cf Aesop's Fable about the wolf crossing the stream with a chunk of meat in his mouth - pure fiction. No way is a wolf going to drop a chunk of meat for an image of one.

It IS a valid point. Would be fun to do experiments (then again, playing with your own kids is usually fun - its' OTHER peoples' kids who are the whiney, noisy, spoiled brats. :-)

Re:That's what abortions are for ...

[Golddess]

For the record, I agree with you that there is little difference between an individual a few weeks prior to birth, up through weeks, months, or even years after birth. But House makes a good point IMO in this quote from One Day, One Room:

Patient: "Abortion is murder."
House: "True. It's a life and you should end it."
Patient: "Every life is sacred."
House: "Come on. Talk to me. Don't quote me bumper stickers."
Patient: "It's true."
House: "It's meaningless."
Patient: "It means that every life matters to God."
House: "Not to me. Not to you. Judging by the number of natural disasters, not to God either."
Patient: "You're just being argumentative."
House: "Yeah. I do do that. What about Hitler? Was his life sacred to God? Father of your child. Is his life sacred to you?"
Patient: "My child isn't Hitler."
House: "Either every life is sacred or-"
Patient: "Stop it! I don't want to chat about philosophy."
House: "You're not killing your rape baby because of a philosophy."
Patient: "It's murder. I'm against it. You for it?"
House: "Not as a general rule."
Patient: "Just for unborn children?"
House: "Yes. The problem with exceptions to rules is the line-drawing. It might make sense for us to kill the ass that did this to you. I mean, where do we draw the line? Which asses do we get to kill and which asses get to keep on being asses. The nice thing about the abortion debate is that we can quibble over trimesters but ultimately, there's a nice clean line: birth. Morally there isn't a lot of difference. Practically, huge."

Re:That's what abortions are for ...

[trolltalk.com]

I could always say that's above my pay grade, but why not just send an email to the ultimate authority :-)

Re:That's what abortions are for ...

[Golddess]

Because I don't really care about the answer, I'm just asking the question to ask the question. :P

Seriously, I tend to find that lately, I've begun feeling about the same way as Gregory House.

Re:That's what abortions are for ...

[badkarmadayaccount]

I hope you realize that psychiatric illnesses are quite a bit more complicated than that...

Schizophrenia is basically excess dopamine wreaking havoc, but what happens if that red-line dopamine is a preventative measure for a wider population who's dopaminergic system is a bit weak. From nature's POV, better N per 100 schizophrenics, than 10xN per 100 ADHD/OCD/MDD/?, no? And keep in mind that my analysis is oversimplified. Just my $0.02.

Re:That's what abortions are for ...

[trolltalk.com]

From nature's POV, better N per 100 schizophrenics,

Fortunately, we don't have to settle for nature's fucked-up math. We CAN sterilize schizophrenics, and maybe eventually eliminate them from the gene pool. Or better yet, identify fetuses in utero and abort them.

Better 0% schizophrenics. We CAN eliminate it. While we're at it, let's throw in bi-polar syndrome/manic-depressive/whatever they call it this week.

It should be possible to identify the genes associated with the disease, and test fetuses for it. Ditto Down's Syndrome.

Re:That's what abortions are for ...

[XcepticZP]

Ah, the old Slippery slope fallacy. Nice one!

You should stick to rhetoric, buddy. At least that way we can't point out your flawed arguments so easily.

Re:That's what abortions are for ...

[trolltalk.com]

How is it a slippery slope?

The idea is to eliminate genetic defects in utero. Not "genetic defects ... and also this trait and that trait and this other trait."

Or are you going to argue that schizophrenia bipolar syndrome and downs' syndrome don't have a genetic component? Downs, for example, is caused by an extra chromosome. If we can identify fetuses that are going to turn into schizophrenics, manic-depressives, multiple-personality-disorders, or downs, why not flush them and try again? It's not like we're dealing with a person, just a fetus that, at 12 weeks, has less brains than an adult aardvark, or at 20 weeks, less than a pig or cow. "Nobody home", since the "home" isn't large enough to "house" anyone at that stage.

Note that I haven't suggested we develop a test for susceptibility to a particular thought, such as religion, for example - because such susceptibility, while it may have a genetic component, is mostly environmental/societal, and is definitely curable. So, no "slippery slope" to see here ...

Re:That's what abortions are for ...

[badkarmadayaccount]

You nitwit, I was insinuating that blowing off genes associated with schizophrenia could lead to a disproportionate increase in other illnesses, bi-polar disorder included.

Re:That's what abortions are for ...

[XcepticZP]

I have absolutely no idea what you're going on about in your reply to my post. But I can comment on your previous comment, the one I commented on.

You basically said "sure lets test for the bad trait schizophrenia and eliminate it by aborting the fetus". Or something along those lines. Then you said, "while we're at it, let's throw in bi-polar".

That's a slippery slope fallacy. You're basically saying that starting to eliminate a really bad trait will lead to us progressively eliminating more and more traits that also have progressively more benign effects.

Just because we decide today that we should abort all fetus's or embryo's if they have the genetic signs of schizophrenia doesn't mean we will eventually come to a stage where we decide to do the same for a much less harmful trait such as depression.

Re:That's what abortions are for ...

[trolltalk.com]

That would be like arguing that, because you took out all the red M&Ms, there are now more purple M&Ms. So what?

If we have a problem with both the red and purple ones, remove them both. We don't have to stop at just one gene or one issue.

Besides, your argument is based on a false premise - that a certain percentage of schizophrenics somehow means fewer other mental diseases. Seems to me that it would increase, not decrease, the numbers - after all, living with a crazy can drive you nuts. Ask anyone who's ever dated, married, or raised a bipolar. It's *not* healthy.

Re:That's what abortions are for ...

[trolltalk.com]

Just because we decide today that we should abort all fetus's or embryo's if they have the genetic signs of schizophrenia doesn't mean we will eventually come to a stage where we decide to do the same for a much less harmful trait such as depression.

What's the problem if its' a harmful trait? More harmful, less harmful, who gives a shit, really. If it's harmful, get rid of it.

