Genetic Screening

GENETIC SCREENING….Healthcare plans are in the news, and a couple of times lately I’ve made offhand statements about how national healthcare is “inevitable.” But it occurs to me that the last time I explained why I believe this was about six months ago, well before I had comments on this site.

So here it is again. There’s nothing original here, and my argument has nothing to with political ideology. It’s entirely technical.

The problem is the increasing effectiveness of genetic screening. There’s still room for dispute about how accurate this kind of testing will ever get, but let’s stipulate for the moment that in the next 10 or 20 years genetic screening becomes pretty accurate for a fairly wide range of diseases.

When that happens, private insurance is no longer possible. Here’s why:

  • If screening is done on a widespread basis but the results are kept confidential, people with high risks will all go out and buy more insurance. Result: this is a classic case of asymmetrical information, and the insurance companies go bankrupt.

  • Conversely, if the results are shared with the insurance company, they will decline to insure anyone with a high risk for an expensive disease. Result: very large numbers of people will be completely excluded from receiving healthcare for serious (often fatal) illnesses.

In both cases, the system fails. Either the insurance companies go broke, or else the ranks of the uninsured swell to enormous numbers. Even large group plans would start to feel some pain as people began making employment decisions based on the results of genetic screening tests.

This is why single payer national healthcare strikes me as inevitable. Only by insuring everyone and spreading the risk across the entire country do you make individual riskiness unimportant.

So the only real question left is a technical one: how good will genetic screening get? There are certainly limits to its accuracy, and it will never yield anything more than probabilistic estimates, but probability is what insurance is all about. Move the odds a bit, and the whole system falls apart.

The unfortunate thing is that this problem will creep up slowly as these tests get incrementally better over time. As this happens, and political pressures build, we will apply small patchworks to the existing healthcare system, and we will do this over and over until we have a rickety edifice that is literally the worst of all possible worlds. On the other hand, if we put away the ideology and understood the changes that technology is going to bring, we could work now to build a system that makes sense for the future. In the long run, we’d save a ton of money and a ton of anguish.

But there’s not much chance of that because everyone sees this as a partisan issue, not a technological one. That’s a shame.

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