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. (http://www.nytimes.com/2008/02/24/health/24dna.html?pagewanted=1&_r=2)

[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.:eye-poppi

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]

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”.

[volatile]

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”.

Ummm...Bob.

Hate to tell you this, but a) I didn't say "free", but "free at the point of use", and b) the post above yours explains just how wrong you are.

The NHS, the fully-comprehensive, cradle-to-grave, all-bases-covered-in-nearly-all-circumstances system, costs the UK taxpayer $3,000 per person per year from central taxation. In your wonderful, private-insurance option, not only do you pay more than me out of taxation for Medicaid you have no access to, you then have to fork out, if Kev's numbers are correct, another $1,500 a month on top for less comprehensive care, with "deductibles".

So, you can shout "which would unavoidably result in poorer quality health care, at higher total costs" for all you want, but the experiment's been done, and your hypothesis is proven false.

[volatile]

"Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This report—an update to two earlier editions—includes data from surveys of patients, as well as information from primary care physicians about their medical practices and views of their countries' health systems. Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill."

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678&#doc482678

[Soapy Sam]

It seems to me there is a danger for the insurers in genetic testing.
If gene x causes condition y and my insurer says I must be tested and I do not have gene X, then they will insure me against Y.

But if I do not have gene X, I do not need the insurance.

[Rolfe]

:jaw-dropp :jaw-dropp :jaw-dropp :jaw-dropp :jaw-dropp :jaw-dropp :jaw-dropp :jaw-dropp :jaw-dropp :jaw-dropp

There aren't enough jawdrops for this entire thread!

I wonder what Beerina and Bob Blaylock are orbiting. Volatile is exactly right. NHS care is hugely, vastly superior to the US system if one considers the little matter of access. It's main problem is waiting for non-urgent treatment. However, if your problem is urgent you will get treated. No question. Immediately. Nobody says, you can't be seen for your ruptured appendix or your myocardial infarction till next month! Even elective things are prioritised by clinical need, so someone in a lot of pain will get their hip replacement sooner than someone coping OK. And everybody will be treated, it doesn't matter if you're a top rocket scientist or an unemployed single mother with a heroin habit.

A lot of sniping goes on over the wait times, because some waits have been too long (and that is being addressed), and of course people who have to wait tend to bitch about it, often to the media, and guess what, that is instrumental in getting things improved. However, nobody would seriously trade a wait of a few weeks or even months for elective surgery free-at-the-point-of-need (is there any way to stop people just quoting that first word out of context?) for the chancy and wildly expensive US system. Anyway, France has a universal healthcare system that operates a different way, and they don't have waiting lists. So if that's your big gripe, go look at how the French manage it!

As someone commented on another thread, the reason some people get such quick service in the USA is that others, whose need may well be even greater, cannot access the system at all.

And waiting times aside, I've yet to be told about anything available in the US that wouldn't be provided to a patient who needed it in Britain. (OK, there have been occasional stories of people raising money to fly to the USA for some pioneering procedure, but that's a function of the relative affluence and the size of the US meaning that some things do emerge there first, not of strangulation of innovation in Britain.) Some drugs have been kept off the menu, but the reasons for that have been mainly lack of sufficient evidence of efficacy. How about this one? (http://www.theherald.co.uk/news/news/display.var.1982567.0.Six_weeks_ago_she_made_histo ry_now_Abigail_is_ready_to_play.php) Would that child have been treated any better in the USA? If that child had been American, would she have been assured of treatment, no matter who she was? Just what is it that the US system will provide to insured patients that won't be provided to patients in Britain (if possibly a little later in some cases)?

Beerina thinks that more people die and suffer more misery because of lack of innovation. This is "not even wrong", as they say. It displays such a complete lack of understanding of how such systems work, and in particular the way medical innovation just goes right on its merry way, profits and all, that I simply despair.

Bob Blaylock announces, in the teeth of all the evidence, that we "would" have poorer quality health care at higher total cost (than the USA, presumably), if we had - the system we actually have! News flash. We pay, from our taxes, a smaller percentage of our net income, to fund the whole caboodle, for everybody, from antenatal care to heart transplants, than you guys pay just to fund Medicare and Medicaid, from which you derive no benefit.

I doubt if you'd find ten people in Britain who would trade that for your system, on a bet.

And you're not even interested in considering it, because of spurious ideological objections that don't even relate to the real world. Wake up and smell the coffee.

Rolfe.