This might sound SO terrible now, but get used to it - we'll be doing this within 100 years by choice. No need to make it mandatory - people's egos will see to that. It just won't be "fashionable" to have kids who are prone to depression, or schizophrenia, or bipolar, or downs, or adhd, or whatever. Heck, I'll go further - it will be seen as the height of ignorance, an attempt to foist your selfish beliefs that somehow your DEFECTIVE genes are more worth preserving, and damn the cost to everyone in society.

Never underestimate the power of cheap tech, money, and fashion.

Re:That's what abortions are for ...

[XcepticZP]

I definitely agree with you on this. This society really does need more control. Right now we have a shit load of ugly, obese people that can not lead normal lives and do nothing but eat themselves to a stroke.

Anyone that can possibly think that a obese and/or ugly person can lead a normal happy life are seriously mistaken or living in a fairy tale. It's like prolonging an animal's suffering, when instead nature would have let it die, or die out, a long time ago. I'm not saying we should euthanize ugly/obese people. I'm saying, since nature no longer plays a part in the selection of our species, that we should do it ourselves. For the sake of the greater good. For the sake of the happiness of our future generations. For our future children!!

People with predisposition for obesity should never be allowed to procreate. And mandatory weight loss programs for anyone that goes over the obese line. Or tax the hell out of obese people, as they really are taking up more space, more food and create more waste.

Pretty soon as our population bubbles out of control, which it will, we will be forced out of necessity to restrict procreation. Only the rich and/or healthy will be allowed to propagate their genes. It's the way things are headed, so start bracing yourselves now, idealists!

While we're at it. Don't forget to impose this on the entire globe so that it is fair for all people. Can't have selfish people hogging all the planet's resources because they feel the need to spread their genes with wanton disregard for the greater good.

Re:That's what abortions are for ...

[badkarmadayaccount]

Please tell me that was tongue-in-cheek, or go do some serious reading up on psychiatric illnesses. Of course it means less other illnesses! Nature prunes out not individuals, but genes that are unfit for survival, so genes that cause schizophrenia, save [more] others from something [worse]. For some things, we are ready to make the compromise, like trading malaria resistance (pretty useless in most of the modern world nowadays) for AIDS and/or cancer resistance (much more useful), but the picture is always more complicated than "blast this gene, and you are resistant to psychiatric illnesses". I hope you realize this.

Re:That's what abortions are for ...

[trolltalk.com]

You're arguing that schizophrenia somehow "protects" against other mental diseases. I don't buy it.

I've lost all patience with dealing with them, after seeing how much damage, up to and including death, schizophrenics can cause.

This turned out to be a "good thing" years later when one of my friends had a relative staying with her who refused to take his meds. He indulged in a lot of bizarre behaviour, including never flushing the toilet. I told her that's easy enough to fix. Next time he came out of the can (without flushing) I confronted him just outside the door to the toilet and told him to go back in and flush. He said he had. I shoved him in the can and pointed to the bowl he had just filled with disgusting turds. He then tried to claim it wasn't his. I shoved his face in it, and told him that if he EVER EVER didn't flush, I'd make him eat it.

From then on, he ALWAYS flushed, even though he was off his meds and doing all sorts of weird shit. And as long as he flushed the toilet, I treated him civilly enough. He might have been crazy but he was using it as a lever to engage n his own style of passive-aggressive bullshit.

What most people fail to realize is that, while you're not doing anyone a favour by enabling them to continue such behaviours, trying the "normal methods of communication" not only won't work - you become an enabler. You have to communicate the same way you would with an angry dog. Fearless, and in command. They have to KNOW, at the lowest level possible, bypassing all (ir)rationalization, that this is the way it is. No if, no else, no but. The behaviour modification has to be done at a bio-chemical, instinctive level, and this is one way to do it.

Of course, most people can't do it, because they lack confidence, same as they can't grab a snarling 120-pound dog that has just tried to attack another one by the face and shove their face into its', and say "You EVER do that again and I'll turn you into a fucking rug!" That dog went on to become the best-behaved dog anyone had ever seen, super-loyal and very happy, but everyone who had seen the original incident said he should be put down immediately, and nobody wanted to go near him for months after, even though his change in behaviour was immediate and permanent.

Sometimes all it takes is one act to permanently alter behaviour. But we're too "nice" to be "mean enough" to actually do it. Just like we want to maintain the illusion that we're too "humane" to cull destructive genes, when in actual fact we betray future generations by condemning them to suffer with diseases we can eliminate in a couple of generations.

There's no excuse for not sterilizing all schizophrenics and bi-polars as a public health and safety measure.

Cheapest plan for everyone

[Anonymous Coward]

1. Prenatal genetic testing.
2. Genetic counseling for prospective parents.
3. Actuarial estimate of lifetime healthcare costs at birth.
4. Mandatory front-loaded health savings accounts, funded by income withholding, until the amount saved in the account is equal to the amount necessary until end-of-life medical care, based on actuarial estimates.
5. Parents pay into the account until the child reaches adulthood, then the person covered continues until the account is fully funded.
6. Account holders can use their health savings account on any recognized treatment required, but reimbursement is limited to the rate set by the government. For example, if the limit is $5000 for a particular treatment, and the patient spends $10,000, the remainder is paid by the patient directly. This prevents draining the account, either by unscrupulous doctors or by fraud.
7. Shortfalls for necessary treatment are covered by the government, but treated as a loan with interest.
8. Money left in the account is passed on to heirs, while shortfalls are taken out of the estate in probate. Any remaining shortfall is covered by the government and paid through taxes.
9. Actions that increase medical risks (obesity, smoking, excessive drinking) are handled by increased payment into the health savings account. Actions that decrease risks, such as maintaining healthy weight and regular checkups result in lower amounts withheld for the account. Actions that benefit the community -- organ donor cards, blood donation, willing their body to medical science, etc -- get a bonus put into their account.

Of course, this won't happen as long people prefer to pass healthcare costs to the next generation in budget deficits, rather than paying for their own care.

Re:Cheapest plan for everyone

[evanbd]

You know that crystal ball you have there that lets you predict the cost of common treatments for common problems 30 years in the future can probably tell you all sorts of neat things. You should try playing with it more, I bet there are all kinds of other social problems it can reduce to a paragraph of arrogantly vague policy directives.

