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Comments: 575 +- Your Rights Online: Bill Prohibiting Genetic Discrimination Moves Forward on Thursday April 24 2008, @04:20PM
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An anonymous reader writes "The bill to ban genetic discrimination in employment or insurance coverage is moving forward. Is this the death knell of private insurance? I think private health insurance is pretty much incompatible with genetic testing (GT) for disease predisposition, if said testing turns out to be of any use whatsoever. The great strength of GT is that it will (as technology improves) take a lot of the uncertainty out of disease prediction. But that uncertainty is what insurance is based on. If discrimination is allowed, the person with the bad genes is out of luck because no one would insure them. However, if that isn't allowed, the companies are in trouble. If I know I'm likely to get a certain condition, I'll stock up on 'insurance' for it. The only solution I can see is single-payer universal coverage along the lines of the Canadian model, where everyone pays, and no one (insurer or patient) can game the system based on advance knowledge of the outcomes. Any other ideas? This bill has been in the works for a while."
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Nature, to be commanded, must be obeyed.
-- Francis Bacon
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Genoism... (Score:5, Insightful)
But no one takes the law seriously.
Re:Genoism... (Score:5, Insightful)
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Good (Score:5, Insightful)
Health care needs to be a right, and the risk or cost spread over everyone, with no one excluded. This also means that any benefit in savings must be good for the whole. Private profit making business can not be part of this for it to really be fair to all.
We could have had really top notch health care for everyone for less than we have spent on this silly war in Iraq, and with the give away's big political donors in the name of 911, we could all have our own Doctor.
Health care just needs to come from general revenue, like the Military, and cover every one. We spend more on weapons than the rest of the world combines, and most of that is greedy contracters gouging us. Just the waste in the Pentagon budget could cover everyone.
I really think it is time to take our government back and have it serve us.
So There
Re: (Score:3, Insightful)
At some point, there is a fundamental problem. Even after you magically remove all the various waste, corruption, and frivolous lawsuits, you get to a point where we know how to spend more money keeping people alive in the face of nast diseases than we can afford to, at a national level. When that happens, you have to either start rationing healthcare in some fashion, or the country *will* go bankrupt.
That's not to say we shouldn't have national healthcare; I think it would be an improvement, and that w
Re: (Score:3, Insightful)
Unless we nationalize every supplier needed to run a healthcare system, there is the chance (and I'd argue the likelihood) of private companies gouging the government for supplies, services, etc. In fact, I'd say that this is considerably more likely to occur with a government health care system because private institutes typically make decisions on who to purchase from based on profitability and price
Re: (Score:3, Insightful)
Suppose that a new treatment was invented that allowed people to live healthy lives indefinitely, but the t
Re:Good (Score:5, Interesting)
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Re:Good (Score:4, Insightful)
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Re:Good (Score:5, Insightful)
Here in America, that's what the goal is supposed to be. Over most of the world, during most of history, the goal has been to improve the lives of the leaders at the expense of the rest of the people.
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Re:Good (Score:4, Interesting)
Parent
Re: (Score:3, Insightful)
Yeah, and let's just ignore the part of the world that also has the same goal as America, but is doing a better job of it by providing health care for all of its people.
Yes, most of the world for most of history has been a terrible place for the commoners. That is not and should not in any way be our goalpost.
Re: (Score:3, Insightful)
Nor are you being now. You're being accused of dismissing our failure to reach that goal by saying that life has been worse somewhere and somewhen else, akin to responding to a failing in our respect for human rights by claiming that at least we're better than China. Having to use such a comparison is in reality an admission of failure.
And surely those to whom we should actually be com
Odd comparisons... (Score:3, Informative)
I don't see how it is a hop/skip/jump away from afflictions of -choice- (obesity is debatable, as that can have medical and heck, genetical, factors) to afflictions in which you, at least, had no particular choice. Perhaps your parents did (did your mom booze up during her pregnancy - d'oh?), but you yourself didn't get a whole lot of say in that and shouldn't become a victim of it.
Insurances already 'discriminate'
Gattaca anyone? (Score:3, Interesting)
Because genetic planning, or whatever, exists it doesn't really matter whether genetic discrimination is allowed or not. It is simply the fact that genetically better people are more suited for things than genetically worse people. It's no more a matter of discrimination or not, but simply a matter of objectively looking at the attributes of each person.
The Insurance Industry really wants this... (Score:3)
The Insurance Industry really wants this because it will eventually destroy them, IMHO.
Let's say the insurance industry has free reign for genetic testing. First, they deny all the people that has "pre-existing" conditions. Now, the folks who are accepted know that they're free and clear and do not buy the insurance (OK, they'll buy the accidental death stuff). Therefore, the insurance industry loses all those folks as customers. Of course, I'm over simplifying but I think you get the idea.
