Tim Worstall

Gene Testing and Insurance.

I’m not sure whether I really understand what’s at issue here. Why shouldn’t insurers know the resilts of gene tests when setting insurance rates? For example:

Women who inherit damaged versions of the BRCA genes have between 40
and 80 per cent chance of developing breast cancer at some point in
their lives. Approximately one in 850 women in Britain inherit a faulty
BRCA1 gene.

Pretty high probabilities there. Yet:

An alliance of 45 leading charities, unions,
scientists and lawyers will today call on the Government to ban genetic
discrimination. They include the Alzheimer’s Society, Breast Cancer UK,
the Disability Rights Commission, Macmillian Cancer Relief, and Gene
Watch UK, which highlights the ethical questions surrounding genetics.

Dr
Helen Wallace, the deputy director of Gene Watch UK, said: "People
should be able to make the difficult decision about taking a predictive
genetic test on health grounds alone without the fear that it could
affect the financial implications. Genetic testing should not become a
vetting tool for employers and insurance companies."

I could understand (although still might not agree) if being unable to get medical insurance meant that one could not get treatment but that’s not the situation.

At one extreme one can look at it this way. Someone is tested and knows they have the BRCA mutation. They then go and buy shedloads of the various insurances…this is screwing the insurance company which is pricing it on the general population, not the more detailed knowledge held by the individual.

Maybe there is an argument that the insurance companies should not be allowed to use such tests but it hasn’t been explained to me as yet. Anyone want to try?

In

11 responses

  1. Peter D. Avatar
    Peter D.

    The reason that some people object to insurance companies getting the results of gene tests is that if the company correctly priced the premium the person might not be able to afford insurance. I agree that this might be the case, especially in the early stages of policy pricing, because the insurance coy might price the policy higher than subsequent history will show is appropriate.
    However, the reverse of this is that the person of high risk gets relatively cheap insurance. This costs either the insurance company, or its other, low risk, policyholders.
    The consequences of this are that, either; a) the insurance company goes broke, or decides not to offer the type of insurance sought. This benefits nobody, certainly not the people who are at high risk and want insurance. Or, b) the people of low risk who view their insurance premiums as too expensive and then withdraw from the insurance marketplace, and are no longer subsidizing the high risk people. The premiums for the high risk people then go up to the level appropriate to their actual risk level.
    So, whether the insurance companies are allowed to access gene test results or not, the market will eventually sort this out and price risk appropriately. And that’s gotta be a good thing. Ain’t markets wonderful.

    Reply
  2. Rob Read Avatar
    Rob Read

    It should be strongly recomended to purchase insurance BEFORE starting the testing.
    Insurance works on prior odds.
    I’m sure specialist insurance could be developed.

    Reply
  3. Rob Read Avatar
    Rob Read

    It should also be compulsory to purchase pre-birth insurance for your children (so the state can eliminate disability benefit).

    Reply
  4. N.I.B. Avatar
    N.I.B.

    …and if you refuse to or “can’t afford to” buy the insurance, or if the tests show the child will be biologically inferior, they should abort the child and sterilise you.
    We have to do whatever it takes to cut down my tax bill.

    Reply
  5. Rob Read Avatar
    Rob Read

    Or ask for charity…
    N.I.B. I’d prefer not to help subsidise those who have genetic problems to pass on those genetic errors. You want to jail those who refuse, and you insinuate I’m doing it for selfish reasons.
    Socialism is state-worship AKA another religious mental illness.

    Reply
  6. David B. Wildgoose Avatar
    David B. Wildgoose

    I’ve got some bad news for you Rob. YOU have genetic problems. We ALL do. Estimates say that everybody has on average 2 dangerous recessive genes.
    For example, 1 in 25 people of European extraction carries a copy of the Cystic Fibrosis gene. It’s recessive, and so only dangerous if both partners have it, AND both partners pass it on, (50/50 for each). That means a 1 in 625 chance of two such people having children, and then an additional 1 in 4 chance of them both passing on the faulty gene, leading to the 1 in 2500 incidence we have in the general population.
    So Rob, now you know you’re genetically inferior, are you going to follow your eugenics logic and have yourself sterilisised?