Slight Risk

[Anonymous Coward]

Be careful what you ask, you might not like the answer the test provides you. The test is just a test, it is wise to get a genetic counseler to help you interpret the results.

One of many currently uncurable examples: http://en.wikipedia.org/wiki/Huntington's_disease

My two cents

[cyberzephyr]

I've been reading the fiction book "Next" by the late Michael Crichton (RIP). His spin was that greedy doctors and mortuary employees are taking over the human genome by trickery and theft to own and then resell you your own body back to you.

Now, i don't wear a tin foil hat but this discussion sounds like this crazy book i got for Xmas.

Insurance IMHO is like gambling, you and them bet you might or might not get sick and one you pays for the mistake. National healthcare is a good thing for a lot of people right now considering our situation.

Re:My two cents

[ekhben]

Insurance is not like gambling, I'm afraid. Gambling is contained: when you gamble, you wager something (typically money) for a large increase against a greater than even odds risk of a total loss. If you don't wager, you don't lose anything.

Insurance, on the other hand, is where you already stand to lose something. In the case of medical insurance, you already stand to lose your income, your house, and your life. The real gamble is if you fail to mitigate that risk in any meaningful way.

I thought it didn't work like that

[obarel]

Let's say insurance companies only chose the healthy ones, or rather made it cheaper for healthy (genetically speaking) people to get insurance and a lot more expensive for genetically "ill" people.

The immediate result is that 80% of the genetically ill people can't afford the insurance, and 80% of the genetically healthy people decide not to buy insurance (after all, they've done the test and they know they're in a low-risk group).

Net result: insurance company loses.

I thought this was the way it worked in general, which is why insurance companies would only go so far in separating people into groups and charging according to cost to the insurer.

I was "almost" a subject of this experiment

[tlord]

I used to work as a contractor for the George Church lab. My supervisor was a student of Church's. Church was his boss. I was working on bio-informatics (if anyone cares, I can tell you some tricks for regexp-searching of genetic sequences).

My family was under extreme financial duress. In light of that knowledge, my supervisor (tells me, at least) that he took my situation to George and they came up with this: "Sign up to be one of the first 10 PGP subjects. Give us all of your medical records from the past and into the future. Agree to have your sequence published. We think we can get Harvard to agree to pay for your medical insurance for life. Don't you think your family deserves for you to make that trade-off?"

I said, flatly, "no." I pointed out, among other problems, some severe technical problems in the line of sequencing research we working on. Ultimately, we (me and the lab) part ways on less than amicable terms after this.

I think these people are scum.

They were eager to exploit my poverty as leverage to make me a human subject to rather dangerous experimentation based on highly dubious scientific claims - and they punished me for dissenting from this plan, as nearly as I can tell.

-t

Re:I was "almost" a subject of this experiment

[evanbd]

How would it be dangerous? This is me being curious, not disagreeing, btw. Obviously it's an invasion of privacy, and I'd like to think I'd have said the same thing had I been in your position. But I haven't heard anything about the PGP that suggests they're doing much beyond collecting DNA and records, which doesn't sound dangerous to me. Is there more going on I don't know about?

Re:I was "almost" a subject of this experiment

[Creepy Crawler]

1. He said "We think we can get Harvard to agree to pay"
2. These invasive (to his records) studies would lead to his offspring not being covered.
3. It wasnt enough compensation.

Re:I was "almost" a subject of this experiment

[tlord]

If you want to put it in cold economic terms, the economic benefit of "insurance for life" (especially in the context of a nation that looks poised to implement national health care well before such a contract would expire) is greatly outweighed by the many exploitative possibilities of having your medical history and your genome exposed. The risk of those things extends to your progeny and your relatives, as well. For example, participation in the PGP experiment - especially as one of the first 10 - makes you a political symbol; an object. People can prove things to third parties by "doing things" to you (or your genetic material-sharing relatives). It's like painting a target on your back.

I also had deeper misgivings because of the scientific sloppiness I witnessed in my work at the Church lab. The only thing in genomics work that is worse than a rush towards the new eugenics is a rush towards the new scientifically false eugenics - which was the rush my supervisor's work was aimed towards when we parted ways. These guys are bad news. On a personal level, I did not find either my supervisor or boss to be people I could sustain even a presumption of respect for. They are, in my experience, sloppy in important ways (me, I try to be sloppy in the unimportant ways) - bad science, bad ethics, money-hungry, self-serving twits.

-t

Re:I was "almost" a subject of this experiment

[tlord]

Thank you, "Creepy Crawler", that's right. There's more to it, as well, but that's a big part of it.

-t

Re:I was "almost" a subject of this experiment

[evanbd]

That doesn't strike me as what I'd normally consider "dangerous" in a medical context. "Dangerous" to me has connotations of risky procedures. Regardless, it sounds bad enough, and I think you did the right thing in declining. Thanks for clarifying.

Re:I was "almost" a subject of this experiment

[Creepy Crawler]

I have written, semi-privately, on specifically: Medical testing, patent law, and human ownership of genes. It was about 75 pages, 150+ sources, 8 revision (hopefully with no errors).

It was for a senior uni case study concerning a few major happenings about 1.5 years ago. I was urged to publish, but after I stepped back and realized what exactly I had written, I thought otherwise. I petitioned that the school keep it internal and not release potentially disastrous critiques of many companies, organizations, and governmental law.

Why dont you take a look at Bayer Cropscience Rice disaster...Oh wait. That wasnt in the news here in the USA.

Re:I was "almost" a subject of this experiment

[Klootzak]

It was for a senior uni case study concerning a few major happenings about 1.5 years ago. I was urged to publish, but after I stepped back and realized what exactly I had written, I thought otherwise. I petitioned that the school keep it internal and not release potentially disastrous critiques of many companies, organizations, and governmental law.

Sounds like FUD mixed with BS to me... What University? Give me an example of one of these disastrous critiques?

You wouldn't happen to be this bullshit artist would you?

Re:I was "almost" a subject of this experiment

[Creepy Crawler]

No, Im not a bullshit artist. And Im certainly not that one listed there.