Genetic discrimination and public health systems? (Score:3, Informative)
Sharing risk (Score:5, Insightful)
Re:Sharing risk (Score:4, Insightful)
Parent
Good for patients and insurers (Score:3, Interesting)
Without the risk of discrimination, increased genetic testing could be a boon to both consumers and insurers. The earlier we know about a condition, the less expensive and more effective it is to treat, with likely a higher quality of life. Genetic testing would allow us to better assess who to monitor to attain this early detection. Moreover, with increased knowledge of risk factor, a patient could choose lifestyle changes that are preventative. (Even cheaper for insurers and further improved quality of life for patients!)
Take skin cancer: if you know you lack a key tumor suppressor gene that makes you more sensitive to UV damage, you'll be much more likely to use sunscreen and avoid peak sunlight hours (lifestyle/preventative); you'll also know to keep closer tabs on your freckles and moles for melanoma (monitoring).
With a level, non-discriminatory playing field, both patients and insurers benefit from the knowledge, rather than just insurers who want to drop any patient they can. -- Paul
Eugenics (Score:5, Funny)
Better yet: Perform mandatory genetic testing at birth, and if they have problems, kill them. Then insurance companies won't have to worry about them.
Re:what? (Score:5, Interesting)
Trust me, this is not a good thing for the consumer if such data becomes a standard part of ones medical history and I SELL travel medical insurance.
Parent
Re:what? (Score:5, Insightful)
Yes, of course. But what does that have to do with the submitter's claim that banning genetic discrimination means the end of private insurance?
We've had private insurance for a long time without genetic discrimination, because genetic discrimination wasn't possible. This legislation bans genetic discrimination, thus keeping the status quo on this issue. How does that mean the end of private insurance?
Parent
Re: (Score:3, Insightful)
at least thats the way i see it as a medical insurance salesman.
Re:what? (Score:5, Insightful)
Your comment illustrates exactly what is wrong with the medical insurance system we have today: the idea that the purpose of insurance is to save everyone money.
With a properly functioning insurance system, you would expect to probably pay a bit more for your premiums than you would for the medical care that you actually receive. In return, you would be protected from having to foot the bill for an unlikely catastrophe.
Instead, modern medical insurance has degenerated into a sort of payment plan for routine medical expenses.
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Re:Medical 'insurance' is an extended warranty (Score:5, Insightful)
But hey, since when have stupid things like "facts" or "ethics" ever meant jack shit to conservatives?
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Re:Medical 'insurance' is an extended warranty (Score:5, Insightful)
It doesn't matter to you that medical expenses are the leading cause of bankruptcy in the United States, and for millions of Americans, getting sick or injured at the wrong time can destroy their savings and ruin them for the rest of their lives.
It doesn't matter to you that millions of people are unable to move to better jobs, even when those jobs are available, because they're dependent on their current employers for health insurance.
No, apparently all that matters to you is how well the system works for the wealthiest individuals, and to hell with everyone else.
If your private insurer won't pay for a facility that can provide those "basic services" immediately, I suppose you can shop around and find a facility that will, but you can also do that under the national health care systems that Obama and Clinton are proposing.
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Re:Medical 'insurance' is an extended warranty (Score:5, Informative)
In other words, it doesn't matter to you that millions of people are unable to afford routine preventive health care, and are forced to wait until their problems become emergencies (because the ER can't turn them away for non-payment), driving up costs for the rest of us.
There are some who cannot afford health insurance, and there does need to be a solution for them. However, do not forget that a sizable percentage of those that don't have health coverage choose to forgo that expense, figuring that they don't need it. A third of those without it live in households of $50K or more annual income. It's possible that certain situations lead to some of those genuinely unable to afford coverage, but that's still millions that could afford it and choose not to.
In addition, there are millions eligible for government-sponsored health care intended for low-income people but who simply never sign up for one reason or another, be that lack of knowledge, laziness, or even pride at not being supported by the state.
No, apparently all that matters to you is how well the system works for the wealthiest individuals, and to hell with everyone else.
My parents were far from the wealthiest individuals when I was growing up. Dad worked in SoCal aerospace which paid well -- when he was working. It was very cyclical, and he was often driving trucks for $6 an hour in the late 1980s. A few years ago, he was hurt badly enough to go on permanent disability, leaving only my mom's income as significant. Mom worked at a hospital as a ward secretary, eventually moving into working for health insurance companies. She now works for a homeowners association management company. Despite what they've been through and what she saw from the inside of the health care system -- and it often wasn't pretty -- they still don't want a nationalized health care system.
