According to an ABC report http://www.abc.net.au/news/stories/2009/09/07/2678070.htm people are refusing to take tests that might detect a genetic susceptibility to particular diseases, because it might prevent them taking out life insurance.

This set me thinking. The purpose of insurance is to spread risk across a large group who pool sufficient resources to cover the average risk. While most won't collect, a few will, and for them the money will ensure that the happening of the insured event is not financially catastrophic.

We accept that insurers should be able to discriminate between risks. Younger drivers pay higher premiums, teetotal drivers can get cheaper premiums. Premises where food is fried at high temperature will pay more for insurance than say a clothing retailer, because of the fire risk. If you build a house in the middle of a flood plain you may not be able to obtain flood insurance.

But all these are generally examples of things that you can opt-out from. No-one forces you to drive, or cook fish and chips, or live in a flood plain. But we can't choose our parents, and so have no control over our genetics. So should insurance of the person proceed on the same principles as insurance of things?

I'd be deeply troubled if health insurers were allowed to penalise people with genetic susceptibilities because of the increased risk. Discriminating against people who have unhealthy habits is also problematic. Part of my reasoning here is that health insurance is really part of the apparatus of social security these days, and social security ought to be as widely available as necessary.

But I'm not so sure about life insurance, which is in my view more optional than health insurance. Although we all probably have death cover as part of our compulsory superannuation.

So what do others think? Where can you draw the line? Should insurers be able to take increased health risk into account?

The era of genomic medicine is upon us. At the moment you can get your genome sequenced for about $40K. When this gets to under $5K and eventually under $1K, genome sequencing will be a matter of routine, like x-rays or allergy tests. Once done, the genome features will remain on file, so that medications and treatments that are likely to work can be prescribed, and those that are potentially harmful can be avoided. Make no mistake, this sort of research is being conducted right now.

I think that because of this, insurers may actually end up penalising those who do not have a genome on record, as this will then constitute an unknown risk to them. At least if you have your genome sequenced many of the genetic risk factors will be known and can be managed.

Crocodile tears, Graham. You supported the Howard government to the hilt, even while it tried to hand over our universal healthcare to the insurance privateers, and you continue to protect Turnbull via editorial interference.

Hypocrisy notwithstanding, insurers are businesses and are expected to configure their coverage for maximum return. No-one with a genetic predisposition to disease should include private cover in their plans.

Thankfully, we have a public system that protects all Australians, and which the private-care-dominated US is attempting to emulate.

Graham Y >'I'd be deeply troubled if health insurers were allowed to penalise people with genetic susceptibilities because of the increased risk'.

I can't imagine that the insurance companies would be able to penalise people in these cases because there is only a genetic possibility they might develop a disease or disorder.
However, I know they already penalise people whose parents have high blood pressures or diabetes, so who knows?

Sancho, we do indeed have medicare that is supposed to protect all Australians, but only those who are prepared to wait (unless it is a dire emergency)!

Personally, I could never give up private health cover because I have worked in both private and public hospitals all my life and I don't want any 'Doctor Butcher' who is the only one on call on the night I present to emergency at a public hospital!
I want to choose who I see.

I too heard the story and I think it is much more about life insurance than health insurance.
It is even being used to check suitability for some jobs.
In some instances used like a criminal record check.
However unfair it is you can expect it to be used
Insurance has always been about money and risks.

It would be very concerning if insurance companies could refuse insurance or raise premiums (to unaffordable) for those with genetic predispositions. Lets face it we are all gentically disposed to something.

Insurance is about spreading the risk. The risk is no more for someone predisposed to diabetes if they live a healthy life than for anyone to be hit by a bus. This is one of those cases where as a collective we can ensure that others are not disadvantaged (or their families) should they meet an untimely death, for those who choose to take out insurance.

Is this the start of a new brave world: (I can see it now - the year is 2090 and all the genetically predisposed humans have been hived off to live in the sewers, or have died through natural attrition and only the super human clones have survived. Vaccines for cancer and diabetes are only available to the rich and the sub-humans who dwell in the tunnels under the city live with the threat of whooping cough and other diseases everyday. Life insurance is not available to the sub-humans who are at greater risk of disease. The super clones enjoy low premiums and the only deaths ever recorded are from accidents from the airborne automotives that whip through the skies at ever-increasing speeds...)