Case: BRCA1 gene.

Lady has herself undergo genetic testing due to breast cancer with help of University of Utah. With her and doctor, they find the gene expressed that when triggered, causes breast cancer. Because of her genetic background (Ashkenazi Jew) they were able to isolate it.

The rub: if somebody goes and has a test for BRCA1, they are required to answer if they are Ashkenazi. If they are, Myriad demands an extra license fee. That, and the lady who helped by being a specimen has no rights to the "discovery".

My paper revolved around patent law concerning testing, discovery, and creation of special creatures. Just looking at the Golden Rice fiasco shows what exactly is wrong with these type of patents.

Re:I was "almost" a subject of this experiment

[Klootzak]

Very well, my apologies for the hostility.

I had thought that the BRCA1 Gene Patent was amended allowing other people's methods for applying the test to be used without licensing fees to be paid for Myriad?

A quick Google for the topic brings up a few articles dated some time ago.

Do you know what the current state of play regarding this is now?

I'm curious as I'm currently studying "Regulatory, Ethical and Legal issues in Biotechnology" in anticipation of filing a Patent for one of my own implementations of a "Special creature".

To clarify, I don't believe I should be allowed to patent a naturally-occuring sequence I discovered, however if I come up with a unique way to implement a new function in an organism I think I'm entitled to own the method via which it is done.

Re:I was "almost" a subject of this experiment

[Creepy Crawler]

From what I gather, the patent is in full effect in the USA, as it is in the EU. However, there is a meeting later this month to determine the quality of their version of the patent.

However, Im not quite sure if Myriad is playing the "Humble Testing Agency" by allowing, for now, royalty free testing until this clears up.

Still, these types of patents outline a rather nasty problem:

genetic disease is found
- patent applied for specific gene
- patent applied for testing of said gene
After time passes...
- patent applied for general expression of gene
- patent applied for creature that expresses said gene
- copyright applied to genetic map of said gene (patent disclosure was obfuscated and unusable in genetics)
And more time...
- patent on drug that cures and/or alleviates symptoms of said "defect"
- copyright on full genetic map containing said gene

Our patent system was supposed to be full disclosure so that others could replicate the founders work, but now we end up with layers upon layers of patents and copyrights, so that anybody wishing to even view the research is embroiled with royalties and payments.. And much of this research is maintained by government monies (and we have only Reagan to thank, and his education profitization bill).

The gene for "/.".

[Anonymous Coward]

"Pinker believes that personal genomics is just too much fun to ban, but for now suggests: 'if you want to know whether you are at risk for high cholesterol, have your cholesterol measured; if you want to know whether you are good at math, take a math test.'"

Ok I'm taking the slashdot test.

Like all new Technologies...

[Klootzak]

Genetic testing offers a great number of benefits, and some pretty (dire) consequences too, if it's not used Ethically.

Fortunately most Genetic testing is medically vetted/requested. The old Doctors Hippocratic Oath, theoretically means it would only be used when Medically sensible.

Part of the biggest problem faced with this type of technology/research is the "I don't want to know" factor combined with paranoia about Eugenic ideology. I've read articles by stupid misinformed Journalists describing Geneticists as "The Devil's Messengers" - of course based off that I tend to think "Well, then Physicists must be the Devil himself!".

My opinion, is that the research should continue, however under regulation (as happens currently), and that private interest (corporations) be prevented from developing tests and or technology that could be used to discriminate and differentiate amongst individuals in one of the worst ways imaginable... the worst thing we can do is run off half-cocked and start preaching the benefits of technologies not yet ready.

Disclaimer: Just my (somewhat-unhumble) opinion. I am NOT a Molecular Biologist, but I do have some understanding in this area.

I'm not afraid of health insurance and genetics

[Hojima]

I'll just show up with my steel-clad genes and live an extremely unhealthy life style, then use my health insurance funds to undo the damage. Take THAT "the system"!

Re:This will actually reverse the cost of health c

[Anonymous Coward]

>I have health insurance for BIG stuff, hence me HUGE deductible (5 figures).

Bullshit.

Im only 33 and need insurance. My sleep apnea machine costs a few thousand dollars. No "emergency" insurance covers that, yet SA is as serious as anything else. Toss in the sleep studies and my insurance probably paid out 6 or 8 grand. I would have lost all my savings and more if I had "emergency" insurance only.

I used to be poorer and had no insurance and pretty much begged doctors for the "cash rate." All my medicines were samples. I barely scraped by and I got lucky. I was young and healthy. No major accidents. Now in my 30s I cannot do that. No way.

You sure as hell are not having a baby safely by paying cash. No emergency insurance is going to cover pre-natal, delivery, post-natal, etc.

>Wash your hands after touching sick people. Cut back on excessive drinking and smoking. Wear a condom. Don't eat too many sugars or starches. Do some exercise. It's not so hard.

Yeah, youre a moron. I do all these things. Kids born with diabetes arent going to exercise it away. Youre not going to fix a broken leg with happy thoughts. Not eating a twinkie doesnt cure a MRSA infection. Not drinking beer doesnt fix a rotted tooth.

>Then you can SAVE YOUR MONEY when you're young to prepare for the care you'll need when you're old.

My dad's CPOD and Alzheimer's treatments are in the 5 digits. In 10 years its going to be well over 500,000. Thats a lot to save on top of retirement.

How old are you? Some college student who has yet to grow up and see how your body falls apart when youre older? Its all downhere from here. If all of Europe can do national healthcare then so can we. Dont let being "college liberatarian" make you more ignorant than you already are of health matters.

Re:This will actually reverse the cost of health c

[dada21]

Here's the catch: your treatment cost you thousands, because other people who have insurance through State sponsored means, or State enforced means, or other catches, caused the rates to go WAY UP. Congress limits medical degrees in America. Your government makes health care expensive.

And then you pass it on to people who aren't predisposed to expensive health problems. It's sad that you have a condition. I have two medical conditions that I work on without insurance, even though other people spend 4-5 figures a year on them (total between the two). I spend about $500 a year. It's doable. Doctors don't want to charge as much as they do, but they do because of the regulation of industry, because of the limitation on how many doctors can practice (thank you, AMA the lobbyist), and because insurance doesn't work due to overregulation.