There are about 300 million people in the US. A rough average of uncovered residents is about 45 million. That means that 255 million are covered. I'm fairly certain that 85% of the country includes a lot more than just those that are wealthy.
In America people do not wait months for basic services.
Actually, they often do. Private health insurance (especially HMO) doesn't guarantee that you'll be treated any more quickly than people in Canada or the UK.
Until recently, when I flipped to a PPO for flexibility (and ironically lower paycheck cost to me), I was on HMOs for most of my life. My brother and both parents needed arthroscopic surgery, which they were able to get within a couple of months of diagnosis (my brother actually got it within a few weeks, and before my mom started working in the health insurance field). In Canada, the median wait time for such surgeries is a significant fraction of a year, even in more heavily populated provinces. Neurosurgery patients can wait for six months from seeing a GP to getting their actual surgery. Life-threatening situations are treated much more quickly, of course, but those kinds of waits go beyond a nuisance for someone whose life is being affected by a given condition. I would find it simply outrageous to have to wait such times.
I have also read and heard anecdotally -- and this may be a misunderstanding -- that Britain's NHS has denied surgery to certain aged or extremely sick patients on the basis that they may not survive despite the treatment, or that others have a higher chance of survival and so the surgical slot is assigned to someone else. If I've been paying into the system for, say, thirty years, I'm going to have some serious concerns if coverage is denied on that basis. Yes, these things happen stateside, too, but the idea that they're unique to for-profit insurance companies in the US may be flat wrong.
On top of this, the overhead for a nationalized system is not necessarily better than in a corporation. Its budget has ballooned from £65.4 bi
Parent
Re:Medical 'insurance' is an extended warranty (Score:4, Insightful)
Travel around parts of Europe for a time, for example. The subtle and not-so subtle attitude changes that come when people aren't deeply afraid of economic debilitation from injury or disease are remarkable. And these changes smack of freedom.
As to the earlier poster's argument about the risk of gov't trying to control your life: a) have you been paying attention to the US political climate? You call this new? and b) that's what the old saw about "eternal vigilance" is for, eh? In this case, it's a matter of the controlling power of corporations (insurance companies) vs. the controlling power of government. At least we have elected voices in one of those groups.
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Re:Medical 'insurance' is an extended warranty (Score:5, Interesting)
By then it was too late, the wear on my cartilege was irreversible, and the bones had begun to fuse. (constant pain? you bet!).
The criteria for an MRI was that I had to lose bowel or bladder function from nerve damage.
But they certainly got my monthly premium all that time.
Parent
Re:Medical 'insurance' is an extended warranty (Score:4, Insightful)
The point is: medical care is a fundamental necessity in any society--modern or otherwise. Denying it because of affordability (which is ultimately your "solution") isn't just ludicrous, it's positively Dickensian. Healthcare has to be, by nature, universal, or perfectly preventable deaths occur on a wider scale than most would like to admit. Sure, you're "Free", but is the guy who lives on the street "Free"? What about the the woman down the road who's barely holding down her job in the bar and earning a pittance?
Perhaps your thinking is that people who can't afford healthcare should just become victims of natural selection, in a manner of speaking, so that only the frugal survive. Or, perhaps you think the Government can skirt the issue by providing some voucher scheme or something which provides free healthcare to those who can't afford it themselves: which, thanks to the wonders of taxation, is more unfair than just a straight healthcare tax (or "National Insurance" as it's called over here).
Britain might be "talking about" denying people access to medical care under certain conditions, but that's about all it's doing. Don't believe everything you see on Fox.
And, for the record, the NHS isn't by any means perfect--in no small part thanks to the efforts of our Glorious Government to outsource critical areas to the private sector--and for that reason alone people are perfectly free to pay a premium to avoid waiting lists, get a private room or prettier nurses in a commercial clinic; the healthcare they get should be of an approximately equal standard in either case, but people who can afford luxuries are welcome to splash out on them if they wish.
(Also, while the NHS isn't perfect, I'll take it over the US "sorry, you don't have any insurance, come back on Thursday for the free clinic and pray you don't need surgery" crap any day of the week).
Parent
Re:Medical 'insurance' is an extended warranty (Score:5, Insightful)
Boo hoo. Food is a fundamental necessity. So I guess the only solution is to nationalize the means of production, distribution etc of foodstuffs?
Shelter in much of the country is a fundamental necessity and pretty damned useful everywhere else. So do we nationalize housing and ration it too?
Outside of cities with mass transit, a car is now a fundamental necessity. See where your reasoning goes?
> Sure, you're "Free", but is the guy who lives on the street "Free"?
