How could the results of genetic testing affect insurance groups and rates?
This is a very interesting issue because on the one hand, if you or I test positive, let us say, for a gene that is going to predispose us to one or the other genetically related condition, we are going to have a very large incentive to purchase as much insurance, whether it's life or health or long term care insurance, as we possibly can. And if the insurer to whom we go to buy this insurance doesn't know of the condition, we are really violating a principle of justice. We are acting on the basis of information that we have but they don't. So, one could argue, on the basis of the principle of justice that the insurer ought to know as much about us as we know about ourselves, at the very least, in order for this to be a fair business transaction. And yet if they do know about it, it's unlikely that we are going to be able to purchase the insurance we want.
Which has led me to think that the one way around this really tough dilemma is to push for universal health insurance as President Clinton tried to do in 1992. The idea being that for any of us who work for a large institution, as I do say, at Stanford, I can purchase life, health, and long term care insurance, without ever being tested medically or genetically because the group is large enough to spread the risk over a fairly large pool. So I could be anonymous in that group because the actuarial data suggests that when you have a group of 10,000 people, you're able to distribute risks fairly equally across the board and set premiums on the basis of actuarial data rather than on individual data about each employee. But if I'm self-employed or if I work for a very small employer who cannot afford a group policy, then I'm going to have to be tested before the company will sell me insurance.
Therefore, what I've argued is that we have to encourage individuals and small employers to band together in health insurance purchasing cooperatives to get the benefits of group coverage which otherwise would not be available to them. And that's, in fact, what President Clinton tried to do in 1992. It was misinterpreted, I think, and politicized and we had these health insurance alliances that became heavily criticized as instruments of the take-over of medicine by big business, which was completely false.
So, this remains a really major issue.