[Sir Robin Goodfellow]

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.


I see. Thanks for the response. Where I live, if I break my arm, I just go to the hospital and they do what needs to be done. I won't get a bill for treatment, but I'd probably have to wait all day to see a physician. There's no perfect health care model. It's such a complex issue. Politicians make it sound like such a simple issue, though.

[Rolfe]

I see. Thanks for the response. Where I live, if I break my arm, I just go to the hospital and they do what needs to be done. I won't get a bill for treatment, but I'd probably have to wait all day to see a physician. There's no perfect health care model. It's such a complex issue. Politicians make it sound like such a simple issue, though.


Actually, you probably won't have to wait all that long, unless you break it on a Saturday night. The press highlights the worst waits, but a lot of the time you can show up and be seen in 15 minutes.

Rolfe.

[Rolfe]

Sometimes, it's pretty shady (the company cancels a woman who developed breast cancer because she lied about her weight).


Seriously? What would someone caught in that situation actually do? Die?

What if someone's healthcare insurance is part of an employment package, and they then develop a health problem that means they lose their job?

What about the family shown on TV here last week, who had been relying on the wife's employment-related healthcare insurance because her husband had a chronic illness, and whose employer suddenly announced that coverage for family was going to be discontinued?

I'm so glad I'm not you, guys. I wouldn't swap places for any incentive in the world.

Rolfe.

[volatile]

Seriously? What would someone caught in that situation actually do? Die?

That or go bankrupt.

http://www.pnhp.org/news/2008/january/make_that_22000_uni.php

"In 2002, the Institute of Medicine (IOM) estimated that 18,000 Americans died in 2000 because they were uninsured. Since then, the number of uninsured has grown. Based on the IOM’s methodology and subsequent Census Bureau estimates of insurance coverage, 137,000 people died from 2000 through 2006 because they lacked health insurance, including 22,000 people in 2006."

Yes, you read that right. In 2006, 22,000 people in America died because they could not afford healthcare.

Go, free-market!

[Rolfe]

That or go bankrupt.


Well, yeah, I'd kind of assumed the bankruptcy. But then what? Will the woman get treatment for her breast cancer? Will Medicaid/care whichever give her her surgery and her radiotherapy and her taxol and her herceptin and all the followup tests and so on?

Should do, for what it costs, but I'm getting the crawling suspicion it's maybe not as simple as that.

Rolfe.

[Rolfe]

To get back to the OP, I think if it becomes easier and easier to predict the diseases someone will get, then universal healthcare becomes more essential. At the moment it's still just a small fraction of the population who are affected by things that will show up in the DNA. But as it gets greater?

The whole basis of the US system is premiums set according to risk, and now I'm realising that (just as with a house built in a flood zone that has flooded) the insurers can actually refuse to cover you for an illness you actually have.

That, my dears, is barbaric. I know of no other word.

The more this is likely to happen, the more you really will have to look at funding healthcare by premiums set according to ability to pay, at a rate sufficient to ensure the entire population gets decent care, and nobody is excluded.

And if experience in other countries is anything to go by, your costs will probably halve....

Rolfe.

[Sir Robin Goodfellow]

Actually, you probably won't have to wait all that long, unless you break it on a Saturday night. The press highlights the worst waits, but a lot of the time you can show up and be seen in 15 minutes.

Rolfe.


In my experience this depends. I live in a small city. During the day, there is no physician in the emergency department (or anywhere else in the hospital), as they are at their offices seeing patients. In the evenings, the doctors take turns covering the emergency room.


I needed stitches in my finger a few years ago, on a Sunday. If I recall correctly, I waited five hours for treatment. However, in that case, someone came in after me suffering from a heart attack, so, of course, that person had priority. I didn't mind. I wasn't going to die.


A few years later, I needed stitches again. This was a more severe injury (I could see tendons moving in my hand. It was kind of neat, in a gross way.) There was a paramedic assessing patients who did some initial first aid so I would stop bleeding on the floor. About an hour later a doctor sewed it up.


Wait times vary greatly for non-life threatening procedures. The worst cases are trotted out by those with an axe to grind, but by and large, the system works reasonably well.

[autumn1971]

The old "waiting time" canard is so pathetic as to be not worth replying to (but I will anyway). I actually finally have secured pretty good coverage for my family here in the States, even including dental.
My son went to his dentist recently (twenty dollar co-pay on a policy I pay about 500 dollars a month on) and was seen to have a cavity which, in the words of the dentist, "should be taken care of immediately".
Again, we're fully covered by a decent plan.
"When," I asked, "can he be seen to take care of this?".
"We'll make an appointment three months from now."

