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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.'"
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.
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...
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.)
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.
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.)
Blasphemy is a human right. Blasphemophobia kills.
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.
Life is not for the lazy.
>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.
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.
Help stamp out iliturcy.