Your medical condition costs you thousands a year. If your household, between you and your significant other, earns $70,000 a year, you're paying about 10% of your income to paying for your own health care needs. Those costs are HIGHER because people with insurance push them higher. That's how it is. Before the HMO Act of 1973, people afforded health care WITHOUT insurance much of the time. Look at the statistics.

Rotting teeth can be solved by not shoving fructose into children's mouths and teaching them proper hygiene. Or, just toss it at the insurance company and SOMEONE ELSE WILL PAY for your laziness.

Kids born with diabetes are about 5% of the number of kids with diabetes who get it from overeating crap and overdrinking fructose. Look at the facts. Again, the cost of treatment rises because of insurance, not because it doesn't exist. Insurance again is a scam.

I'm 35. I've lived with a few health conditions all my life, from massive TMJ issues to kidney stones to a variety of other illnesses that I have worked through. I am self employed. I have significant savings in my HSA, more than 15% of my income a year goes there to prepare for the future.

If I have to pay for the public care of others, I want detailed documentation on what they're spending their money on. If they're frittering away their savings or not busting their back working an extra job, why should I cover them? It's ridiculous.

Re:This will actually reverse the cost of health c

[Anonymous Coward]

Dude, you're full of shit. $35/visit, eh? Ya. So assuming the doctor's day is full of patients (no gaps) and each "visit" is 30 minutes the doctor makes $70/hr. Now you add in business taxes and he makes ~$50/hr, maybe less. Then you factor in office space and ... oh fuck he's losing money and we haven't even factored in equipment, supplies, other staff (let's face it if his day is full of patients he's going to need at least one receptionist), etc, etc, etc.

Now as to saving for your own medical care. That's nice and all but unrealistic. For one everyone has high medical costs when they are old. But only say a quarter of the population is going to have a real need for major medical treatment before they are old. And guess what... Those who are unfortunate to need such medical treatment are likely to be needing well over $100,000 in services. The average *FAMILY'S* income in the US is what $45,000/yr. I'll let you do the math on that one.

He's right

[Anonymous Coward]

"if you want to know whether you are at risk for high cholesterol, have your cholesterol measured; if you want to know whether you are good at math, take a math test"

And if you want to know if you carry the Alzheimer gene, get a genetic test.

Bad genetics can happen to anyone.

[Anonymous Coward]

Why don't people get it? "Risk" should have absolutely no bearing on the cost for an individual's health plan/insurance. Why should someone who's unlikely to get Alzheimer's pay less than someone who's almost guaranteed to get it?

IT'S THE LUCK OF THE DRAW AT BIRTH! Why should person A pay less than person B because person A rolled a 1d6 and got a 3 instead of the 6 that person B got?

Every single human being should be covered for any genetic problem, without having to fork out more money than those with "healthy genes". Anybody who thinks that their good genes should reduce their medical costs deserves to die of 20 different types of slow, painful cancers.

MOD PARENT DOWN!!!

[Klootzak]

There is no genetic rights. Businesses can exclude you from working for them due to it. Health insurance can disclaim all the "bad gene" illnesses, that is if they accept you at all. The government can pidgeonhole you in some god-awful plan in which you cannot escape.

Why don't you lie a bit more and spread some more FUD?

There is ALREADY LEGISLATION AGAINST THIS!!!

Re:MOD PARENT DOWN!!!

[Koiu Lpoi]

WHY DON'T YOU TRY TO TELL HIM LOUDER!? I don't think there's ENOUGH CAPS for him to HEAR YOU!

Not the probelm

[rastilin]

That isn't the problem. The point is that they agree to accept a monthly payment in exchange for anteing up with MORE money if needed. Statistically they come out on top anyway, unless a plague happens. The problem is when they decide to break their agreement and not keep up their end.

Re:This will actually reverse the cost of health c

[dada21]

Dude, you're full of shit. $35/visit, eh? Ya. So assuming the doctor's day is full of patients (no gaps) and each "visit" is 30 minutes the doctor makes $70/hr. Now you add in business taxes and he makes ~$50/hr, maybe less. Then you factor in office space and ... oh fuck he's losing money and we haven't even factored in equipment, supplies, other staff (let's face it if his day is full of patients he's going to need at least one receptionist), etc, etc, etc.

Google: Cash Only Doctors. It's a fact. Most doctor visits do not last long. A decent doctor can see 8 patients in an hour for the basic checkup, cold, or other minor ache or pain. I also pay an annual fee that covers joining the clinic.

Some cash-only doctors actually get tips, too. No joke. I know of 2 AAPS doctors that earn more than their annual billing. Most doctors who accept insurance earn far LESS than their annual billing because of the insurance haggling, red tape, and administrative costs.

Now as to saving for your own medical care. That's nice and all but unrealistic. For one everyone has high medical costs when they are old. But only say a quarter of the population is going to have a real need for major medical treatment before they are old. And guess what... Those who are unfortunate to need such medical treatment are likely to be needing well over $100,000 in services. The average *FAMILY'S* income in the US is what $45,000/yr. I'll let you do the math on that one.

Again, you can blame this on insurance and public health programs that drive the cost of medical services up, combined with Congress colluding with the AMA to keep the number of doctors graduating down. It's like education: when government started subsidizing school loans, the cost skyrocketed. Get government out of health care, and education, and the costs will DIVE.

If someone has a great need for medical treatment that is expensive, they use INSURANCE. I tried to find an insurance policy with a $100,000 deductible, but they don't exist. I pay, for EXCELLENT emergency treatment, about 20% of the cost of a typical smoker my age. Why? Because of my high deductible. I buy generics when I need any medication.

The more we create third parties, the more prices go up. It's a simple financial fact.

All insurance is a form of gambling

[symbolset]

Where you have to lose to "win".

That's when the game begins because you get to find out that you're gambling against the house and the terms of the wager are usually that if you "win" big they don't have to pay. Nowhere is this more prevalent than health insurance where if you need lifesaving treatment and they deny it, they make a side bet on whether you die before you win the lawsuit. It's a sick, sick game I wish we didn't have to play, but the alternative is to rely on stone-age medicine because the insurance companies have cornered the market on care.

