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Genome and insurance

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1richardbsmith
Mar 8, 2012, 4:53pm Top

http://www.washingtonpost.com/blogs/ezra-klein/post/how-a-1000-test-could-destro...

A lot to discuss in the exciting area of the human genome and all the impacts from individual genome mapping. All the problems come to mind about privacy and discrimination, but I had not thought of this: individuals selecting cheaper insurance that does not cover certain illnesses for which that individual likely is not subject to.

How will this change medicine, insurance, and employment, other areas - how should it change things?

"In 2008, Congress overwhelmingly passed, and President George W. Bush signed, the Genetic Information Nondiscrimination Act. Ron Paul was the lone dissenter. The legislation bars insurers from denying coverage or raising premiums on individuals who show a genetic predisposition toward particular diseases. And in doing, it armed a time bomb beneath the health-care industry."

2Lunar
Edited: Mar 9, 2012, 1:47am Top

The result would be, in insurance terms, an “adverse-selection death spiral,” as the healthy opt out of expensive insurance, the sick opt into it, and premiums spin out of control.

I'm not so sure that we can really divide people into "healthy" and "unhealthy" groups with genetic testing. I think ethnic differences in health risks bear comparison to individual genetic risks. There's a table in the Wikipedia article here showing high and low risk ethnic groups for various conditions. No ethnicity is spared. There is no "healthy" ethnicity nor an "unhealthy" ethnicity. Every ethincity has got something to guard against.

I don't think it would be that much different at the individual level. Different individuals may have different risk levels for a given condition, but your low individual risk for one condition could be high for a different condition. Or moderate. Unless the journalist can cite an actual geneticist about a bifurcation between genetically healthy and unhealthy people, this article needs to be treated as the puff piece for "Medicare for All" that it admits itself to be in the last paragraph. Citing a geneticist who says "Wow, this changes everything!" without the geneticist himself elaborating on how does not count.

3reading_fox
Mar 9, 2012, 4:59am Top

This is an area worth considering - but only because it's coming in the future. We're along way away from such detailed risks at the moment, advertising from various companies not withstanding.

If you submit a smaple to different testing companies you'll get reports back giving you different risks for different diseases from each of them. There is yet no agreement on what alleles are risk factors for the vast majority of diseases. There are yes a very few diseases where the presence of absence of a specific point mutation(s) has a known effect. But theses are very very rare.

Then again there is the whole 'measuring risk' argument which is tricky to do. And as Lunar says gonig from aggregate statistical information to individual level responses is tricky.

But progress is being made on this area every day. The concept of personalised medicine is coming to the future near you.

4richardbsmith
Mar 9, 2012, 6:52am Top

I wonder how long away these issues are. Knowlege and data in evolutionary biology and genetics seem to me to growing very fast.

I know from my familiy history certain things I should guard against. Genetics will ramp that up.

Personalized medicine sounds to be a good thing, but I think it will change things.

5Bretzky1
Edited: Mar 9, 2012, 8:46am Top

#2:

While it is true that some individuals will likely have a high risk for "X" but a low risk for "Y," the problem arises when X is far more costly to treat than Y, meaning that the increased premiums that the insurance company might charge for having a higher risk for X would overwhelm the reduced premiums for having a lower risk for Y.

I think the real worry about genetic testing for disease risk vis-à-vis health insurance is the possibility that insurers will create disease-specific insurance premiums and coverage. For example, someone who tests for a high likelihood of developing Parkinson's disease might have to sign a separate, highly expensive insurance contract to cover that possibility, or, insurance companies might even treat it like they do flood insurance for homeowners and simply exempt coverage for Parkinson's disease altogether. Think of it as à la carte insurance coverage, but the insurance company is the one making the choices.

In the end, if governments haven't already done so in some countries, I imagine that insurance companies will be prohibited from using genetic testing to determine premiums, just like they are currently prohibited from using race to set life insurance premiums.

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