Finding Genes That Fit

Ezra Klein makes the convincing argument that sub-$1,000 human genome sequencing procedures means the end of the health insurance industry as we know it.

At the moment, our understanding of the genome remains relatively crude, and our ability to predict future health risks based off of genomic sequencing is limited. But we’re getting better at it. For instance, women in families with a high rate of breast and ovarian cancer can have themselves tested for alterations in the BCRA1 and BCRA2 genes. If they test positive, it means their risk of developing breast or ovarian cancer is significantly higher.

As we sequence more genomes, mine more data, and conduct more studies, we’ll find a lot more of these connections. Eventually, genomic testing will be a powerful predictor of future illness. And it raises the potential that young people will get themselves tested and then purchase insurance based off the result. So those with a clean genomic result might go for a cheap catastrophic plan, while those with a high risk of developing pricey illnesses will opt for more comprehensive insurance.

The result would be, in insurance terms, an “adverse-selection death spiral,” as the healthy opt out of expensive insurance, the sick opt into it, and premiums spin out of control.

So yes, regardless of what thick-headed Republicans think about the HORRORS OF SOCIALIST OBAMACARE, the reality is that widespread accurate and cheap genetic testing will be the norm in about a decade or so, give or take a few years.  Insurance companies will insist on knowing what's in your genetic cards before you get insured, and so will employers, potential spouses, etc.

Before he left office, Dubya signed GINA, the Genetic Information Nondiscrimination Act, into law.  Literally everyone in Congress voted for it except for Ron Paul.  GINA says that genetic information cannot be used to deny coverage or raise insurance rates on people.  What it means is smart people will get tested and then buy appropriate insurance.  Since insurance companies exist to guess rather than know, and they can't use that knowledge to set your insurance coverage, they're suddenly in real trouble if all the folks with the genetic predisposition towards disease buy insurance and all the less likely folks buy cheap stuff because they know they won't need it.  That's going to bury the insurers and they know it.

So no, it doesn't actually matter what happens to the PPACA.  It's not going anywhere, really.  Neither is GINA.  But insurance companies?  They're going somewhere.

Straight down the crapper.