Thanks Graham. One of my pet topics.

The mathematics of insurance have always fascinated me. People put money into a pot, some of it is extracted in the form of sales commissions, management fees, administration costs and the like, and the remaining amount is divided out between people who qualify for a payout.

So by definition, there will always be losers, i.e. people who put in but do not take out. These people are prepared to pay that price in exchange for some form of peace of mind.

But there is another dimension.

If you are in control of the pot of money, you need to hedge your bets sufficiently that you always pay out less than you take in. Like bookmakers, you adjust your rules to the volume of money coming in from a particular direction; if you are more likely to pay out on people with a genetic disposition to, say, heart attacks, you either restrict the number that you insure in that particular category, or you raise the price.

Problem is, if you increase the cost by too much, no-one will play your game. And if you prevent too many people with pre-dispositions, you will end up insuring people who don't need insurance. And it won't be long before they notice.

So it is going to be a balancing act for a good while yet.

Fortunately, it doesn't apply so much to our private health insurance system, which is "community rated". So everyone can play, genetically disadvantaged or not.

All
Personally I'm not convinced that base services non discretionary services should be in the hands of "for profit" organizations this includes Super and health insurance and no this isn't Communism/Socialism by stealth. I do believe some things are rightfully in the realm of Capitalism.

Pericles,
Your theory is right but in practice there are more low risk customers out there so insurance companies don't give a toss if they exclude least profitable (unwanted) categories.
Some car comprehensive insurance financially exclude young drivers in favour of the older more staid ones.

dear Sancho,
A little bit of personal experience of mine . In Feb 2006 I had a stroke and after seeing a doctor in the public health system, He told my friend that I would not last till morning. He wrote me off. As i was totaly incapasitated and could not even pee they kept me under observation and did nothing for me. I thank God for private health cover because in the public system I was assessed past treatment but even though it was the weekend when they were made aware of my mbf cover I was imediatly transfered to a private hospital where diogneses and treatment was started imediately The stroke is genitic and the specialist said I would have another and die. I thank God daily that the specialist does not have the final say for none of us know the hour of our death and doctors are only fallible like the rest of us . This old adage is still true today
"if you fail to plan you plan to fail". Don't leave your future in the hands of others or you may not like the outcome when it arrives.
In this nation the Government has taken the place of God as our provider and are doing a very poor job as managers. They can't even make it rain So they should stop trying to be our fairy God father and get back to basics.

Good topic.I've had similar thoughts.What access do the insurance companies have to our medical records via Dotors?Could Drs be paid secret commissions for access to our medical records?

The corporates want profits without the risk.They want perfect knowledge,but if the the punter at a roulette table or a card table has the ability to slant the odds in our favour by having a good memory,all bets are off.What is good for the goose is obiviously bad medicine for the gander.

It isn't necessarily access that matters, Arjay.

>>.What access do the insurance companies have to our medical records via Dotors?Could Drs be paid secret commissions for access to our medical records?<<

When you take out insurance of any kind (except private health insurance) there is that magic question on the proposal form, which asks whether there is anything else they should know, before they issue cover.

If you don't disclose, then claim, I think you'll find that it is at that point that they are allowed to investigate. If you have hidden anything, your claim is history.

This goes to the heart of Graham's question.

If your enquiry into your genetic makeup throws up a result where you are statistically more likely to have a heart attack, what can you do?

If you disclose, they will - understandably - up your life insurance premiums. If you don't, you leave behind a possibility that your beneficiary will be dudded.

But the sting in the tail might arrive if the insurance companies themselves ask for the tests to be performed - much as they ask for a medical checkup today. If you refuse to have the tests, they might not insure. If you do... see above.

You're damned if you do, and damned if you don't.

Pericles,
You are absolutely right it all comes down to "did you know" in other word your intention to defraud.

If insurance companies get the right to demand genetic tests then an argument can be mounted that insurance is betting on human life philosophically the ultimate blood sport wager?)or a financial way of (de)valuing a human life. In effect a person with a genetic flaw (a genetic propensity not always absolute) and their family's lives are less valuable than some one else. Yet in reality the contributive worth might be the other way.

As it's discretionary that's fine but Life companies precluding workers for super....that's wrong, wrong, wrong (period). Hence my concern over for profit super and health care.