I am always struck by the fact that those who are determined to vilify socialised medicine always trot out the idea that even rich people are only treated like everyone else. These people are always horrified that they would ever have to endure the same treatment as the "working class". This is their entire argument. They are upset that they may not be treated as super-special.

[jimbob]

Autumn1971, further to your post; Rolfe (IIRC) has previously mentioned how his family has sometimes used private helathcare.

Just because we have univeral healthcare doesn't mean that we lack private provision.

It is just that for most people the vast majority of the time, the NHS is perfectly adequate.

[jimbob]

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.

That's economics for you, life is unfair.

Still, it is good to sacrifice your nation's health for the benefit of the rest of the OECD.

ETA:

Is there any evidence to back up that assertion?

[Rolfe]

The old "waiting time" canard is so pathetic as to be not worth replying to (but I will anyway). I actually finally have secured pretty good coverage for my family here in the States, even including dental.
My son went to his dentist recently (twenty dollar co-pay on a policy I pay about 500 dollars a month on) and was seen to have a cavity which, in the words of the dentist, "should be taken care of immediately".
Again, we're fully covered by a decent plan.
"When," I asked, "can he be seen to take care of this?".
"We'll make an appointment three months from now."


Wow. Change your dentist? Unless that wait is because he's the best in the county I suppose.

NHS dental accessibility is patchy. When I moved back to Scotland from England I thought I'd have to go private, because of all the bad press about people finding it impossible to access NHS care. Not so. I lost a filling while I was still living with my mother and looking for a house nearer my new job. I went to her dentist, the practice which had looked after my teeth since before I had any until I'd moved to England 25 years before. They took me back immediately. I was given an appointment within a couple of days, and the filling fixed on the NHS.

Then I had a checkup, because for various reasons I'd lapsed in England for a few years. Four cavities were found. These were fixed in two appointments within a couple of weeks.

Then we found the new house and moved. A couple of people told me about an NHS dentist in Roslin who was taking patients, but then I figured that 40 minutes drive back to the existing dentist wasn't so far, and decided to stay. The only problem I had was that when I lost a crown in January (provided on the NHS 25 years earlier), and got an appointment to have it fixed two days later, I wrecked a wheel of my car in a pothole on the way. I missed the appointment. The dentist said, show up after lunch if you can make it. I did. She squeezed me in and fixed the crown. All on the NHS.

It's just that I didn't go to the papers with that story.

I am always struck by the fact that those who are determined to vilify socialised medicine always trot out the idea that even rich people are only treated like everyone else. These people are always horrified that they would ever have to endure the same treatment as the "working class". This is their entire argument. They are upset that they may not be treated as super-special.


Well, if you're affluent, you can either take out private insurance, or pay out of your own pocket to go privately. Actually, you don't have to be that affluent. When I was a partner in my former business, I had BUPA cover because my senior partner wanted to protect against me having a wait for something that might be affecting my ability to do my job. I got a sinus operation out of it, so it worked out quite well. But if I hadn't had the coverage, I'd have got the operation anyway, and waiting two or three months wouldn't have killed me.

My mother had two glaucoma operations on the NHS, with a very short wait because it was clinically urgent. Her cataracts then started to deteriorate and her sight was no better. This was not deemed clinically urgent, and the wait was 13 months because of particular unusual circumstances (a ward had been closed for eye operations because of a couple of infection incidents). I deemed it to be socially urgent, because my mother lived alone and if she had fallen because of her eyesight she could have been in deep doo-doo. I urged her to go private. She was reluctant, because she "didn't want to skip the queue". I put it to her that by taking herself out of the queue she was letting someone behind her move up. I said that I'd pay for it if she couldn't.

In fact she was able to pay for it quite comfortably, even though she is a clergyman's widow on a pension. She went on to have her bathroom and kitchen renewed the following year, that's how bankrupt she wasn't. But if she hadn't had the money, she woudn't have been left untreated, she'd just have had to be very,very careful about the house for 13 months.

Why on earth should I want to trade this system for an insurance-based one?

Rolfe.

[Francesca R]

The whole basis of the US system is premiums set according to risk, and now I'm realising that (just as with a house built in a flood zone that has flooded) the insurers can actually refuse to cover you for an illness you actually have.

