The New York Times has an article about people who avoid DNA tests because it might reveal or confirm information that will be used against them by insurance companies.
In some cases, doctors say, patients who could make more informed health care decisions if they learned whether they had inherited an elevated risk of diseases like breast and colon cancer refuse to do so because of the potentially dire economic consequences.
Others enter a kind of genetic underground, spending hundreds or thousands of dollars of their own money for DNA tests that an insurer would otherwise cover, so as to avoid scrutiny. Those who do find out they are likely or certain to develop a particular genetic condition often beg doctors not to mention it in their records.
. . .And even doctors who recommend DNA testing to their patients warn them that they could face genetic discrimination from employers or insurers.
Such discrimination appears to be rare; even proponents of federal legislation that would outlaw it can cite few examples of it. But thousands of people accustomed to a health insurance system in which known risks carry financial penalties are drawing their own conclusions about how a genetic predisposition to disease is likely to be regarded.
When I started this entry, my premise was going to be to the effect that “any system that rewards ignorance is fundamentally flawed.” But, when I thought about the nature of insurance, it occurred to me that rewarding ignorance is at the very foundation of what insurance is about. Insurance is about managing risk. Risk is an unknown danger. For example, in the 17th century, if you have 100 ships sailing to the Spice Islands, you can calculate that storms and pirates and whatnot will take out a certain number of them, but you don’t know precisely which ones will be lost. So, the ones who will make the voyage successfully pay in and effectively reward the ones who will lose their ships on account of everyone’s collective ignorance. If the future loss were known, the voyage probably wouldn’t be made in the first place, for starters, but the ones who knew they wouldn’t lose certainly would not be inclined to pay into the insurance risk pool.
Health care sets up something of a different dynamic, however. Someone with a high genetic risk of a disease isn’t going to choose to forgo the voyage. So, as our knowledge of a person’s likely health care profile increases, paying for medical treatment becomes less about managing risk through insurance and more about determining what our obligations might be toward our fellow humans in subsidizing their ability to live and/or remain healthy.
This is tough. Generally it seems that there is some obligation to give a little if that would save the life of your neighbor. On the other side, paying huge sums for the benefit of someone on the other side of the country just so that person can eek out a couple more weeks of an agonizing existence seems unreasonable. Somewhere between those extremes is an appropriate balance. But that balance will rarely seem appropriate to the person who is watching their own mother die.
How about this? If you have a job, you are insured, no questions asked.
The problem with insurance besides not having it, is having insurance but with high co-pays and deductibles. I look at that as a trick of insurance companies not to offer decent service but still say they are ‘offering coverage’. They take it back in co-pays and deductibles,and that kills people earning $30,000 or less.So just counting who has insurance and who works is a misleading way to judge insurance coverage imo.One policy needs to fit all.Then at least we’d be able to separate the apples from the oranges.And how about that ‘doughnut hole’ for perscription drug coverage? It’s time for a change, that’s for sure.
And, once again, we see health insurance conflated with health care.
And Craig’s suggestion is a large part of how we got into the fun situation we are in today.
Why should my employment have anything more to do with my health insurance than it does with my car insurance? And yet, since WWII it has become a key consideration for most of us…
Because if you don’t have a job, you don’t deserve health care! I’m sure it is in the bill of rights somewhere…
Yes, that means YOU, children, stay at home parents, and retirees.
/smarta..
The only way not to tie health insurance and health care together like the twins that they are,would be to have everyone have the same quality coverage,and insure that health insurance be univiversal.That would immediately be dismissed by many as ‘socialism’ before dicussion even starts.
In my opinion, jobs and health care go together like fish and bicycles.
Try re-reading Lou’s comment, replacing the word ‘health’ with the word ‘car’.
[Don’t make me use the word ‘conflate’ again, please!]
Also, Doug, don’t you realize that the fish you can have is DIRECTLY related to your bicycle?
