(Part 1 here.)
DNA testing is slowing and surely growing in common practice. We aren't even close to something on par with the ultra-fast and comprehensive testing portrayed in Gattaca but were clearly headed in that general direction. There are tests now that can identify genetic markers that have been correlated to many types of cancers and other common genetically-induced maladies. All other things being equal, these tests are valuable for patients because they allow us and our doctors a more insightful view of our health. With more information we can make better decisions and, depending on a situation, may have incentive to make lifestyle changes to counter-act some of our genetic pre-dispositions. Using a very broad brush, I would say genetic tests are good for patients health...
... except if that information is by some means conveyed to a health insurance company and they use it to deny coverage. If I know that I have a genetic marker for a certain disease and don't disclose this to the insurance company when I try to buy a policy on the open market (that is, not through work or some other group plan), the insurance company has the ability to cancel my policy if or when they find out (called a rescission) . There was a recent hearing in Congress where health insurance executives were called to account for abusing this area of the law; it was not pretty. I am better off not having this information if I am trying to buy an individual policy because it isn't lying if you don't know the truth. Ignorance of my medical condition works to my advantage...
... except that this is my health we're talking about. I don't want to avoid information that could help improve my health so that I'm eligible for health insurance to treat the life-threatening disease I am genetically pre-disposed to. You see the problem? The incentives in our current system are all wrong. The health insurance companies don't want to have to cover people who are more likely to develop serious medical problems due to genetic pre-dispositions and patients want health insurance but shouldn't have to remain ignorant of any the results of any genetic testing for fear that they won't be able to get coverage.
The problem, once again, is revealed in the semantics: health insurance isn't really thought of as insurance any more, at least not by patients. We all get sick, we all need to go to the doctor, we all will have medical bills to pay. It isn't a matter of "if" but "when" and "how much". For the health insurance companies, I think "insurance" is the right word. They are thinking entirely in terms of liability and risk. We are insuring 500,000 right now: How many are going to get cancer? How many will be in a car accident? What is the average cost per patient? What can we do to improve our odds of having to make a big pay-out? Its all a numbers game and they are in it for a profit.
The fact that health insurance companies would like to have as much genetic testing information as possible so that they can remove as much risk from their pool of customers shows that something is wrong: who is going to cover all of us with genetic propensities that are completely out of our control? The insurance companies want to make as large a profit as possible and, to the extent the law allows, are going to do what they can to maximize that profit. That corporations are interested in profits should not surprise anybody. They have a strong incentive to reduce and eliminate costs by being as selective as they can with who they cover.
Our system is broken when information that is good for our health turns out to also be too expensive to know for our own good.
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