Tuesday, June 12, 2007

Much ado about (not much)

We've addressed the issue of genes and underwriting before, so why bring it up again? Well, Dr Hsien-Hsien Lei (formerly of GeneticsAndHealth, and now at EyeOnDNA) is once again concerned about the use of genetic information in insurance underwriting. So what new information has come to light?
I'll let the good doctor fill us in:
[ed: BMJ is the British Medical Journal]
A quick search of Thomas (and Google) reveals that there's really not much actually happening with this issue, which doesn't surprise me (what with a presidential election coming up, and the recent brouhaha on immigration). I'm just not convinced that this is a particularly urgent problem.
I'm also unconvinced that it's any kind of problem: there seems to be a lot of fear-mongering on the issue in Dr Lei's post (although, to be fair, it's mostly in the comments section, by folks who are woefully ignorant of the underwriting process). These seem to boil down to two items of contention:
First, that somehow carriers will be able to use one's genetic info to make underwriting decisions about one's family members. Aside from the fact that this kind of information isn't shared among carriers anyway, it certainly isn't used to pit the insurance interests of family members at odds.
Second, to the extent that such information is helpful to an underwriter, it's in the realm of pricing (or whether or not to offer coverage at all). It's really no different than knowing whether or not the applicant is a smoker, or a diabetic, or recently had knee surgery. All of this goes into the mix, and genetic information may (or may not) play some role. There's nothing particularly sinister about it (and since I'm a member of a group in which this might be an issue, I can speak with some authority on the matter).
One of the folks involved in the BMJ debate, Prof Soren Holm, opined that "if we allow insurers to have some kinds of health information, such as a person's BMI or cholesterol level we no longer have any principled reason for excluding genetic information." I think that's exactly right: as noted, carriers need as much relevant information as they can get to adequately assess the risk.
That key word, "relevant", is important: underwriters really don't care whether you're a redhead, blond or bald. Neither the color of your eyes or your skin makes one whit of difference in your rate. Prof Holm concludes that "[g]enetic information is not special. It is not inherently more specific, predictive, sensitive or private than other kinds of health information." Right again: it's really no different than your height or weight, or whether or not you smoke.
The danger is that a carrier might conclude that, due to a genetic predisposition, one might become a diabetic, and therefore either decline, or charge more for, someone with that marker. As indicated before, this isn't legal here, nor is that likely to change.
In a related article, a potential insured asks if testing positive for a genetic marker for breast cancer would affect her future ability to purchase insurance. Aside from the legal reasons why this would not be the case, there are practical ones: insurance applications don't ask about genetic tests.
Again, there's just no there there.
Frankly, this seems to be a non-issue.
ADDENDUM: In re-reading this post, it occurs to me that it's unnecessarily harsh regarding Dr Lei's position. She posits an understandable (and often justifiable) skepticism about how insurers might use the results of genetic testing. Inasmuch as current laws pretty much prevent insurers from using such results, I don't share her concern.
On the other hand, if those restrictions were to be lifted, I would definitely want to reexamine the issue.
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