My Genome, My Self? 194
theodp writes "After baring his DNA for the world to see, Steven Pinker follows up in the NYT Magazine with his take on the coming era of consumer genetics. Pinker comes away less wide-eyed than Time Magazine about the current predictive ability of $399 genetic tests, but is convinced enough to opt out of learning whether he has a gene that increases the risk of Alzheimer's and believes that genetic-testing-for-the-masses may hasten the arrival of national health insurance ('piecemeal insurance is not viable in a world in which insurers can cherry-pick the most risk-free customers'). Pinker believes that personal genomics is just too much fun to ban, but for now suggests: 'if you want to know whether you are at risk for high cholesterol, have your cholesterol measured; if you want to know whether you are good at math, take a math test.'"
Re:Isn't it, though? (Score:2, Interesting)
Re:No nationalized insurance without eugenics! (Score:2, Interesting)
Harshly worded, perhaps, but I didn't mean it as a troll.
Why on earth should society deliberately hobble itself supporting people with severe hereditary disease? Never mind the fact that people with these diseases who have children are exceptionally (and unacceptably) selfish.
Just because the dawn of eugenics saw racists trying to justify their views doesn't mean the concept itself is bad.
Besides, once germline genetic engineering is A) possible and B) permitted to fix genetic disease, the problem goes away anyway.
Cheapest plan for everyone (Score:2, Interesting)
1. Prenatal genetic testing.
2. Genetic counseling for prospective parents.
3. Actuarial estimate of lifetime healthcare costs at birth.
4. Mandatory front-loaded health savings accounts, funded by income withholding, until the amount saved in the account is equal to the amount necessary until end-of-life medical care, based on actuarial estimates.
5. Parents pay into the account until the child reaches adulthood, then the person covered continues until the account is fully funded.
6. Account holders can use their health savings account on any recognized treatment required, but reimbursement is limited to the rate set by the government. For example, if the limit is $5000 for a particular treatment, and the patient spends $10,000, the remainder is paid by the patient directly. This prevents draining the account, either by unscrupulous doctors or by fraud.
7. Shortfalls for necessary treatment are covered by the government, but treated as a loan with interest.
8. Money left in the account is passed on to heirs, while shortfalls are taken out of the estate in probate. Any remaining shortfall is covered by the government and paid through taxes.
9. Actions that increase medical risks (obesity, smoking, excessive drinking) are handled by increased payment into the health savings account. Actions that decrease risks, such as maintaining healthy weight and regular checkups result in lower amounts withheld for the account. Actions that benefit the community -- organ donor cards, blood donation, willing their body to medical science, etc -- get a bonus put into their account.
Of course, this won't happen as long people prefer to pass healthcare costs to the next generation in budget deficits, rather than paying for their own care.
I was "almost" a subject of this experiment (Score:2, Interesting)
I used to work as a contractor for the George Church lab. My supervisor was a student of Church's. Church was his boss. I was working on bio-informatics (if anyone cares, I can tell you some tricks for regexp-searching of genetic sequences).
My family was under extreme financial duress. In light of that knowledge, my supervisor (tells me, at least) that he took my situation to George and they came up with this: "Sign up to be one of the first 10 PGP subjects. Give us all of your medical records from the past and into the future. Agree to have your sequence published. We think we can get Harvard to agree to pay for your medical insurance for life. Don't you think your family deserves for you to make that trade-off?"
I said, flatly, "no." I pointed out, among other problems, some severe technical problems in the line of sequencing research we working on. Ultimately, we (me and the lab) part ways on less than amicable terms after this.
I think these people are scum.
They were eager to exploit my poverty as leverage to make me a human subject to rather dangerous experimentation based on highly dubious scientific claims - and they punished me for dissenting from this plan, as nearly as I can tell.
-t
Re:Isn't it, though? (Score:3, Interesting)
Re:This will actually reverse the cost of health c (Score:5, Interesting)
>I have health insurance for BIG stuff, hence me HUGE deductible (5 figures).
Bullshit.
Im only 33 and need insurance. My sleep apnea machine costs a few thousand dollars. No "emergency" insurance covers that, yet SA is as serious as anything else. Toss in the sleep studies and my insurance probably paid out 6 or 8 grand. I would have lost all my savings and more if I had "emergency" insurance only.
I used to be poorer and had no insurance and pretty much begged doctors for the "cash rate." All my medicines were samples. I barely scraped by and I got lucky. I was young and healthy. No major accidents. Now in my 30s I cannot do that. No way.
You sure as hell are not having a baby safely by paying cash. No emergency insurance is going to cover pre-natal, delivery, post-natal, etc.
