People Avoiding DNA Testing To Keep Being Insured

[LostAngeles]

There's an article in the NYT about how some people are avoiding getting checked for genetic predisposition to diseases and conditions because they don't want to lose their insurance. Some of them, however, are having the tests done privately. That strikes me as odd, except, perhaps, in this case:

... Mary, a freelance camera assistant in Brooklyn, for instance, sent a swab of her cheek cells to DNA Direct to find out if her extreme fatigue was caused by hemochromatosis, a genetic condition in which the body retains too much iron.

“I would rather not lay out the $200 myself,” said Mary, who requested that her last name be withheld for the same reason she paid for her own test. “But it seemed safer.”

Treatment for hemochromatosis typically involves removing a unit of blood twice-weekly by phlebotomy. But that would mean disclosing the condition to a doctor, so Mary is planning on becoming a frequent blood donor.
...

I know when you give blood they check your iron levels. If they're two low, you can't give blood, but what if they're too high? What does that mean for the recipient? Anything? Nothing?

This girl I feel for:

...After receiving a similar warning from her doctor, Katherine Anderson’s parents did not allow her to be tested for Factor V Leiden, a genetic condition she might have inherited from her father that increases the risk of blood clots.

But last year, with nothing in Ms. Anderson’s record to indicate reason for concern, a gynecologist prescribed a birth control pill to regulate her uneven periods. Six weeks later, Ms. Anderson, then 16, developed a clot that stretched from her knee to her abdomen. The pill, combined with the gene she had indeed inherited, had increased her clotting risk by 30-fold.

Now largely recovered, her primary concern is whether she will be viewed as a health insurance liability for the future.

“I don’t want to have to work for a big business just to get insurance,” she said. “This could be determining what I can do for my whole life.”
...

Although I can't understand why they didn't tell the doctor that the father has an increased risk of blood clots and why they didn't want to do the testing and look for other options. However, the result of being concerned about your future health insurance is something I sympathize with since I'm graduating soon and the best way for me to ensure I get the care I need is to go into a group plan from my current group plan with the university.

NYT Story here.

 

[skeptifem]

I know when you give blood they check your iron levels. If they're two low, you can't give blood, but what if they're too high? What does that mean for the recipient? Anything? Nothing?

blood from people with hemochromatosis is unusable for transfusions. i assume its harmful for recipients the same way it is to the people with the condition.

ive only seen theraputic phlebotomy ordered a handful of times in the past year anyway, its a pretty rare condition.

 

[Sir Robin Goodfellow]

Off topic a bit, but something I've always wondered. If you have a house fire, your house insurance goes up. If you crash your car, your vehicle insurance goes up. What happens if you break your arm? Do your health insurance premiums go up? What about routine check-ups? Do they raise your rates? Does it get more expensive if you use your health insurance at all, or is there some threshold where it increases?

 

[Boo]

Routine well care is actually favorable and some plans will cover it without any co-pay or deductible. Chronic medical conditions that require ongoing treatment or increased risk for developing a chronic condition i.e. smokers and those with strong family histories will either raise your premiums to the point they are unfordable or make you un-insurable. Some companies will offer insurance but may choose not to cover any treatment, hospitalizations, medications or other services related to that condition in addition to charging higher premiums.


This is the problem with genetic testing. If you have it done and are found at higher risk your policy can be dropped, premiums raised or any care related not covered. If you have it done and do not declare it when applying for insurance that will also void your insurance and make any company unlikely to insure you.


Not only does this impact health insurance but will also effect any life insurance policy.


Boo

 

[volatile]

This is a consequence of the lack of a nationalised health system. People will avoid getting treatment for minor ailments because they either are uninsured and cannot afford it, or are insured and do not want escalating premiums. This means that minor problems are left untreated until they become severe, harder and more expensive to treat.

If you had free healthcare at the point of use, this would not be an issue at all.

 

[kev]

Off topic a bit, but something I've always wondered. If you have a house fire, your house insurance goes up. If you crash your car, your vehicle insurance goes up. What happens if you break your arm? Do your health insurance premiums go up? What about routine check-ups? Do they raise your rates? Does it get more expensive if you use your health insurance at all, or is there some threshold where it increases?

It certainly does go up. That is why people can't afford health insurance. I work for a school district. In 2002, If an employee elected to take full family coverage with a $100 deductible, the plan would cost $986 per month. The district provided about $430. So, the individual would pay out of pocket about $540 per month.

Today, the same policy costs $2076. The district pays about $510. So, if a person elects for this coverage, they pay about $1550 out of their pocket per month These rates are icreased directly proportional to the use of the people in our district. So, every claim that is put in, results in a proportionally increased rate so that the insurance company will always make money.

