New at Reason

With genetic testing technology improving rapidly, is a Gattaca-style insurance market just around the corner? Ronald Bailey renders his diagnosis.

Comments

Tingy Wah | February 23, 2005, 11:44am | #

Speaking of Gattaca-style situations, did anyone watch Code 46? The premise was that artificial reproductive technology had been so abused that humanity had only a few genotypes to go around. As a result the world government segregated genotypes into geographic areas to prevent inappropriate matings. Anyone caught having relations with a person of the wrong genotype was guilty of a code 46 violation and exiled. If you know the first thing about genetics then you know the premise is bunk, but I could suspend disbelief for the sake of the story. The disbelief I couldn't suspend was that it would take a massive government effort to keep people from creating disastrously malformed children. Not surprisingly the film stars ultra-statist Tim Robbins.

P.S. Still a decent film and it features Samantha Morton nekkid.

Bern | February 23, 2005, 12:45pm | #

Limiting information which can be used by insurance companies is akin to limiting political speech/information via McCain Finegold. It won't work - even though the statist senators voted 98 to Zero in favor.

The result: Insurance companies will move offshore to offer their prtoduct to those willing to test. Just like the gambling industry which has moved offshore to escape the stupid US laws.

Mike | February 23, 2005, 1:06pm | #

I understand that for most people, the bad genes and good genes will cancel each other out. But what about the outliers? The people who have a genetic disposition for cancer AND heart disease: it seems like a rational, unrestricted insurer would be loathe to cover such a person. Do we just allow them to go without coverage?

c | February 23, 2005, 2:00pm | #

Don't you think we're asking the wrong questions here? What does insurance have to do with this? The idea of insurance is to cover you for some kind of event whose likelyhood you can't calculate accurately enough to prepare for otherwise. If you get one of these tests and you find out you're certainly not going to get some disease or other, why buy insurance? If you get the test and find out you certainly will, then you had better start saving!

We can argue about the basic injustice of genetic disease (and what policies we need or don't to ameliorate it), but insurance is beside the point.

Mike | February 23, 2005, 2:30pm | #

If you get the test and find out you certainly will, then you had better start saving!

The problem is, none of the tests are likely to be that clear. Do you buy insurance if you have an 80% chance of getting the disease? 50%? 10%?

We can argue about the basic injustice of genetic disease (and what policies we need or don't to ameliorate it), but insurance is beside the point.

Actually, insurance is entirely the point, because these genetic tests amount to probabilities. Right now insurance companies use population-wide probabilities. This would allow them to use individual probabilities, which could easily disqualify individuals.

Obviously, most of the time these are going to be edge cases -- my high blood pressure gene cancels out my low diabetes gene -- but the edge cases are going to be the ones that decide the issue.

Isaac Bartram | February 23, 2005, 2:37pm | #

Don't you think we're asking the wrong questions here? What does insurance have to do with this? The idea of insurance is to cover you for some kind of event whose likelyhood you can't calculate accurately enough to prepare for otherwise.

Thank you for putting it so plainly.

I am constantly amused (and frustrated) when women complain that their insurance does not pay for birth control pills or pap smears, or men complain that insurance doesn't pay for their annual EKG. Or that they can't get "insurance" to pay for drugs to treat a condition they already have. If people want a subsidy why don't they just ask for one?

c | February 23, 2005, 2:45pm | #

You're right, mike, that right now these tests give us nothing more than probabilities. But the core issue of the article, and the real problem at hand, is that the better the tests become, the more certain the predictions will be. I'd argue that the more certain the tests get, the less this is about hedging against risk (insurance) and more about correcting the misfortune of some of use getting saddled with hundreds of thousands of dollars of medical bills.

Nicholas Weininger | February 23, 2005, 4:06pm | #

In point of fact, though, it is only true up to a point that "the better the tests become, the more certain the predictions will be". Most diseases, as Bailey is at pains to point out in the article, have a considerable non-genetic component to their causation. That will not go away no matter how good the tests get, and it will not be any less insurable either.

Poustman | February 23, 2005, 4:36pm | #

As usual, a clearly thought out position on this matter will depend on where a person stands in regards to more foundational matters.

Several posts above seem to suggest that people have a 'right' to insurance. Others suggest that insurance is not a right of all individuals.

That needs to be decided before deciding 2nd or 3rd-tier questions that depend on it.

If insurance is a right everyone has, then it needs to be changed already-- some people are being denied.

If it isn't a right then why should genetic profiling be verboten?

This law seems to me to be as foolish as a law forbidding insurers to use actuarial tables would have been long ago.

Ball of Confusion | February 23, 2005, 9:06pm | #

c,
I'd argue that the more certain the tests get, the less this is about hedging against risk (insurance) and more about correcting the misfortune of some of us getting saddled with hundreds of thousands of dollars of medical bills.

I think it is already almost entirely about that. I believe that people who study the US healthcare system will immediately concede that the word "insurance" as commonly used in healthcare is an unfortunate misnomer. I think the viewpoint at which you express incredulity is just people recognizing how the system works today and was designed to work, despite the unfortunate use of the word "insurance". And for that matter, since it's largely a contract between an employee and an employer (disregarding the very significant exceptions of Medicaid and Medicare), I think people are free to demand/negotiate/expect whatever they want out of it.