Yup. Freedom that doesn't include the possibility of failure isn't Freedom. Freedom includes the right to do things you (and me) think are dumb/wrong/etc. or it isn't Freedom.
If some guy uses their freedom to screw their life up I see no reason for you (using the power of government) to seize the product of my labor to help the asshole out. Now, being a civilized person, I might help the guy out if he is in my neighborhood (and he is ready to BE helped) but that is MY decision.
NO karma is granted for 'helping' with other people's money. Since the victim (taxpayer) didn't give it willingly they don't get any either. And since the target usually doesn't actualy get helped when some nitwit social worker tries to manage their life it is a loss all around. If you guys would get that fundamental truth into yer heads the world would be a better place.
The problem with wanting stuff for free is TANSTAFL. Somebody pays. And any system of distributing goods and services beyond voluntary exchange quickly leads to lowering production and thus to rationing.
Our current mixed free/socialist medical system offers ample examples of this in action, comparing and contrasting it with full socialist systems and with the historical record of a fully free system should be enough to convince any person capable of rational thought as to the more desirable direction we should be attempting to seek reform toward.
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Fundamental Necessity (Score:5, Insightful)
> Food is a fundamental necessity.
Actually, humans survived for millenia without medical care. They rarely survive more than a few weeks without food.
Arguably, medical care isn't a fundamental necessity. Of huge value if you'd like to live comfortably for longer and have greater odds of surviving to maturity... but not actually a necessity for the species.
The problem is we mistake medical care for being a fundamental necessity. Then, when idiots choose to make payments on a bigger car or TV, instead of their health insurance, we wring our hands and give a damn when the consequences of "I'd rather have more money now and accept the increased likelihood of suffering or dying later." come back and bite them. Instead, "Wow? You made a really dumb choice, didn't you. Hope the TV was worth it." becomes "Oh, that's tragic. Look how the system failed to provide you with your basic necessity. We must do something!"
Medical care isn't a fundamental necessity - just damn nice to have and pretty sensible. If people would own their own dumb choices, it wouldn't be such an issue. Instead, we're in a society where we make stupid short term choices then whine about how unfair it is when the consequences hurt us, expecting others to help mitigate our stupidity.
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Re:Medical 'insurance' is an extended warranty (Score:4, Informative)
Completely nationalize it? No. But the means of food production, distribution, et cetera, are very heavily regulated, from farm policy to food stamps. (And if a food emergency hit, yes, nationalizing the food supply might be the best option.)
But the poster wasn't asking about a situation with no possibility of failure. Just softening the landing of one does fail.
But yet, if said asshole sets up camp on your front lawn, you want to use the power of government to move him. (To where?) And you want to use the power of government to seize the product of my labor to make me pay for the police force to do it.
Paying for a social safety net is the ante you owe if you want to play the game of private property. If you want to border off some land for your home and keep others off, use government force to turn land into real estate, the price you owe is providing everyone minimal shelter. If you want to border off some land to make a farm and keep the harvest to yourself, turn the bounty of the earth into agricultural commodities - again, using government force - the price is making sure nobody starves. If you want the government to issue patents on drugs, use government force to keep people from making copies in order to secure profits to big pharma, you have to make sure no one dies from lack of access to them.
Parent
Re:Medical 'insurance' is an extended warranty (Score:5, Insightful)
> afraid of society, but we recognise that humanity is a family - we take
> care of each other and recognise that we're interdependent".
In other words YOU are deciding the crazy old coot is WRONG and by virtue of your superior morality/reasoning/whatever you claim the right to make another your slave and force him to obey your will.
By MY moral code that crazy old coot has every right to give you a 2x4 response applied directly to the forehead when you try it.
The right to be wrong is THE fundamental human right. It's fair game to reason with someone you think is making a bad decision but the second you use force to impose your will on them you have lost the argument. (Cases of extreme mental illness being an obvious exception. The moral argument being that the person isn't a free moral agent and will probably be grateful once they are sane.)
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Re:what? (Score:4, Insightful)
Cancers like Leukemia or Lymphoma can strike anyone at any time. Look at the Hockey players and most recently the American Football player from the Minnesota Vikings who've come down with Leukemia.
I say this because I was young (8) and fit and I got Leukemia. Later I relapsed, and even later I've had a Cavernous Malformations of the Brain and a non-cancerous tumor of the nerve sheath.
Sometimes there is just a health bullet with your name on it.
Parent
Re: (Score:3, Funny)
OK, that's why you hang around on /.
What's my excuse?
Re:what? (Score:4, Insightful)
It only takes 1 uninsured driver not paying attention long enough to change that for you. Young and healthy is not mutually exclusive with accidental injuries.