This example is a group rate, but I assume that the same sort of thing is done on an individual basis as well. Bottom line is VERY simple. Insurance companies will NEVER lose money. If claims are submitted, premium goes up. No claims submitted, premiums go up less.

 

[WildCat]

This is a consequence of the lack of a nationalised health system. People will avoid getting treatment for minor ailments because they either are uninsured and cannot afford it, or are insured and do not want escalating premiums. This means that minor problems are left untreated until they become severe, harder and more expensive to treat.

Exactly! And as technology and understanding of the human genome improves, the number of people with "pre-existing conditions" will only rise, increasing the number of uninsurable people.

If you had free healthcare at the point of use, this would not be an issue at all.

"Free healthcare"? No such thing. What you mean is a single-payer system where you cannot be denied coverage.

 

[shadron]

This is all a part of the health insurance crisis. Insurance is a bet placed with a company that you will (live, not have an accident, etc) for a given period of time. The company employs statisticians (called actuaries) who compute average stat on the coverage, and make sure that they charge enough to come out even on average, and make a profit as well. The ability for DNA analysis to predict the future for individuals breaks all the assumptions underlying insurance; an insured, if they find out they have a good chance of something in their future, buys insurance on the cheap, or avoids buying it if they know they won't have the problem, and the same advantage accrues to the company - worse, actually, because they can come across your DNA in the investigation of any sort of problem or even in the application procedure and have the wherewithal to get it analyzed and interpreted wholesale.

Solving this problem would seem to take one of two extremes - we do away with insurance altogether as a society, or we make everyone join up (and the company insures everyone for the same amount at the same cost), willy-nilly, so that the averages are restored.

 

[volatile]

Exactly! And as technology and understanding of the human genome improves, the number of people with "pre-existing conditions" will only rise, increasing the number of uninsurable people.

Indeed.

"Free healthcare"? No such thing. What you mean is a single-payer system where you cannot be denied coverage.

You're right, of course. That's why I didn't say "free healthcare", but "free healthcare at the point of use".

In another current thread, I pointed out that the approx. tax burden for our entire, comprehensive, (virtually) no-quibble NHS is $3,000 per person per year. That covers GP, prescription drugs, ambulance, surgery, physio, geriatric care, maternity, post-natal, accident and emergency, in-patient and out-patient care, most dentistry (though this is a little contentious), some opthalmic care and pretty much everything else. Hell, if you jump off a bridge and need a helicopter to come fix you up, you get the damn helicopter. How much would an equivalent breadth of care cost (with no excess and no exclusions) in the US, on an insurance policy?

 

[Lisa Simpson]

I understand the concern over getting a genetic test done. When son #2 was diagnosed with Juvenile Rheumatoid Arthritis he was given a genetic test for Ankylosing Spondylitis. I worried that if he had the gene they were looking for, not only would he be at an increased risk for this disease, but it would give insurance companies a reason to not insure him. Fortunately, he doesn't have the gene and eventually he grew out of the JRA.

 

[Beerina]

This is a consequence of the lack of a nationalised health system. People will avoid getting treatment for minor ailments because they either are uninsured and cannot afford it, or are insured and do not want escalating premiums. This means that minor problems are left untreated until they become severe, harder and more expensive to treat.

If you had free healthcare at the point of use, this would not be an issue at all.

Yet treatments for this and other diseases are slowed by the reduced profit in "free health care" systems. In the long run, more people die and suffer more misery because treatments and cures are delayed over where they would have been, had more profit been involved.

I'd rather have 2008 medical tech in a for-profit environment than free 1990 level tech. This discrepancy is masked by the fact that silly humans share their tech around the world. Hence a society that produces much fewer treatments, per capita, can still offer the "best the world has" to it's population, "for free", even as they rely on other, more profit-driven societies, to do the lion's share of the work. Shameful.

 

[volatile]

Yet treatments for this and other diseases are slowed by the reduced profit in "free health care" systems. In the long run, more people die and suffer more misery because treatments and cures are delayed over where they would have been, had more profit been involved.

That is absolute nonsense.

Are you saying that there has been no healthcare innovation in the UK? In fact, by removing the profit motive by funding universities to do medical research, in certain cases, you actually encourage research into commercially risky but potentially beneficial areas.

In any case, the NHS buys drugs from drug companies. It's a guaranteed market, and one that allows people access to your products who would otherwise be unable to afford expensive drugs.

Nonsense, as I said.

I'd rather have 2008 medical tech in a for-profit environment than free 1990 level tech. This discrepancy is masked by the fact that silly humans share their tech around the world. Hence a society that produces much fewer treatments, per capita, can still offer the "best the world has" to it's population, "for free", even as they rely on other, more profit-driven societies, to do the lion's share of the work. Shameful.

