Genetic discrimination

Congress just passed a law banning genetic discrimination by health insurers. This shows the flaws of privatized health insurance and the logic of single-payer socialized health care.

Here's a NYTimes article on the law:
The legislation, which President Bush has indicated he will sign, speaks both to the mounting hope that genetic research may greatly improve health care and the fear of a dystopia in which people’s own DNA could be turned against them.

On the House floor on Thursday, Democrats and Republicans alike cited anecdotes and polls illustrating that people feel they should not be penalized because they happened to be born at higher risk for a given disease.

...Many who do learn that they are at higher risk for a disease opt not to ask their insurance companies to cover the costs of the genetic test, to keep the information secret.

...While the intent of the law is to prohibit discrimination by insurance companies based on genetic tests, the bill does allow the companies urge patients take them. The goal would be not to deny coverage but to help find the best, and least expensive, therapy for a patient.
Here is the text of the bill. The House passed it 414-3 (3 Republicans including Ron Paul opposed it), the Senate passed it 95-0, and Bush is expected to sign it - this bill is even less controversial than Mother's Day (which Republicans voted against!). The fact that this bill was so uncontroversial signals an unease with the basic premise of private health insurance.

Genetic screening would be a normal part of any insurance underwriting process - trying to screen out high-risk customers so the insurance company doesn't get bogged down solely with expensive patients. Right now apparently about one in eight people who apply for health care individually are denied through the underwriting process, and even more are forced to pay higher premiums (pages 8-10). Some of the reasons may be under a patient's control (smoking, etc.) while others aren't (chronic diseases, family's medical history). This is distasteful but necessary to any method of paying for health care that does not agglomerate all potential patients in a single risk pool (single-payer).

Nothing separates screening out patients with a genetic predisposition towards expensive illnesses, and patients with chronic yet dormant illnesses that may have expensive flare-ups in the future (both have current low costs but a high risk for future high costs). Congress outlawed the former because the concept of genetic screening is icky (a technical term). The later is legal.

A lot of conservatives like to blather on about how the free market will fix the way we pay for health care. Companies succeed in the free market by increasing revenue and cutting losses, which is exactly what Congress just outlawed. This is not evil behavior - if a company gave coverage to anyone who wanted it, it would go out of business and not be able to cover anybody.

Some people say that the government can pick up all the really sick people that are uninsurable. All that does is privatize the profit (from low-risk insurance policies) and socialize the risk.

Free markets are great for some things, like selling my fridge. They are not great at charity and ensuring that the least fortunate in society are taken care of. Universal single-payer health care is the way to go.

5 comments:

Joe said...

You're telling me if the Govt. gets a monopoly on health care it won't make the same determinations to keep its inflated costs down?

Socialized health care will become a drain on our treasury the likes you've never seen. Social Security will pale in comparison. To cut costs, govt. will determine what it will cover and what it won't cover, and it will go through the same "discrimination" you are faulting private companies for.

Joe said...

Furthermore, why are we passing laws that interfere with the practices of a private business?

Adrian said...

The government wouldn't have to kick people off of coverage in order to stay solvent, because they are mandated to cover everybody. Just like it doesn't kick people off Social Security because they are going to live long into retirement.

We pass laws interfering with private businesses all the time. Debt collection agencies aren't allowed to beat people up if they are behind on payments. That is interfering with private business. But I don't really want to "interfere" with this particular private business, I want to eliminate the business aspect of it. People's health decisions should be as far away from business decisions as possible.

"Socialized health care will become a drain on our treasury the likes you've never seen." Given that the US spends more on health care than other advanced countries that actually do have socialized systems, I think not.

Mike said...

"The government wouldn't have to kick people off of coverage in order to stay solvent, because they are mandated to cover everybody. Just like it doesn't kick people off Social Security because they are going to live long into retirement."

...which is why I'm fully confident I won't see a lick of the money I put into Social Security. Any program that has a cover everyone clause will continue to eat funds.

The free market may not be good at charity, but the government isn't much better. I'm not a fan of any institution that delivers charity that it collects from behind the barrel of a gun, which is exactly what single payer health care would be.

Actually, if you look at the stats, charities that run based on free market principles tend to be a helluva lot more efficient and do a lot more good than the myriad of government programs that are in place to do the same thing.

Adrian said...

"Any program that has a cover everyone clause will continue to eat funds."

True, it will be expensive, but the goal isn't to save money but instead to cover everyone. Saving money will be a side benefit if it happens. The US pays more for health care than any other country, and a lot of that is because people without insurance don't get preventative care and instead have to have expensive ER procedures. So the "cover everyone" clause might be the thing that actually saves money. The moral thing to do may be the economically sound thing to do as well.