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TMFHelical (99.09)

Thought on GINA

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June 18, 2008 – Comments (6)

No, this isn't a company (I honestly didn't look to see if it is used as a ticker).

GINA is the Genetic Information Nondiscrimination Act which recently passed.

Here is an interview with Francis Collins on the subject.  http://content.nejm.org/cgi/content/full/358/25/2661/DC1

Now I agree with GINA in general, and do feel it should be law.  But...lets play devil's advocate because it isn't that obvious that it should be. A key provision is that insurer's and employers can't use genetic information against you. Its only marginally useful now, so we are really talking about future info and correlations.  Well, why not?  Can't you use it against them and thus bias the playing field?

Put employers aside for a moment and look at insurers.  Insurance is based on measuring outcomes by using all the information available to asses risk.  Genetic information is part of that information.  Now it sounds insidious that an insurance company would deny a policy based on a genetic screen.  But what prevents a customer from using that information?  Insurance is based on risk analysis and the presumption that the customer is at a disadvantage in the appreciation of that risk.  If that balance were to change however, wouldn't that change the entire industry?

For example, say a customer with young children just learned through a BRCA1/BRCA2 (breast cancer) or HNPCC (colon cancer) screen that they were very high risk, would they then take out 5X the life insurance that they otherwise would have?  Would you?  As someone with young kids, I sure as heck would consider it.  Will this throw existing insurance models out the window and force price increases for everyone? Insurance already has to model for fraud - isn't this a form of fraud?

As for employers, there are two factors at work.  One is that genetic information that indicates personality preconditions (and this doesn't exist yet) would be used.  It shouldn't be.  But in some professions (say law enforcement), personality profiling is certainly acceptable.  Would anyone suggest we do away with this (not me).  What if (big if), genetic information eventually proved to be more accurate than personality profiling.  Shouldn't it be used?  What about in positions of public safety?  Or child education?  It isn't honestly an easy question to answer.  But now that you 'can't' use the information, could it be used against you.  Could you learn of a trait and become handcuffed by that knowledge?  Again, not simple IMO.

The second factor is employer based healthcare (that this model will have to change into the future should be the subject for later posts). Employers, especially smaller ones, bear the burden of heath care costs.  That is OK (for now), small businesses can really be clobbered by the something as unpredictable as the unexpected illness of one employee.  It isn't just the loss of a key employee, but they can really see their healthcare costs run out of control.  So again, while it may seem awful to not hire someone based on a genetic screen, is it different from being unwilling to risk hiring an older or visually unhealthy worker.  It is I think, but not a whole lot.  If I were healthy and later on in life but still wanting to work, could I thrust a clean genetic test into an employer's face as evidence that I won't burden the company with lost time and healthcare costs?  Can I?  If I do, are they liable if they hire me instead of someone who didn't present such a document (knowing they can't ask?).

So good for GINA, I'm glad it has passed.  I hope it does indeed do more good than harm.

Zz 

6 Comments – Post Your Own

#1) On June 18, 2008 at 11:01 PM, TMFHelical (99.09) wrote:

Note that life insurance and long term care and such are not covered under GINA.  It is just the health insurance industry.  I should not have used life insurance as an example.

Still, I expect that health insurance will be more and more individual (not job) based and transferable, so one can still select a level of care based on expectations of getting ill that could be biased in the customers favor by genetic testing.  A less extreme example than life (or long term care) insurance, but still relevant. 

Zz 

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#2) On June 18, 2008 at 11:35 PM, wolfhounds (29.30) wrote:

I don't feel sorry for the health insurance industry. They've been discrimating as much as possible, but not nearly as much as life and long term care. One example I'm familiar with is veterans who try to get long term care or life insurance. It's common for insurance companies to demand extraordinay information to verify that you're not on death's bed even if an illness connected to your service occurred 40 years ago. I curse all of them.

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#3) On June 19, 2008 at 2:04 AM, FleaBagger (28.76) wrote:

That discrimination is efficient pricing. If you want to know what insurance looks like without discrimination, look at Massachusetts. When you ban insurance discrimination, the ones who suffer are the poor. The insurance folks will find a way to get by. (Most likely by not insuring poor people.)

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#4) On June 19, 2008 at 9:00 AM, chk999 (99.97) wrote:

Tim Harford talks about this in his book The Undercover Economist (which I heartily recommend BTW). He thought is that really good genetic insight spells the end of the healthcare insurance industry, since the risks will be too computable and the ones with health issues to be won't be able to get insurance, and the ones without won't buy the insurance.

(Good post, you write interesting stuff.) 

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#5) On June 19, 2008 at 5:50 PM, nicestnurse (29.25) wrote:

Well, years ago "nicenurse" was taken, so I had to settle on "nicestnurse" as my Yahoo email name.  So now I have a reputaion to uphold  :D   Interesting info on GINA, I must say.  I'll have to read more about it.  Good luck in the contest!!

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#6) On June 19, 2008 at 10:20 PM, madcowmonkey (< 20) wrote:

Wow I could have so much fun with that sn, but I will be good. 

As insurance rates keep going up and the government keeps throwing loot at the situation, do you think there will be only a few that will get the benefit you mention. All the others will not be able to afford the premiums, therefore the "good" customers will ultimately pay more in the long run. Not that we have to worry about this, soon nobody will be able to keep up with the doctor visits/bills. Once again my tax money has been shifted out of my pocket to some old geezer, non-taxpaying/citizen, or they just lost the funds altogether. I don't think I will see them comeback to me in my lifetime:(

At this point it would almost be nice to see everybody paying one flat rate and get the same service, but I know that could never happen. So, of course we would have to make special circumstances for the "economically elite."

I think I could go on this topic for another decade, but it would be one big circle. Nice post Zz. 

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