Nonsense. In what way do "more profit-driven societies", by which I presume you mean the US, "do the lion's share of the work" in treating the sick in the UK?

Further, your argument is irrelevant. This has nothing to do with the matter at hand. The NHS is not about medical innovation, it is a system of healthcare provision. Drugs companies, medical equipment suppliers etc. are all run for profit in the UK; I can't imagine why you thought they weren't.

What does all that have to do with the fact that your country's healthcare system systematically and inherently discourages people to seek treatment for their illnesses? What kind of "healthcare" system actually predicates illness?

It's nonsense from beginning to end.

 

[volatile]

Insurance Policies Discourage Doctors from Counseling Alcoholic Patients: http://www.jointogether.org/news/headlines/inthenews/2000/insurance-policies-discourage.html

"Such catastrophic insurance often lacks primary preventive health care such as mammograms, prostate screenings and mental health care. Higher deductibles and co-pays tend to discourage early treatment, resulting in higher future costs for chronic or emergency crisis care." - http://www.pnhp.org/news/2007/september/about_singlepayer_i.php

"Higher deductibles and copays tend to discourage early treatment, resulting in higher future costs for chronic or emergency crisis care. Lacking access to basic screening, uninsured U.S. women are reported twice as likely to die of breast cancer." - http://www.thebell.org/blog/208/?q=node/57

"]Goldman v. Standard Insurance Company: Many private insurers that offer individual coverage in the event of an insured becoming disabled from working (e.g. long-term disability insurance providing income replacement, mortgage insurance providing house payments) impose blanket exclusions upon individuals who have mental health conditions, and/or who receive or have received psychiatric or psychological treatment. This underwriting practice is not supported by actuarial data, and instead reflects the assumption that individuals with psychiatric conditions are so likely to lose their jobs or to become unable to work that they are "uninsurable." As a result, thousands of working people are denied important, employment-related benefits, and are unprotected in the unlikely event of becoming disabled from working, whether due to a mental or physical condition. Moreover, from a public policy standpoint, these underwriting practices heighten stigma associated with mental health conditions, and discourage early and effective treatment." - http://www.las-elc.org/disability.html

 

[boooeee]

Off topic a bit, but something I've always wondered. If you have a house fire, your house insurance goes up. If you crash your car, your vehicle insurance goes up. What happens if you break your arm? Do your health insurance premiums go up? What about routine check-ups? Do they raise your rates? Does it get more expensive if you use your health insurance at all, or is there some threshold where it increases?

Laws and practices vary from state to state, but in general, no. If you bought an individual policy, your rate increase will not be tied to your specific claims history. You'll get the same increase as anybody else on the same plan with the same demographic characteristics. Also, in general, your policy is guaranteed renewable, meaning that the insurance company can't cancel your policy if you get sick.

An exception to this is a practice called "rescision", which has been getting a lot of press recently. This is when an insurance company retroactively cancels a policy if they determine that an individual lied on their application for health insurance. Sometimes, this is clear cut (the applicant answers "No" on the Pregnancy question, and they have a baby three months later). Sometimes, it's pretty shady (the company cancels a woman who developed breast cancer because she lied about her weight).

In group insurance, the company raises rates for the entire group based on the aggregate claims experience of that group. But, if you're a sick employee, you're not going to have to pay more in premiums than a healthy employee.

 

[boooeee]

From the article:

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.

Insurers say they do not ask prospective customers about genetic test results, or require testing. “It’s an anecdotal fear,” said Mohit M. Ghose, a spokesman for America’s Health Insurance Plans, whose members provide benefits for 200 million Americans. “Our industry is not interested in any way, shape or form in discriminating based on a genetic marker.”

It's an interesting issue, but the fear appears to be unfounded. Genetic tests are currently not preventing people from getting insurance or employment. I think what's really at play here is the psychology of not wanting to know if you've got a death sentence lurking somewhere in your genetic code.

I think this is irresponsible reporting by the Times. The article is stoking the fear that genetic tests will keep you from getting insurance, thus increasing the likelihood that people won't get tested.

 

[shadron]

I understand the concern over getting a genetic test done. When son #2 was diagnosed with Juvenile Rheumatoid Arthritis he was given a genetic test for Ankylosing Spondylitis. I worried that if he had the gene they were looking for, not only would he be at an increased risk for this disease, but it would give insurance companies a reason to not insure him. Fortunately, he doesn't have the gene and eventually he grew out of the JRA.

Yes. So now he knows he needn't worry about ever needing to get insurance to cover that potential problem in his future. As well, the insurers now know he's not a risk for that, and so may "cherry pick" by offering him cheaper insurance, making it somewhat more expensive for the rest of everyone else. Granted, that particular disease is not one that makes much difference, but suppose it was a marker for colon cancer, or prostate cancer, and asserted by a significant number of insureds. (Glad to here about your good luck, though ).