My short answer is no, they should not be able to discriminate. With just about any other form of insurance the answer would be "yes". But not with health insurance. The reason is a little complex.

Insurance lets us share the load of unpredictable and infrequent disasters. It works well because the moment something becomes predictable (eg a bush fire might destroy your house), you can do something about it - like move house. And the moment you can do something about it, it sounds reasonable to me that you shouldn't be a burden on the rest of us if you choose not to, and coincidently your insurable goes up.

Bad genes are also a infrequent and unpredictable disaster, of course, but you can't do something about it when you find out about them. Changing bodies isn't as simple as changing house. And since it isn't, it does seem unreasonable to me that we all share the burden.

Where this becomes interesting is when a person does know there is a high likelihood of getting bad genes into the pool, but proceed anyway. When does that happen? When the parents know they are the carrier of some horrid genetic disease, and don't take steps to abort any foetus who they pass the bad genes onto.

So here is a question that isn't so easy to answer. When that happens, is it reasonable to hike the health insurance for the resulting child? I happen to think the answer is yes. But with that answer comes another consequence. The insurance companies will then in effect become arbiters of what genes are allowed back into the gene pool.

Oh, what a tangled web we weave...

That's ok then, rstuart.

>>no, they should not be able to discriminate. With just about any other form of insurance the answer would be "yes". But not with health insurance<<

Health insurance is non-discriminatory, by law.

The only qualification is to be alive.

Pericles: "Health insurance is non-discriminatory, by law."

True. My mistake. I don't know why I wrote "health insurance". I meant intended my comments apply to any form of insurance.

Pericles,while it is true that lying about your health at the time of taking out an insurance policy can negate a claim;what if during the time of the policy you develop a disease that limits your lifespan?Can your insurance company then increase premiums at will because of this new found knowledge? Insurance companies can increase premiums each yr beyond inflation,so if they have inside medical info, they know that you are between a rock and a hard place in terms of taking out a new life policy.

Medical and genetic info should be with held from all insurance companies.It is time to get back to mutual societies that exclude corporate rapacious greed and Govt waste.

There's no need for the polemic, Arjay, you are on the right track.

The idea of insurance is to spread risk across a community.

If you define too narrowly the community that you insure, then the entire objective is lost.

Instead of insurance having a community purpose, it simply becomes a means to make a profit from the misfortunes of others.

A bit like lawyers.

And politicians.

How can ya keep any sort of information away from anybody.
Science has the tools to fix genetic problems.
So the problem is selected.
In breeding is definately a problem.
People mate with any one at any time you don't even have to know the persons name.
40% of woman don't know the father of their child, weather they are married or not.
Children with problems are becomming one of the biggest problems we have.
Insurance is a private business, if ya tell them lies or withhold imfo they will get ya in the end.
Of course ins will discriminate against people with genetic defects, wouldn't you if you were an employer, or any other sort of buisiness
Au has a very small population and this was always bound to happen.
The solution can only ly in the hands of human nature, which will never happen

“So what do others think? Where can you draw the line? Should insurers be able to take increased health risk into account?”

I don’t see how one can draw a line since genetic susceptibility is often a result of environmental exposure where one may become cannon fodder for a rogue industry and the DNA damage can be passed onto the progeny.

For instance recent scientific findings are consistent with animal studies that have shown low-level, chronic exposure to radiation, such as from the fallout of bomb tests, can cause some genetic mutations that are passed to the next generation.

Such mutations can be traced to radiation exposure affecting sperm at a critical phase of its development.

Other researchers learned after sampling and genetically profiling many gull families is that colonies close to integrated steel mills transmit DNA mutations to their offspring more frequently than those at rural sites.

In addition, the closer the colony to steel mills, the higher the mutation rate. Here’s an easy to read evaluation:

http://www.science.mcmaster.ca/biology/faculty/quinn/Detecting%20Induced%20Heritable%20Mutations%20in%20situ3.htm

And recently I read that victims of the drug thalidomide have now given birth to progeny with similar afflictions. Why should they be penalised?

There is currently scientific controversy over the mutagenic chemicals present in diesel exhaust that are inhaled where the body metabolizes them into activated substances that damage DNA by reacting with it to form adducts. If this damage is not repaired by the cell before the DNA is replicated during cell division, mutations may be introduced that persist through future generations of cells. How do these mutations impact on the DNA of progeny?