Regardless, Insurance companies use every form of information available to consider their risk and hence the odds (your "premiums" vs your "coverage"). No surprise here; they're not charities. This would obviously include any information about your genetic risks they can get their hands on. I'm confident they're partnered with every genetic lab in the country for "privileged" information sharing, for public health reasons of course. I would be shocked if they didn't require genetic profiling as a minimum standard of care sometime in the next decade.

Get anybody in your family on the wrong list and let your coverage lapse even for a day - and you'll find your entire family in the medical stone age for the rest of your lives. No antibiotics. No X-Rays. No dentistry. Not for you. Not yours.

Liberal, conservative..

[symbolset]

Liberal, conservative, nationalist, federalist, socialist, communist, Democrat, Republican... For the last decade I've come to wonder if these words ever had any meaning at all. Certainly they don't mean the same things I learned about in social studies when Carter was president.

Did I not get the memo? Was there some global polar reversal I missed somewhere? Ok, I'm off topic so mod me down but somebody go AC and answer please.

Re:This will actually reverse the cost of health c

[symbolset]

He doesn't even take insurance, Medicare, or credit cards. He's also available for house calls.

Lucky you. He's a rare bird indeed. Treat him well. There are not enough of him for the rest of us.

And who says governments do not profit?

[tjstork]

It's the profit part of the equation that borks everything: when your money depends on not paying out benefits

Everyone seems to think that having something in the government removes the profit motive and really, nothing could be further from the truth. It's only a recent thing that government did not control the exclusive right to all commerce in the western world. Of course government wants to make a profit on something and then misuse them. In fact, on nearly every income stream, from social security set-asides to tobacco trust payments, turnpikes and port authorities, recent government enterprises has been nothing but a profit center with which to blow more money on other things.

Re:And who says governments do not profit?

[QuoteMstr]

You're confused. You seem to think taxes are "blown" on nothing and the money is shredded and scattered into thin air. It's not.

Government takes and spends money, and yes, tjstork, the government can sometimes allocate that money better than the private sector would have. For starters, it doesn't have a three-quarter bottom line in mind.

Government spending is a good thing.

Re:And who says governments do not profit?

[drinkypoo]

Government spending is a good thing.

You'd have an easier time convincing me of that if we weren't in a hole of debt we can never climb out of without "winning" another world war due to government spending on an illegal war.

Re:And who says governments do not profit?

[Bombula]

You may be misunderstanding the meaning of profit. In a strict sense (and this is going to be confusing if you're not an economist), it is the proportion of an economic surplus that is disbursed as rent to those with property rights.

Government can't really 'profit' in this strict sense because individuals cannot claim property rights over government capital, and therefore cannot be enriched by the economic surplus (the 'rent') those assets generate - at least in modern democracies. This does not mean there is no corruption. Sure, in the US and elsewhere plenty of government funds get allocated to purposes that are designed to enrich a handful of particular stakeholders, but it is incorrect to conflate the inefficiencies associated with particular instances of corruption and the overall model of redistributive governance. It's the same in big corporations - they lose a bit of money from employee corruption and stealing too, but that doesn't render the corporation's business model useless.

Re:And who says governments do not profit?

[Anonymous Coward]

"the government can sometimes allocate that money better than the private sector would have."

If we are not talking about the rare case of technical or natural monopolies you are absolutely wrong.

Not so

[symbolset]

You forget about the part about where people with no coverage get no care at all. Even people with average risks need to get a bone set, an infectious ailment treated with antibiotics now and then. If they have no coverage, what are they to do? Go to Mexico? Have you tried to board a plane with an untreated compound fracture lately? That's a no-fly listing for sure.

This is why the game is crooked. They can choose not to cover you and with no coverage you have no hope for care. That makes genetic testing for unknown but potentially expensive conditions bad for averageman.

Re:Not so

[obarel]

The point was about genetic testing - the "horror scenario" is that insurance companies would test you and find out if you have specific genetic properties that would make you an expensive case, and then refuse to insure you.

Insurance companies can't perform a DNA test that would tell them if you'll be involved in a car accident, so there is always risk (and reward) even for good drivers.

However, the scenario of 100% knowledge is absurd - if insurance companies could tell that you are going to have disease X then it's game over for them. If you have that genetic deficiency, they won't insure you (and see $0 from you) and if you don't have it, you won't insure yourself (and they'll see $0 from you). Now why would they want to do that?

Of course, I don't think we'll get to 100% knowledge, there will always be some risk and reward for the insurance comany. But my point is that if insurance companies only insure the people that will not need this insurance, they will see their profits going down.

Would you buy life insurance that's only valid for 6 months? Probably not. If you did, they wouldn't want to sell it, because it meant you knew something they didn't. In theory, that's the best situation for insurance companies - they'll insure only those who don't need this insurance. In practice, nobody would buy it because people aren't totally stupid.

General medical insurance is different, because "you never know what's going to happen". But with genetic testing pinpointing specific diseases and refusing insurance, we're back to insuring only those who don't need the insurance, a situation that doesn't happen in real life.

Re:Not so

[symbolset]

if you don't have it, you won't insure yourself (and they'll see $0 from you).

This would be true only if you were buying specific insurance against a specific genetic ailment. But that's not how it works. If they find you have a specific ailment, then can choose not to offer you coverage. But even if you don't have it, you still need coverage against everything else so you still have to pay.

Re:Not so

[obarel]

I'm not sure it's that extreme, again coming from the point of view that insurance companies want to make money and people aren't stupid.

If I live in a valley that gets flooded every year, it would be very hard for me to find an insurance company to insure me against flooding. But I'm sure I'd be able to find someone to insure me against fire. Just because I have a genetic disease doesn't mean insurance companies can't extract money from me, insuring against other illnesses and excludinig the specific disease.

But even this is quite extreme. If the valley only gets flooded once a decade, I might still find someone to insure me against fire, floods and hail - I might have to pay a higher premium, but as a package the insurance company might still get more out of me than I get out of them (and who knows, just because the valley gets flooded doesn't mean my house has to be rebuilt every time from scratch).

