The Biggest Game Changer to Insurance Companies Since Obamacare
The goal of an insurance company, whether it be health or life insurance, is to minimize risk and maximize profit. The goal of an insurance buyer is to reduce cost and maximize potential benefits. These seemingly competing goals help form the insurance market we heavily rely on today. Risk-analysis models can generally aid you in predicting health abnormalities. These models take into account: family history, current behaviors, habits, and objective looks at symptoms as they arise. With the introduction of genetic testing to the mainstream, people can now use saliva to analyze their genetic codes. This information determines the ancestral history and gene variants that are likely indicators of disease genotypes. One obvious result of this scientific advancement is that by using this newfound knowledge, steps can be taken to prevent the manifestation of diseases such as breast cancer or heart disease. While commercializing genetic testing seems like a valuable tool in improving healthcare outcomes, the drawbacks are underestimated and, most times, not fully understood. As the popularity of genetic testing grows in the consumer market, the side-effects of providing this kind of information to people become more and more dire.
While commercializing genetic testing seems like a valuable tool in improving healthcare outcomes, the drawbacks are underestimated and, most times, not fully understood.
Consumer genetic testing companies such as 23andMe, have been able to market their product as a fun investment intended to help the mainstream consumer discover their genetic information. Over 2 million people since 2007 have had saliva samples analyzed by 23andMe home tests (Brown). During the holiday season, especially during Black Friday, companies such as Amazon suggested a genetic testing kit as a thoughtful holiday gift and offered it as low as half price. People do not realize their genetic code is as sensitive as their social security number. Most usually gloss over the fine print of mandatory disclosures before accepting the terms and conditions of products. But in this case, blanket consent is given to the company to use your information, including disseminating data to third parties.
The positives of such genetic testing are numerous. Once individuals learn they are at high-risk for a disease, they can alter their lifestyles in hopes of a healthier outcome. An example: A person having a higher risk for diabetes will make a point to improve their eating habits and make regular exercise a priority. However, imagine hearing at age 18 that you have the gene for Huntington's disease, a disease with a high early mortality rate. The effect of knowing that can be severe on your mental health, leading to potential issues such as depression or various unhealthy coping mechanisms. Several scientific studies have been conducted using data accumulated from commercial genetic testing. For example, a large cohort of 531,575 individuals were examined to quantify the penetrance of dominant Mendelian diseases in a population (Minikel et al.). Both of these examples provide crucial evidence that genetic testing and analysis is beneficial in this regard.
The ethical concerns, however, are just as numerous as the positives. Health and life insurance companies use medical information, among other details of one's life, in an algorithm to determine coverage eligibility and pricing. While health insurance companies provide a necessary good, they are also a business. The basic model of a health insurance company is to have both healthy and sick people covered at the same time to balance out the risk and cost. A healthy person will continue to pay their monthly premiums even if they don't see a doctor or have prescription medications. The profit made from that situation decreases the number of high-risk people diagnosed with a preexisting condition, such as epilepsy or cancer, have to pay to acquire coverage (The Economist). A significant disruption to this model is the introduction of direct-to-consumer genetic testing. In 2008, Congress passed the Genetic Information Nondiscrimination Act. The act protects individuals from being required to disclose the results of these genetic tests, so they're able to avoid discrimination by employers and health insurance companies based on these results (Zhang). Since insurers have no indication otherwise, nothing is stopping them from thinking these people are healthy and should pay a lower premium.
The concern here is people taking advantage of their insurance companies if they are genetically predisposed to a disease. A currently healthy individual does not have to deal with the risk of paying out expensive claims. If more and more people take advantage of insurance companies like this, the company could incur a higher net loss. Essentially, they are setting off a chain reaction that would force premiums to go up for everyone, upending the health insurance market. Having access to this sort of genetic information is a double-edged sword. While the GINA Act protects against health insurance discrimination, it does not cover other types of insurance. Applying for life insurance when you are known to have the gene for breast cancer could be tricky. As part of any insurance company's risk analysis, you would be denied coverage because of your high-risk status (Kolata).
Having the gene for a disease and having the disease are two entirely different things. Gene expression comes from a multitude of factors, not just the presence of a gene. The environment, lifestyle, and exposure to possible carcinogens also play a massive role in the ultimate expression of a gene. As is evident in this current political environment, laws such as GINA are not set in stone. If the insurance market is upended due to the concealment of genetic information, amendments and new laws may be passed that no longer protect the confidentiality of your genetic results. In 2015, the genetic testing market was valued at approximately 70 million and was projected to grow to nearly 340 million by 2022 (Brown). Some near-sighted politicians may not even realize the ramifications of changing GINA. In contrast, others may be heavily influenced by insurance company lobbyists that do not care for the wants and needs of the citizens themselves.
While curiosity about one’s genetic information is inevitable, regulating and educating the public about these home genetics tests is crucial. Marketing these kits as great gifts for holidays and birthdays insinuates that no harm could come from them. I'm positive that if the two million 23andMe customers had been appropriately educated about the risks of being provided their genetic information, fewer of them would have gone through with it. Market rules mold the regulation of genetic testing and the dissemination of results, so the topic of health insurance reform greatly impacts this industry.
While curiosity about one’s genetic information is inevitable, regulating and educating the public about these home genetics tests is crucial.
Nationalizing healthcare, like the Medicare for All proposal that has been tossed around by some Democrats, would be a helpful solution. On the one hand, nobody could be discriminated against for having a harmful gene mutation that might not manifest. On the other hand, using genetic testing results would help introduce more preventative treatment. Doing this would drive down the costs of care by catching the problem before it has a chance to become severe, among many more possible positive outcomes. The moral question is if we have the technology to find diseases and abnormalities before the emergence of symptoms, should we be compelled to use it? Finding a balance between consequence and benefits is proving impossible within our current healthcare system. Maybe if coverage in the future is treated as a right and not as a business, the pros of genetic testing would then heavily outweigh the cons.
By Brandon Schiro
llustrations done in collaboration with the New Media Artspace at Baruch College. The New Media Artspace is a teaching exhibition space in the Department of Fine and Performing Arts at Baruch College, CUNY. Housed in the Newman Library, the New Media Artspace showcases curated experimental media and interdisciplinary artworks by international artists, students, alumni, and faculty. Special thanks to docent Stephanie Jones for creating artwork for this piece.
Check the New Media Artspace out at http://www.newmediartspace.info/