That, my dears, is barbaric. I know of no other word.I don't think this is "barbaric" in an emotive sense on the part of the insurer--it's quite rational and is a symptom of the problem of missing markets. You can't sell risk in a whole host of ways in a "free" market.

If society thinks you should be able to lay off risks such as medical expense for a disease already contracted, that is, society thinks it is barbaric, then that's where government intervention makes sense. Except to people who have set their head against such things . . .

[TragicMonkey]

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.

[..snip..]

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.

It's not exactly a bet. Insurance is the pooling of risk. Mary may or may not develop a heart problem. Say that 1 in 10 people do. So her chances are 10%, in her pool of one, of getting that heart condition. And if she does, she'll pay 100% of the costs of it. But suppose she clubs together with ten other people. One of them will likely get that heart condition. But when he does, it's okay, because they agreed to split the bill ten ways. He'll pay 10% of the cost. True, the other nine are paying ten percent each of the cost of a problem they don't have...but that's what they agreed to do. Each person agreed to because it was worth it--because each of them might have been the one unlucky one.

Of course, then what happened is they stuck for-profit businesses in charge of collecting the pools of people, ranking them by risks, and deciding what the costs are at all the steps, plus the overhead and need to make extra.

So you're right. One solution is to continue pooling the risk, but make the pool larger. Say that a state has a population of 20 million. Put them all in the pool together. They each pay 1/20,000,000th of the total healthcare expenses of all 20 million people put together. Some of those 20 million will be very expensively sick. Others will be healthy as horses. It should average out, unless everybody gets expensively sick, which would be a crisis beyond the mere monetary impact anyway. (People would worry about a lot more than the money if a whole state suddenly got cancer.)

There would be administrative costs, of course, but don't we already pay some body to administer things? As in, governments? Government has an advantage over private business: it doesn't have to pay taxes, and it doesn't have to turn a profit. So it's going to cost less than private for-profit companies. (And we'll also save because if the government's running it, we won't need to have so many government regulatory bodies to keep the private insurers in line, like we do now.)

I think the idea of insurance is sound, but it's too vital to the citizenry to leave it to companies to handle. Like the mail and the military and the roads. These are things for the public good, that the public needs, and that the public should be willing to spend public money on. Either way, you're going to have a bite taken out of your paycheck. I'd rather it went to actual healthcare and not to padding Aetna's coffers.

[El Greco]

It looks like that in spite of all our incompetence, long-term use of healthcare funds to cover other holes, long wait lists and unprecedented corruption, I have at least found something that we do much better than the US: Healthcare.

[Francesca R]

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.This is amusing because you seem to be complaining that the UK (for example) is freeloading off the US in respect of healthcare technology, like they are a bunch of patent thieves or something. Oh dear, are you serious? If so, what are you proposing should be done about that?

[Francesca R]

I think the idea of insurance is sound, but it's too vital to the citizenry to leave it to companies to handle. Like the mail and the military and the roads. These are things for the public good, that the public needs, and that the public should be willing to spend public money on. What is deemed too vital is the facility to have variable cost health services free-at-delivery. That's the public good, rather than the actual use of the service. Free-at-delivery will not ever be provided voluntarily by a profit-seeking mechanism. It's a question of whether you want it, not really of how it can be done if you do.

[jimbob]

El Greco, I have little knowledge of the Greek system, could you elaborate please?

Even better in this thread (http://forums.randi.org/showthread.php?postid=3484674#post3484674).

[dickenslover]

I see. Thanks for the response. Where I live, if I break my arm, I just go to the hospital and they do what needs to be done. I won't get a bill for treatment, but I'd probably have to wait all day to see a physician. There's no perfect health care model. It's such a complex issue. Politicians make it sound like such a simple issue, though.

Where I live, I had to wait 6 hours in the emergency room to receive stitches in my foot. I wasn't a high pain priority, true --but when the doctor finally stitched me up, she commented that if I had waited any longer, it would have been too late to stitch me up. Had I waited another half hour, I would have found myself with a foot that needed 12 stitches (but couldn't get them), a waste of a day of work & an emergency room co-pay (minimum of $50). Other countries do not have an exclusive on having to wait for treatment.

[jimbob]

dickenslover, what country do you live in, please?