    Reply
  7. N.I.B. Avatar
    N.I.B.

    Tut, tut – you’re ‘projecting’ again.

    Reply
  8. David Taylor Avatar
    David Taylor

    Insurance is about protecting yourself against unpredictable risks. You benefit because as an individual no one knows if you will suffer the consequences of the risk, the insurance company makes money because it knows the risk to itself collectively as a result of taking in a large enough part of the at risk population.
    However, this system collapses if individuals, know (to a high enough degree) whether they are at risk or not. Note it isn’t just those who have tested positive, those who have tested negative could ask for a lower pemium or opt out of insurance altogether.
    Provided the market is free i.e. all knowledge is available the market self corrects, those at very low risk don’t buy and those at higher risk pay a a higher premium.
    You can’t insure against certainty only against a predictable risk. That’s the definition of insurance. Anything else is welfare, all pay to alleviate the consequences for the few. This may be laudable but it isn’t insurance.

    Reply
  9. Rob Read Avatar
    Rob Read

    David B. Wildgoose,
    “So Rob, now you know you’re genetically inferior, are you going to follow your eugenics logic and have yourself sterilisised?”
    We know no such thing, you cannot generalise from a group risk to an individual. I hope you we re-read what you’ve written and consider an apology? What are you going to do to stop the testing or insurance markets drying up? The only viable option is to link to two as I suggest.
    Unless my approach is used, then their will no insurance and we will be financially worse off (i.e. have to keep more in the bank to cover risks), or the state will insure everyone and we will be genetically worse off (subsidise poor risks).
    Your position boils down to this you think people should be jailed for refusing to subsidise other peoples reproductive choices.
    NIB I have no intention of having children. If you having children “for the good of society” send them round on tuesdays to do my dishes please.

    Reply
  10. David B. Wildgoose Avatar
    David B. Wildgoose

    Actually I will apologise, seeing as I was also reacting to NIB’s take on what you were saying.
    But don’t you see what is wrong with comments like “It should also be compulsory to purchase pre-birth insurance for your children (so the state can eliminate disability benefit).”?
    After all, you are in effect saying that only those who can afford insurance should be allowed to have children. I find that to be a pretty extremist position. I have 3 children, the eldest of whom has Asperger’s Syndrome and was born with club feet. By your logic I would have been priced out of the ability to have my other 2 children, both of whom are active, healthy and highly intelligent. (As indeed is my eldest for that matter, splints and an operation at 9 months old and now he runs around like anyone else).

    Reply
  11. Petrona Avatar
    Petrona

    There are lots of problems with it.
    First, “insurance” means things like getting a mortgage, going on holidays abroad, etc. It isn’t just about people thinking they are going to die so they will buy lots of insurance policies for their kids, it is about trying to lead a “normal” life.
    Second, the BRCA genes, even if you have them, don’t mean you are going to get breast/ovarian cancer. They are implicated in less than 5 per cent of these cancers.
    Third, the current arrangement is that insurers can charge a higher premium for Huntingdon’s carriers. Huntingdon’s is one of the few “single gene” defects known. Breast cancer, like every other disease, is complex and mysterious. Environmental factors are involved as well as a suite of genetic factors.
    Fourth, in the 1980s, insurance companies started asking on their forms whether the applicant had ever had an HIV test. There was an outcry and the offending sentence was removed. Presumably, people with breast cancer-related genetic defects are not considered to be an appropriate group for defending.
    Finally, and mainly, the insurance industry makes a tonne of money, and surely everyone can afford to have their premiums slightly higher (a fraction of a penny, probably, as the numbers are so small compared with the general population) to support those — not who have a disease but who MAY develop a disease or may not, we just aren’t sure? Shame on everyone who goes along with this nasty, weasally scheme.
    (I know I said finally, but;;;they won’t stop with BRCA genes you know).

    Reply

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