Insurers say they do not ask prospective customers about genetic test results, or require testing. “It’s an anecdotal fear,” said Mohit M. Ghose, a spokesman for America’s Health Insurance Plans, whose members provide benefits for 200 million Americans. “Our industry is not interested in any way, shape or form in discriminating based on a genetic marker.”

Perhaps. Industry spokesmen aren't what I would call ultimately reliable sources for corporate management insight [c.f cigarette manufacturers spokesmen over the last 50 years], and even if it is true, that's today, not 10 or 50 years from now.

 

[boooeee]

Perhaps. Industry spokesmen aren't what I would call ultimately reliable sources for corporate management insight [c.f cigarette manufacturers spokesmen over the last 50 years], and even if it is true, that's today, not 10 or 50 years from now.

Fair point. The interesting thing about genetic testing is that even if you prohibit insurers from using genetic testing, it still has the potential to crash the insurance market.

Insurance thrives on, needs, uncertainty. Because healthcare costs are unpredictable, people are willing to buy insurance and pool their risk with thousands of other people. However, even now, healthcare costs aren't completely unpredictable. You may not know if you're going to get bit by a bus tomorrow, but if you have diabetes, you know that somebody's going to have to pay for your insulin.

The fact that healthcare costs are somewhat predictable is why we have a health insurance problem, or crisis, or whatever you want to call it. If you're healthy, you're more than likely to opt out of buying health insurance (and hope you don't get hit by a bus). If you're sick, you're going to try your hardest to get covered. With healthy members opting out, this makes premiums more expensive, which leads to more people opting out, and you end up with a self-perpetuating problem (often referred to as a "death spiral").

Now throw genetic testing into the mix. Depending on how well genetic testing can predict your future health status, that's just going to exacerbate the problem of healthy members opting out and sick members opting in.

Because of this, I think some sort of universal coverage plan is inevitable in the US.

 

[LostAngeles]

It certainly does go up. That is why people can't afford health insurance. I work for a school district. In 2002, If an employee elected to take full family coverage with a $100 deductible, the plan would cost $986 per month. The district provided about $430. So, the individual would pay out of pocket about $540 per month.

Today, the same policy costs $2076. The district pays about $510. So, if a person elects for this coverage, they pay about $1550 out of their pocket per month These rates are icreased directly proportional to the use of the people in our district. So, every claim that is put in, results in a proportionally increased rate so that the insurance company will always make money.

This example is a group rate, but I assume that the same sort of thing is done on an individual basis as well. Bottom line is VERY simple. Insurance companies will NEVER lose money. If claims are submitted, premium goes up. No claims submitted, premiums go up less.

Yes. UCLA dropped BC/BS and went to United Health Care because students were making too much use of the student health services.

While at the student health center, I'm seen by doctors, N.P.s, and such, if I go outside to a department in UCLA Medical, I'm often being looked at by a med student or a med student will be present. Not that I'm complaining, but you'd think since I'm also educational material...

 

[volatile]

It certainly does go up. That is why people can't afford health insurance. I work for a school district. In 2002, If an employee elected to take full family coverage with a $100 deductible, the plan would cost $986 per month. The district provided about $430. So, the individual would pay out of pocket about $540 per month.

Today, the same policy costs $2076. The district pays about $510. So, if a person elects for this coverage, they pay about $1550 out of their pocket per month These rates are icreased directly proportional to the use of the people in our district. So, every claim that is put in, results in a proportionally increased rate so that the insurance company will always make money.

This example is a group rate, but I assume that the same sort of thing is done on an individual basis as well. Bottom line is VERY simple. Insurance companies will NEVER lose money. If claims are submitted, premium goes up. No claims submitted, premiums go up less.

Seriously? $1,500 a month in premiums?

The comprehensive, free-at-the-point-of-use NHS, which everyone has access to and which provides everything from GPs to surgery to A&E to physio to drugs to mental health care to geriatric care, costs the public purse approx. $3,000 per person per year. Y'all getting screwed over.

 

[Bob Blaylock]

There is no such thing as “free health care”.

If you had free healthcare at the point of use, this would not be an issue at all.

There is no such thing as “free health care”. Health care costs money — lots of money — and there is no way around the fact that it has to be paid for one way or another.

When people speak of “free health care”, what they usually mean is health care which is paid for by taxes, filtered through several levels of wasteful government bureaucracy; and which would unavoidably result in poorer quality health care, at higher total costs, than would occur under any free-market-based system. This is a very odd use of the word “free”.