Lou said
I’ve never figured out what the line in the sand is that other people are seeing (not meaning you, Lou). Every federally funded program, service, or (what would you call roads in this case?) is, at least partially. “socialized.” Even Education and Health Care to some (sadly, small) extent. Yet, we can’t seem to say “this is the minimum acceptable level of coverage that we will fund for all people of our nation.” (Well, we *have* said that – it’s 0.)
And it will have to be a minimum level – although that minimum would hopefully move up over time. We are quickly reaching a point where we can keep a *body* alive indefinitely. Stacks and stacks of baby boomers hooked up to machines (a la the would-be criminals in “Minority Report”) obviously cannot be supported. I do not envy the people who have to draw *that* line.
In the long run, it only makes sense; a healthy, educated group of people make for a good workforce (read, taxbase).
Doug, I think the connection is obvious – the fish will go with the employer who is offering the better bicycle.
Parker,
I see your point,but that would mean that cars and health care are the same moral value,and have the same historic development. The point is that health care and health insurance tied to jobs has been the American model for a long time. And we have to replace this arrangement simultaneously while in the process of getting rid of it,if we do.Whoever is making big bucks in the present arrangement will not want to change it. If fish and bicycles had always been sold together, I would venture a guess that most people would see them as related,and those making money from both would be the first to moralize their connection.
Lou, does it have to be either/or? Can we start with a system in which *both* socialized and private health insurance could co-exist in the same way we have both public and private education? (Not that the current state of our public education is something to strive for.) As a first step, I would like to see everyone have free preventative coverage – think how much we could catch before it becomes a huge issue.
The only problem I have with health “insurance” is that it isn’t a taxable benefit.
What you people call “health care” is nothing more than an elaborate tax avoidance scheme, one that is government endorsed no less.
The irony is that this “insurance” DOES pay for preventative care. What it doesn’t pay for is really catastrophic things. Most insurance plans have lifetime limits of $1M or so.
What we need is for people to pay for more of their own care out of their own pockets. We also need a massive deregulation of the health care system. Doctors should have less control, individuals more. If I want to go to Walmart and see a nurse practitioner rather than a doctor in private practice, whose business is that other than mine? yet, in most of this fine country, that’s illegal.
And why does the AMA control how many doctors graduate every year? Why can’t schools graduate as many doctors as they want?
We need to worry more about what is paid by health care consumers and less about the incomes of doctors.
Man, I’m on a roll here. Somebody stop me before I blow a gasket.
Doug:
You wrote,
“So, as our knowledge of a person’s likely health care profile increases, paying for medical treatment becomes less about managing risk through insurance and more about determining what our obligations might be toward our fellow humans in subsidizing their ability to live and/or remain healthy.”
I agree; the problem is, conservative and LP libertarian ideology holds that the sum total of those obligations is zero. Moreover, they have standard bearers like Ayn Rand who exhort that compromise is immoral.
(IIRC one of Rand’s quotes on the subject is: “In any compromise between food and poison, only death can profit.” Clearly the words of someone who did not spend a few years building up an immunity to iocaine powder.)
Branden sez “I agree; the problem is, conservative and LP libertarian ideology holds that the sum total of those obligations is zero.”
Well, no, it’s not that we think our obligation is zero, it’s that we think it’s our choice and our business (not the governments) to whom and how much we would like to participate in helping our fellow citizens.
tim zank,
Doesn’t make it much of an obligation then, does it? :)
Brenda,
Yes, I think government and private sector need to work together on health care.Government’s role is being the voice of the patient and medical personnel .That’s what missing now in my view.The perception is that costs are controled only to maintain a certain profitability rather than improve care. And we must do away with this awful notion that going to ER is part of a universal care system.ER is for on-the-spot emergency treatment.I would be happy to see a system that strives to come out even. No one should be buying a private yacht from health care profit.Ask a doctor ,not a CEO, should be our Health Care motto,and I don’t include doctors working for insurance companies.
We need to worry more about what is paid by health care consumers and less about the incomes of doctors.
Man, I’m on a roll here. Somebody stop me before I blow a gasket.
That’s pretty cool
Nice blog
Jade Borg
http://www.gpjobsaustralia.com/