[Wheezebucket]

Last time I went into the emergency room was for a kidney stone. I don't know if you know what that's like, but...they suck - bad. I had to wait for almost 2 hours in the waiting room trying not to scare people with my moaning and writhing, and then wait another hour and a half laying down waiting for the doctor. By the time someone showed up, I had almost finished passing the stone. Another few hours later, after a quicky cat scan, they said it was gone but I had another one coming that they couldn't do anything about, gave me a pee filter (to catch it so they could analyze it later, like I was going to come in and pay a million dollars for that) and a bottle of vicodin and sent me on my way. My bill was roughly 3,200 dollars. I spent maybe 10 minutes with a doctor, 30 total being assisted. This was in Minneapolis, Minnesota. I was (and am) uninsured. I'm still paying it off to this day, only I had another visit from a year early I was still working on paying off. On my tiny, tiny budget, this is unmanageable.

I don't care for our system. I would like NHS, please. I'm more than willing to pull my weight, but these thieves (excuse me, insurance companies) are bleeding me dry and I can't keep up. I don't smoke, I eat relatively well, I take care of my body - but, like everyone, I need medical assistance sometimes. As it stands, one more trip to the doctor and I'll have to spend virtually all of my yearly income just paying off medical bills. It's difficult to live like this.

Oh well.

[Sir Robin Goodfellow]

Last time I went into the emergency room was for a kidney stone. I don't know if you know what that's like, but...they suck - bad. I had to wait for almost 2 hours in the waiting room trying not to scare people with my moaning and writhing, and then wait another hour and a half laying down waiting for the doctor. By the time someone showed up, I had almost finished passing the stone. Another few hours later, after a quicky cat scan, they said it was gone but I had another one coming that they couldn't do anything about, gave me a pee filter (to catch it so they could analyze it later, like I was going to come in and pay a million dollars for that) and a bottle of vicodin and sent me on my way. My bill was roughly 3,200 dollars. I spent maybe 10 minutes with a doctor, 30 total being assisted. This was in Minneapolis, Minnesota. I was (and am) uninsured. I'm still paying it off to this day, only I had another visit from a year early I was still working on paying off. On my tiny, tiny budget, this is unmanageable.

I don't care for our system. I would like NHS, please. I'm more than willing to pull my weight, but these thieves (excuse me, insurance companies) are bleeding me dry and I can't keep up. I don't smoke, I eat relatively well, I take care of my body - but, like everyone, I need medical assistance sometimes. As it stands, one more trip to the doctor and I'll have to spend virtually all of my yearly income just paying off medical bills. It's difficult to live like this.

Oh well.



Did you ever think of emigrating north? We need workers up here...

[a_unique_person]

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:



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:



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. (http://www.nytimes.com/2008/02/24/health/24dna.html?pagewanted=1&_r=2)

Australia has community rating by law. Everyone gets insured, at the same rate. People can only be turned down if they want to join up the day after they find out they have some medical condition, and expect to get treated the next day, but that only means their application will be delayed.

[shep]

Only skimmed the first page, but thought I'd try out my angle on the silliness of 'health insurance', as inspired by economist Tim Harford (second time I've brought him up this month!)

People have already brought up the 'uncertainty requirement' of insurance, I see, though I feel it's not quite that simple... there was the assumption of uncertainty, but there was also inside information.

In the past, and largely in the present, it was the clients who had more certainty than the insurers, and this in itself has led to an inefficient system. I might have been pretty sure I was going to get heart disease because my father and grandfather did, but I wasn't going to tell that to my insurance company... they can ask me if I'm a smoker, about pre-existing conditions, etc., but it's all fairly generic stuff and still doesn't give the insurers much to go on, to rate me as low/medium/high risk. The result is that most people pay high premiums. I think.

Now, with all this new knowledge of the human genome and the possibility of DNA testing, this insider knowledge is going to disappear, and insurance will basically be pointless. People who turn out to be high-risk won't be able to hide it from the insurers, and will have to pay premiums so high that they may as well save up themselves for private treatment. People that are low-risk will still pay low premiums, but might opt not to get insurance at all.

Disclaimer: I have very little experience with insurance. I do have health insurance, but in NZ it's not needed to get health treatment, we are covered by lots of complicated programs like ACC and PHOs, etc. I do think it's an interesting topic though.

[WildCat]

Australia has community rating by law. Everyone gets insured, at the same rate. People can only be turned down if they want to join up the day after they find out they have some medical condition, and expect to get treated the next day, but that only means their application will be delayed.
That sounds like a sensible system, similar to what I've advocated for here.