The President calls for a ban on genetic discrimination. (Link)
I betcha this will be a very important topic of our future world. As the (very short) article says, banning this kind of discrimination would have at least two effects:
1. It would eliminate the fear that people might have about getting checked for possible genetic predisposition to disease. (I donâ€™t think thatâ€™s a fear of a lot of Americans today, but give it time.)
2. It would eliminate the unsavory possibility that people could be turned down for insurance because their genetic profile suggests a high risk.
But on the other hand, donâ€™t insurance companies have a right to protect themselves? If their bean counters figure out that youâ€™re 6 times more likely to die before the age of 50, shouldnâ€™t they be allowed to charge you more for life insurance?
Anf if youâ€™re 6 times more likely to need expensive therapies, shouldnâ€™t they be allowed to charge you more for health insurance?
I guess we have a sense that genetic issues arenâ€™t the fault of the person who has the possible predisposition. We donâ€™t have a problem with insurance companies charging more for smokers, or drinkers, or bad drivers, or people in high-risk professions. Do we?
[Then again, if you have no insurance before finding that you have a heart condition, you may be in some trouble, right? Is that your fault? In a way, maybe we think it is, because you could Â have bought the insurance a long time ago. But doctors could find a genetic problem even before youâ€™re born!
Or is the difference that the heart condition has expressed itself, while the genetic condition may never express itself as anything more than a probability?]
Anyway, is it ok to say that if itâ€™s not the personâ€™s fault, the insurance company should carry the difference? Is this a morality thing that we feel? I mean, itâ€™s not the insurance companyâ€™s fault either, so why should they pay?
Then again (again), itâ€™s not as though insurance companies are going broke without this new genetic edge, are they? (Are they?) Maybe this would be one way that they just have to suck it up for the good of humanity. And after all, theyâ€™re not REALLY carrying the difference. Theyâ€™re surely passing it on to all of us.
So in the end, the question is: Are you willing to pay higher prices for insurance in order to cover those who have genetic skeletons in their closets?
[Mind you, this is all aside from whether a company could decide not to hire you because of your probability. Maybe they donâ€™t want to because of higher insurance costs (see all that stuff above), or maybe they donâ€™t want to train you just to have you drop dead at your cubicle. Should businesses be allowed to not hire you for this reason? Some already wonâ€™t hire smokers. Is that ok?]
Off the top of my head, my thinking is that I agree with the Prez. The society that I want to live in is willing to pick up the tab a bit, and wait until a defect actually occurs before assuming that all is lost. Thatâ€™s just off the top of my head. I tend to waver.
I have several concerns regarding the use of genetic testing to determine medical risk:
1) I believe companies are already using confidential medical information to make hiring and firing decisions, despite prohibitions against doing so. Giving them more information is just more temptation for abuse. I don’t like employer provided insurance for this reason, and would really like to see the current tax subsidy given to companies for providing insurance extended to the employee.
2) Genetic information can be linked to race and ethnicity. As an insurer, could I use the fact that African-Americans are genetically predisposed to sickle-cell-anemia as a justification for charging higher rates? We wouldn’t accept that outcome, so why would we accept an outcome that might similarly discriminate against Ashkenazi Jews, or Native Americans, or Scots-Irish?
3) This is the other side of the coin of the “DNA is destiny” argument we hear regarding alcoholism, violent behavior, and even homosexuality. The courts have not widely accepted this argument, and neither should we accept it here. A genetic predisposition toward a behavior or condition does not “make” a person what he or she is. I believe homosexuality is a lot more complex that simply having a particular gene turned on, and I do not believe we can be absolved of our sins (just to be clear, I’m separating homosexuality from sins here on purpose) just because we have a poorly understood genetic propensity for a particular behavior.
The state of science is always in flux. There is a very, very good chance that what we think we understand about DNA and risk factors will be challenged later. Just within the last year there have been several developments disproving the impact of previously identified genes in the likelihood of specific diseases. Any attempts to use these scientific theories to discriminate against people would be a foolish thing to do anyway, as there is a good chance you would find out later that you were discriminating based on something that wasn’t real after all.
But there’s one form of discrimination the government can’t ban (at least by my reading of the constitution, but I’ll bet they try), and it’s probably much more likely to be used. Think of all these people using match.com and other sites that employ psychological profiling to determine your “best match”. Think of that silly New York sperm bank that offered “genius donors” to couples that wanted genetically superior babies. There’s nothing to stop (nor should their be, except for general decency) someone from choosing a marriage partner based on a genetic test. It would be just as (in fact, probably more) likely to be based on faulty science, and would probably not benefit people at all, but I can still imagine lots of people that would hapily submit to the testing in order to find their “genetic match”.
Interesting. Kevin, it looks as though we agree, but I’m surprised.
I would have thought that your outlook would have been simpler: the government shouldn’t tell insurance companies what to do (unless Constitutionally prohibited), regardless of whether they’re using good science or not.
Even if it’s not their destiny, why can’t a private company decide that it’s in their best interest to charge more?
[The sickle cell thing is interesting, but I think that either you have it or you don’t. Or you’re a carrier or you’re not. You have to be tested. It would be outrageous to charge higher rates without even testing.]
The insurance argument is a little dodgy (to me) because, as you say, it’s a private company, not a government entity. However, there are a couple of factors that I think make it proscribable. First, we’re dealing with genetics, and genetics and race and ethnicity are inextricably linked. We don’t even know for sure when we’ve discovered causality versus correlation. Black men have a higher incidence of colon cancer than white men. We don’t know why, but we CAN identify black men by their DNA, thus identifying a genetic factor which is correlated with a higher incidence of colon cancer. I think our current interpretation of Equal Protection under the 14th amendment is probably applicable here.
There are also privacy issues, but unfortunately the constitution does not adequately address privacy. This is unfortunate, and (in my opinion) is the number one driver of some of the wacky court decisions we get trying to invent a right that clearly isn’t there.
I generally think it wrong, whether or not it’s unconstitutional or illegal, to use non-causal information to make important decisions about people. I’ve done it myself, as a landlord, and it just doesn’t seem right. It always smacks of redlining, and given the unfortunate history our country has with race, I think it’s appropriate to take extraordinary care to prevent discrimination.
That colon cancer thing is a very good point, and I agree that there’s a pretty good 14th argument there. And I agree that we need to be extremely cautious about anything affecting race.
How completely satisfactory!
I want to live in a society that values your contribution more than your health.