Parent
Re:what? (Score:4, Interesting)
The other thing you don't think about is how difficult it is to compare prices at different hospitals or locations (plus who wants to constantly switch doctors, it's not like grabbing toilet paper at Aldi's instead of Wal-Mart). I have no idea what things should cost and I have no idea what is required. I keep myself relatively well informed and it's still almost impossible to read the damn receipts. The ones I get from the insurance company are much better. They show what was done, how much the doc wanted to charge, and how much they allowed them to charge (the difference between those two numbers ranges from 10% to 90%, I'm not kidding).
So who is going to keep the docs honest? Consumers don't have the knowledge or the will (put a price on your life?, ok now put one on your mother-in-laws). To abandon the current system would cause at least a decade of skyrocketing prices. Then, when everything crashes and we get used to drinking a foul mixture of herbs in a dirt floor hut for medical care, things will climb back up and normalize. I would rather not see this turmoil.
FYI, I pay about $378 / month for medical and dental to cover my family. I fund a flex acount with $1300 / year which is pretty much gone now and it's not even May. So extrapolating that I would assume I have around $3000 in out of pocket expenses in a given year, this includes eye care. Family of 5 around $50k gross.
Parent
Re:what? (Score:5, Insightful)
It's just like counting cards in blackjack. If you the dealer is not allowed to change strategy on knowledge, players that place their bets according to the cards left in the deck can make a killing. Likewise, if the insurance company is not allowed to charge you according to how likely to you are to get a disease, people who buy insurance with full knowledge of their genetic predispositions will tax the insurance system by making sure they are fully insured for the diseases they will likely get.
The proposed solution of universal coverage would remove this problem.
Parent
Re: (Score:3, Insightful)
Re: (Score:3, Insightful)
Re:what? (Score:5, Insightful)
It's not the end, but it is the first step on that road.
How long until we see companies that offer policies that don't cover specific highly testable conditions? Sure, they can't test for the condition, but you can -- and choose the policy accordingly. Then the "generic" policies cost more because all the people *with* the genetic markers buy those, and the people without buy the other policies. If the consumer has access to the information, they will try to use it to reduce their insurance costs. You can't put the genie back in the bottle, useful information like this *will* get used.
I predict the next law will be one mandating that any health insurance policy cover certain sorts of conditions, specifically to prevent the above. The collection of patches to the insurance system will grow and grow, until it finally becomes untenable and something major changes.
Parent
Re:what? (Score:5, Interesting)
Sorry, but this is not the status quo. You need two look at both sides of the equation. Yes, insurance companies have never been able to discriminate based on genetic testing. However, their clients, us, will have a priori knowledge. If I know I am genetically disposed for a specific condition, I can game the system to make sure I bear as little of the cost as possible. Insurance companies either will not know about the genetic predisposition or will not be legally allowed to act on it, but I will be able to.
The more I think about it, even being a libertarian, the more I think federalized medical care is best. Either private insurers fuck us, or the government fucks us. Either I pay lots of money out of my paycheck (including a lower salary just for participating in the plan), or the government taxes me. At the end of the day we would still have a bloated, expensive system, but if the government runs it, we have better accountability.
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Who's going to keep it away? (Score:3, Insightful)
-Rick
Re: (Score:3, Insightful)
(quickie math, feel free to fix if you are so inclined )
Obviously that means most of those people will not be insured for it, even if anyone is even willing to at any price. They will be the charitable cases that hospitals cover by overcharging those with insurance so your insurance goes up $50 to cover the increased costs.....
Re: (Score:3, Informative)
Re: (Score:3, Insightful)
We've had private insurance with no genetic testing for a long time how.
How is keeping the second condition going to mandate the end of the first? It's ridiculous.
It's not ridiculous, it's just that the summary really, really sucks. What the summary author is trying to say is that if the consumer can use GT to decide if/when they should buy insurance, but the insurance companies can't use it to determine rates/coverage, then the insurance companies will no longer be able to keep their margins up, and will ultimately fail.
Of course, that's only true in a world where insurance companies don't adjust rates to reflect their actual profit/loss AND the primary reason that
Re:Hear hear! (Score:5, Interesting)
Parent
Re: (Score:3, Informative)
those that can and know, do.
pricey capital investment though.
Re: (Score:3, Interesting)
They don't have to mandate it, just make everyone eligible and the private insurance companies won't cover you as a primary -- just like Medicare.
There already exists "universal" insurance plans for two segments of the population, Medicare for everyone 65+ and one for military personnel (I can't remember what it's called).
There was a great special on Frontline called Sick Around The [pbs.org]