It would be very silly for an insurance company to genetically test babies and decide they cannot get any medical insurance just because they have a genetic disease that affects 60+ year old people. Silly in the sense that they can get money out of this baby, and s/he could still die from a heart attack at 49.

Of course, some people might find themselves completely uninsurable (this also happens today). I'm not saying I'd be happy with insurance companies knowing every last detail about everybody (I wouldn't be happy with anyone knowing every last detail about me, including the government and probably my parents as well...), I'm just saying that the view is a bit extreme - if there's money to be made with a certain risk, some people will take the risk and make the money.

Risk assessment is not a solution to medical costs

[symbolset]

This is a supply side problem. We have gatekeepers for doctors. We have gatekeepers for medicines. We have gatekeepers for coverage and the coverage is a gatekeeper for care. The gatekeepers are financially motivated. If you fail any gate, you get no care at all. The gates don't just pass/fail, they also rate limit for the the purpose of maintaining the scarcity of medicine and care, and hence drive up the price. The entire system is designed to hide the cost from the end user, so the upward spiral of cost is guaranteed.

Gene testing for actuarially costly predispositions is just a shortcut to "no care".

To have a more humane system we need to remove these gates. We need to have a federal system for doctor approval, and it needs a fast track and a cross training program to channel in displaced workers. We need to get the FDA out of the pocket of big Pharma. We need to neuter the tort system. We need to do not just one, but all of these things, not gradually but all at once. We also need some sort of agreement on what level of medical intervention is socially useful, and what should be diverted to hospice care.

And... it ain't gonna happen. So let's meet back here in a decade and whine about it some more.

Re:This will actually reverse the cost of health c

[Anonymous Coward]

State sponsored means, or State enforced means

It's not just "the state", insurance companies themselves are fucking with the prices. Remember, they want high prices because A) high prices scare people into thinking they need insurance and B) they dictate what they're going to pay anyway, so high prices don't affect them.

To see this in action, consider a fictitious country: some common and uncomfortable disease exists here that costs $1 to treat. A company comes along and says "For $0.90, we'll pay your treatment cost for you!" Half of the people in the country buy the insurance. The insurance company goes to the doctors and says "I have half the people in this country on my insurance plan. You'll treat them for $0.50, or I'll tell them to go to some other doctor and you get nothing." One or two like dada's doctor will say "hell no" and lose half their patients, but most will think "if half of the patients are on the insurance, I can simply charge the patients who aren't 50 cents more to make up the difference.

A year passes, and it's time for everyone to sign a new contract. The insurance company raises its rates to $1.25 and runs ads about the "recent increase in the cost of medicine". Even more people sign up. The insurance company goes to the doctors and tells them that they have 2/3rds of the patients in the country on the insurance plan, and now they're going to pay the doctor $0.30 to treat them. Some doctors drop out, the rest do the math and figure out that to make up for the money they're losing, they'll have to charge the one-in-three uninsured patient $2.40 to make up the difference.

This pattern repeats until setting a simple arm fracture costs the uninsured patient thousands of dollars for what used to be a couple hundred bucks of time and plaster. Eventually most patients are insured and fewer and fewer doctors drop out of the insurance game because they would have to fight over smaller and smaller pools of patients. The price of insurance never appears to be more than the cost of treatment, but only because the apparent cost of treatment is artificially inflated by the insurance company contracts.

Re:This will actually reverse the cost of health c

[deraj123]

How do I find a doctor like this? Are there labs with similar practices? What about things like Xrays, etc? I would love to use health insurance as actual insurance and not as a health plan - but to be honest, I don't know how to do that given the high prices of medical treatment (I agree that these are the result of the universal nature of HMOs and the AMA, but they're still a reality...). So...educate me - how do I do this?

If I could release it under GPL...

[Anonymous Coward]

If someone offered to sponsor documenting my DNA and releasing the data under terms of the GPL, heck - I wouldn't mind doing it. Of course that means anyone using my sequences and what bit of biological my biological data is known to cross references to it would also be subject to releasing their findings under the terms of the licence...

I wonder what kind of impact copyleft could have on such a technology if implemented.

Your plan is pure evil

[QuoteMstr]

I truly cannot express how vile, dangerous, pernicious, and inhumane this idea is. Either you didn't think this idea through clearly, or you want to create as much misery as possible.

1. Prenatal genetic testing.

2. Genetic counseling for prospective parents.

I'm with you so far.

3. Actuarial estimate of lifetime healthcare costs at birth.

Here is where your plan starts to smell fishy. How are you supposed to predict lifetime healthcare costs for an individual? We can do it very well statistically, but any given member of a population can differ wildly from the mean. If you try to force an estimate anyway, most of these estimates well be wrong.

We can predict the average error based on the statistical distribution, but the error in any one sample is unknown, and that's a huge problem when we consider the rest of your vile plan:

4. Mandatory front-loaded health savings accounts, funded by income withholding, until the amount saved in the account is equal to the amount necessary until end-of-life medical care, based on actuarial estimates.

5. Parents pay into the account until the child reaches adulthood, then the person covered continues until the account is fully funded.

First of all, "cost" is a fuzzy target. The value of currency is subject to wild flings, and unless you index this cost continuously to inflation, the value of this account becomes progressively more divorced from reality, even more than it was in the first place. If you do index the outstanding balance to inflation, you'll end up causing vast economic damage. The total amount of money going through this system would be huge. To index that to inflation would in turn drive inflation change itself, greatly magnifying the normal fluctuations in the value of money. That economic instability would decrease the efficiency of the system as whole. We already see this problem to some extent in social security payments.

This item has major, negative effects on society too: first, it creates a large disincentive to have children. Government ought to create an incentive to have children, since not only does childrearing perform the obvious function of propagating the next generation, but it promotes healthy, stable societies. Among families that did have children, it'd push many of them into poverty. Do we really need children raised that way? And before you say that parents just won't have children: fact is, they do anyway. And the "do it anyway" crowd belongs to the group that needs the most financial assistance anyway.

Again, your plan magnifies negative phenomena we already see in society.