>Wash your hands after touching sick people. Cut back on excessive drinking and smoking. Wear a condom. Don't eat too many sugars or starches. Do some exercise. It's not so hard.
Yeah, youre a moron. I do all these things. Kids born with diabetes arent going to exercise it away. Youre not going to fix a broken leg with happy thoughts. Not eating a twinkie doesnt cure a MRSA infection. Not drinking beer doesnt fix a rotted tooth.
>Then you can SAVE YOUR MONEY when you're young to prepare for the care you'll need when you're old.
My dad's CPOD and Alzheimer's treatments are in the 5 digits. In 10 years its going to be well over 500,000. Thats a lot to save on top of retirement.
How old are you? Some college student who has yet to grow up and see how your body falls apart when youre older? Its all downhere from here. If all of Europe can do national healthcare then so can we. Dont let being "college liberatarian" make you more ignorant than you already are of health matters.
Re:I was "almost" a subject of this experiment (Score:3, Interesting)
No, Im not a bullshit artist. And Im certainly not that one listed there.
Case: BRCA1 gene.
Lady has herself undergo genetic testing due to breast cancer with help of University of Utah. With her and doctor, they find the gene expressed that when triggered, causes breast cancer. Because of her genetic background (Ashkenazi Jew) they were able to isolate it.
The rub: if somebody goes and has a test for BRCA1, they are required to answer if they are Ashkenazi. If they are, Myriad demands an extra license fee. That, and the lady who helped by being a specimen has no rights to the "discovery".
My paper revolved around patent law concerning testing, discovery, and creation of special creatures. Just looking at the Golden Rice fiasco shows what exactly is wrong with these type of patents.
Re:Your plan is pure evil (Score:1, Interesting)
I truly cannot express how vile, dangerous, pernicious, and inhumane this idea is. Either you didn't think this idea through clearly, or you want to create as much misery as possible.
It does have the benefit, however, of controlling costs and remaining solvent, and relying on statistics rather than anecdotes.
3. Actuarial estimate of lifetime healthcare costs at birth.
Here is where your plan starts to smell fishy. How are you supposed to predict lifetime healthcare costs for an individual? We can do it very well statistically, but any given member of a population can differ wildly from the mean. If you try to force an estimate anyway, most of these estimates well be wrong.
And? Insurance companies make estimates all the time -- it's what actuaries do. Front-loaded means people are saving from the start. If conditions change or new factors come up, they can be adjusted while the person is still a wage-earner. Of course, if you prefer, you can extend the period of saving until retirement, and have a lower rate.
We can predict the average error based on the statistical distribution, but the error in any one sample is unknown, and that's a huge problem when we consider the rest of your vile plan:
Vile, dangerous, pernicious -- your thesaurus is really getting a workout. :D
4. Mandatory front-loaded health savings accounts, funded by income withholding, until the amount saved in the account is equal to the amount necessary until end-of-life medical care, based on actuarial estimates.
5. Parents pay into the account until the child reaches adulthood, then the person covered continues until the account is fully funded.
First of all, "cost" is a fuzzy target. The value of currency is subject to wild flings, and unless you index this cost continuously to inflation, the value of this account becomes progressively more divorced from reality, even more than it was in the first place. If you do index the outstanding balance to inflation, you'll end up causing vast economic damage. The total amount of money going through this system would be huge. To index that to inflation would in turn drive inflation change itself, greatly magnifying the normal fluctuations in the value of money. That economic instability would decrease the efficiency of the system as whole. We already see this problem to some extent in social security payments.
How would the amount of money involved be any different with health savings accounts as opposed to universal insurance or single payer? I mean, other than people tend to spend their own money more carefully, and there are fewer free riders with a health savings account.
This item has major, negative effects on society too: first, it creates a large disincentive to have children. Government ought to create an incentive to have children, since not only does childrearing perform the obvious function of propagating the next generation, but it promotes healthy, stable societies. Among families that did have children, it'd push many of them into poverty. Do we really need children raised that way? And before you say that parents just won't have children: fact is, they do anyway. And the "do it anyway" crowd belongs to the group that needs the most financial assistance anyway.
Which is it? A large disincentive to have children, or they'll have them anyway?
And besides, your assumption is wrong. It would remove some of the current subsidies, but that is not the same as a disincentive, any more than reducing the rate of tax increases is a tax cut. And the "do it now" is the group that requires the greatest disincentive to have children, so this would be great if it actually did so.
I will meet you halfway, though -- the government could figure out the net societal benefit of people having children, and give parents that amount to pay for health, education, food, clothing, and the like.
Again, your plan magnifies negative phenomena we already see i