May I suggest that all pollutant industries that fail to rein in their carcinogenic, mutagenic and teratogenic emissions, pay an insurance levy anyway, to cover the potential costs of life insurance for the afflicted, no matter the point source of exposure?

I contracted a persistent fungus on my <snip>'s some 12 years ago and my GP and I considered a pill for same as opposed to just a topical treatment.

Previously, we had noted that there was a history of "Haemochromatosis" in the family and had therefore to consider that the "toxicity" of the drug may not be able to be coped with by my liver.

Accordingly, we requested a test from a geneticist who responded with something like:

"You are 80% unlikely to have the condition."

Even so, based on family history alone and after re-consideration of the matter, my gp declined to prescribe and left me with canestan cream (approx $AU0.80 per 10g in Indonesia)

Interestingly to me, what hasn't been differentiated in this thread so far is that whilst only the likelihood of susceptability can be predicted at this stage in the instance of certain pathology, other known hereditary conditions can be determined with almost 100% certainty.

And I believe that includes conditions that manifest at a particular stage in life, say at or around puberty. So I suspect that some will make strong argument that in certain cases certain conditions which have yet to fully manifest would still constitute a pre-existing condition? Yes/No/Maybe?

Tangentally, I know one Dr, a professor of cancer no less, who strongly advocates for (from memory) 1st trimester down syndrome tests with a view to terminating such pregnancies.

..

Thereafter, this matter raises questions of the sort of society one wishes to have. Idealistically speaking I would like to see our "democracy" evolve a system where the safety net incorporates food, water, health, housing, legal and appropriate insurance.

Is it mathematically viable though, and note that obviously some will have to be paid less? What is the wealth of the nation? How many people are there? And can't we come up with productive work for "all" given we have so few people?

It really does concern me that Australia does price itself out of many gainful pursuits resulting in an overall detriment to our development.

A very unsettling topic. I imagine that insurance would be the first step in any 'Gattaca-like' developments (for those of you who have seen the film).

On the one hand, it's something that concerns me greatly however at the end of the day I'm reassured by the fact that if the insurance companies go too far then like any industry they risk a consumer backlash and the companies with less discriminatory policies will leap into the fray.

However, it would still result in a class of people opting for the cheaper health insurance that they're entitled to.

It all comes down to how large a demographic this 'healthy' sector is. Are they a juicy enough carrot to sustain a large insurance multinational?

Or, will spiralling rates of obesity, heart disease, sedentary lifestyles and cancer mean that the unhealthy demographics ensure they are priced into the market via sheer numbers?

TRTL

Glad to see you back online.

I had a thought (tada!) while reading your post - the emphasis by many politicians for us to breed, which has big business as its catalyst.

A big enough demographic to cover the risks for insurers? Fits with 'growth-at-all-costs' economics.

Another advantage with a large enough population, insurers can afford to discriminate against the high risk categories. None of which fits with sustainable economics, but we are as far from that path as we have been for the past 30 years.

Glad to be back.

Fractelle, you say that these large demographics will allow them to discriminate against high-risk categories. Isn't that already the case? If somebody with a known health condition steps forward, wouldn't they be paying a higher premium?

The strides forward in genetic testing, I would think, wouldn't necessarily alter the percentages of the population that are discriminated against. I guess my point is that there is a very large chunk of the population which is unhealthy. That percentage wouldn't necessarily change with more testing, just become more defined, and the riskiest and healthiest people would be small groups on either end of that large, not-too-healthy-but-not-dying mass in the middle.

TRTL

<< If somebody with a known health condition steps forward, wouldn't they be paying a higher premium? >>

Absolutely.

Already there are discriminations, and, as you say, with the advancement in understanding genetics, something I am sure the insurers follow closely, this bias will indeed be refined further.

One thing we will not hear a lot about from insurers is that genetic susceptibility is not a guarantee that an illness will occur - environment plays a significant part. Now a healthy environment is one where people eat healthy non-chemical food, grow in low density housing free of pollutants, have easy access to parks and other forms of exercise. Like that is going to happen any time soon.

Insurers will take the more cynical approach that we are unlikely to create an ideal world, therefore we need enough people to maintain the status quo. Such is capitalism.

http://www.decodeme.com/

Hmmm .. interesting stuff.