Maggie's Farm

There is also this difference. People cannot control the genes they have been given by their parents. I do not think it right to penalize a person for the way God and a parental embrace made them.

Whereas how they choose to take care of themselves is under their control. Humanoids are supposed to intelligently assess their own risk for certain diseases, and do all possible to prevent developing conditions their genes predispose them to. It's called stewardship. We Puritans have the quaint notion that the body is the temple of the HOly Spirit, so we try to be worthy of it...just restrain me when the chocolate truffles are out!

I could see an insurance company reading one's genetic report card and then offering premium reductions if one does eveything humanly possible to reduce one's risk of developing conditions one is at risk of developing, or if one responsibly manages genetic conditions that developed anyway. Nobody chooses to be bipolar or diabetic or to have high cholesterol. A case could be made that premiums should not be higher for people whose condition is genetic, but should be higher for people whose health practices are self-destructive.

Another point is that because reasonable insurance is only presently available thru work, and tied to particular jobs, anyone who gets sick runs the risk of either being fired by their company because of the insurance liability they pose, or of losing their insurance if they become sick enough, even temporarily, to work. Genetic testing could be used as a pre-employment physical to exclude anybody who potentially might cost the company money. Yet when one tries to buy private health insurance on the open market, one cannot get it to cover preexisting conditions. So God help the breast cancer survivor, or schizophrenic, or man with a wonky heart. Or the non-bipolar members of a family wracked by bipolar disorder over generations.

It is hard to contemplate this from the blog's freedom perspective, however. I suspect that some who believe (I do not) that legislating seatbelt use is an intolerable infringement on people's liberty would say that insurance companies should be allowed to charge for the higher risk that people with, say, bipolar genes pose. I know people who assert both positions. Let me get this straight: it is okay to behave irresponsibly without fear of the law in ways that are likely to cost others a lot of money (Yay, freedom and riding motorcycles without a helmet!) but the law would be tyrannical if it protected those unfortunate enough to have a genetic condition if an insurance company penalized or denied coverage? (Yay! freedom to oppress potential patients!). I can already hear the howls of "Life is not fair," and the growls of "NO NANNY STATE!" But I find it odd that moral people can condone giving a free card out of jail to the irresponsible, and also think it is okay to penalize those whose ill health is genetic not brought on by lifestyle.

Although most disease in fact is overdetermined, a bit of genes, a bit of stress, a bit of rotten character, a bit of nagging wife, etc. the fact is that God and one's parents distribute diseases and conditions most unfairly. We are all free, but many of us have been cursed for free with genetically determined health that would cost too much even for someone with a six figure income. You can have a good character, be a diligent worker, live a moderate and prudent life, and still be felled by a disease that bankrupts you, makes you lose your house, and prevents your kids getting an education. It depends on the genetic lottery.

For example, my doctor relies on catastrophic health insurance as his own family is physically and mentally healthy and he can easily cover the out of pocket expenses and a high deductible. By contrast, during one typical year, my family (none of whom drink, smoke, or are obese) needed some $100,000 of medical care, plus prescriptions, and $100,000 for a therapeutic school. We look normal, our kids are never in trouble and all get As, we can be decent company and neighbors, and are certainly not trailer trash with rusting washers in the front yard....We all exercise, eat healthily (tho probably somewhat too much as family meals are our great pleasure and the kids like to bake), volunteer, go to church, and even crack jokes...

My other concern about the new genetic knowledge (and don't get me wrong, I am pro-science, it is just the use insurance companies may make of it that concerns me) is this: with all these new ways of diagnosing disease when it is merely a predisposition, how can we be sure that insurance companies will not use it to force abortion on parents. To say, "genetic testing shows that this kid will be autistic. If you chose not to abort the fetus, you must sign a release renouncing all future claims for her care." I don't think that it is a paranoid scenario....Just American zealousness about getting paid to assume risk....

But the fact is, someone can have the genetic predisposition and never get seriously ill. Or, if given appropriate medical care, manage an illness well enough to be a productive worker, family member, and contributor to their community. So much is in God's and the individual's hands that do we really want actuaries and clerks telling us who they will cover?

On the risk question? It was not my understanding that insurance companies were intended to be piratical profit centers like investment banks or hedge funds, making gazillions for management and sometimes stockholders. I have the perhaps naive notion that insurance companies evolved from fraternal groupings of people who committed to share their resources so that when some of their number were afflicted, it would not bankrupt them. All sacrificing to protect the unfortunate members of the group. Because getting sick is one lottery number nobody wants. In fact, the more I think of it, I realize that I believe insurance companies should be non-profits, and that any monies they collect in excess of expenditures should be used to reduce premiums. Yeah, right! And ice floes are floating in Hell too... I have not read any stories of insurance companies losing money lately, but perhaps that is my ignorance on display?

Point taken, BD. I did not know they made so little money. Egg on my face!