Another major negative effect of your rotten plan is to grossly skew the income distribution of young people. Not only do you tax what must be a significant portion of their income, but that taxation is regressive: everyone pays the same nominal amount, since (predicted) health does not depend on income. Therefore, the poorer you are, the larger the percentage of your income is paid in health fees. You drive middle class people into the working poor, and you drive the working poor into poverty, and you drive those in poverty to die on the streets. The rich are unaffected.

It's no defense to say that the regressive taxation disappears after some period of adulthood. Social mobility decreases sharply with age, and by the time the taxation disappears, class lines made far sharper by your proposal will already have been drawn.

If you want an analogy, look at student loans. Their often crippling costs act as a drag on the economy is precisely the same way, except that student loans might be progressive: the rich go to more expensive schools, after all.

6. Account holders can use their health savings account on any recognized treatment required, but reimbursement is limited to

Re:Your plan is pure evil

[Anonymous Coward]

I truly cannot express how vile, dangerous, pernicious, and inhumane this idea is. Either you didn't think this idea through clearly, or you want to create as much misery as possible.

It does have the benefit, however, of controlling costs and remaining solvent, and relying on statistics rather than anecdotes.

3. Actuarial estimate of lifetime healthcare costs at birth.

Here is where your plan starts to smell fishy. How are you supposed to predict lifetime healthcare costs for an individual? We can do it very well statistically, but any given member of a population can differ wildly from the mean. If you try to force an estimate anyway, most of these estimates well be wrong.

And? Insurance companies make estimates all the time -- it's what actuaries do. Front-loaded means people are saving from the start. If conditions change or new factors come up, they can be adjusted while the person is still a wage-earner. Of course, if you prefer, you can extend the period of saving until retirement, and have a lower rate.

We can predict the average error based on the statistical distribution, but the error in any one sample is unknown, and that's a huge problem when we consider the rest of your vile plan:

Vile, dangerous, pernicious -- your thesaurus is really getting a workout. :D

4. Mandatory front-loaded health savings accounts, funded by income withholding, until the amount saved in the account is equal to the amount necessary until end-of-life medical care, based on actuarial estimates.

5. Parents pay into the account until the child reaches adulthood, then the person covered continues until the account is fully funded.

First of all, "cost" is a fuzzy target. The value of currency is subject to wild flings, and unless you index this cost continuously to inflation, the value of this account becomes progressively more divorced from reality, even more than it was in the first place. If you do index the outstanding balance to inflation, you'll end up causing vast economic damage. The total amount of money going through this system would be huge. To index that to inflation would in turn drive inflation change itself, greatly magnifying the normal fluctuations in the value of money. That economic instability would decrease the efficiency of the system as whole. We already see this problem to some extent in social security payments.

How would the amount of money involved be any different with health savings accounts as opposed to universal insurance or single payer? I mean, other than people tend to spend their own money more carefully, and there are fewer free riders with a health savings account.

This item has major, negative effects on society too: first, it creates a large disincentive to have children. Government ought to create an incentive to have children, since not only does childrearing perform the obvious function of propagating the next generation, but it promotes healthy, stable societies. Among families that did have children, it'd push many of them into poverty. Do we really need children raised that way? And before you say that parents just won't have children: fact is, they do anyway. And the "do it anyway" crowd belongs to the group that needs the most financial assistance anyway.

Which is it? A large disincentive to have children, or they'll have them anyway?

And besides, your assumption is wrong. It would remove some of the current subsidies, but that is not the same as a disincentive, any more than reducing the rate of tax increases is a tax cut. And the "do it now" is the group that requires the greatest disincentive to have children, so this would be great if it actually did so.

I will meet you halfway, though -- the government could figure out the net societal benefit of people having children, and give parents that amount to pay for health, education, food, clothing, and the like.

Again, your plan magnifies negative phenomena we already see i

Re:This will actually reverse the cost of health c

[QuoteMstr]

The insurance company raises its rates to $1.25 and runs ads about the "recent increase in the cost of medicine". Even more people sign up. The insurance company goes to the doctors and tells them that they have 2/3rds of the patients in the country on the insurance plan, and now they're going to pay the doctor $0.30 to treat them.

This mechanism is insufficient barring a monopoly in health insurance. Can't I, a separate insurer, simply offer to charge people only $0.90, and pay doctors $0.35? At some point, equilibrium is reached.

Through competition, the kind of spread you're talking about should be reduced to zero. Either there's rampant collusion (which I'm not dismissing), actual costs are increasing, or there's some other mechanism at work.

not true

[Anonymous Coward]

A socialist party would try to drudge up money adn advantage for the whole society or at least a big pan of it. The republican party is only socialist when it comes to big money/enterprise/banks. AKA : an incredible minority of rich people. It is more like a ploutocratic socialist where you try to make life easier to your rich friends.

Two parties, ONE goal

[Zerelli]

First, let me be up front and say that I think t sucks that we have become a two party government. This has eliminated competition in the place where it is most needed. I doubt our government will ever bring itself up on antitrust charges so I guess we have to make do. I found it amusing to read that the Republicans are socialist because most of the Republicans I know swear that Democrats are socialists. Socialist has become a dirty word that the two parties use to try and stir up hate to hide the fact that both just look for ways to make money off of the people. I do not understand why socialism is viewed so negatively, the worst thing about it in the USA is tha tnothing good is ever socialized.

What about GINA 2008?

[mr_overalls]

I think you are mistaken; legislation was passed last year. The Genetic Information Nondiscrimination Act of 2008 prohibits group health plans and health insurers from denying coverage to a healthy individual or charging that person higher premiums based solely on a genetic predisposition to developing a disease in the future.

Re:This will actually reverse the cost of health c

[Reziac]

Same principle as everywhere else -- middlemen may be a convenience in some cases, but generally they serve mainly to increase costs -- after all, they want a cut of the profits too!!

Re:Informational != Medical

[whackco]

There are really two types of genetic testing: Informational and Medical. Medical testing is based on large groups of people and controlled study, whereas Informational is just throwing around 'what we think is going on' and is fun to see. I found this site useful to learn more about these differences, and they can even differentiate which tests are right with price comparison: www.AccessDNA.com

I sent the email and...

[Anonymous Coward]

she says it's not true.

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