Universal Health Coverage: In Our Genes?

In today's NYT, Doctor and author Robin Cook argues that advances in genomic medicine will eventually demand the end of private health insurance. His argument is that as we increasingly succeed in using our understanding of human genes as a predictor of illness, the statistical models used by insurance companies to assign risk will become meaningless, or rather, too meaningful:

"Another, and possibly more important, negative consequence of this new ability to predict illness is the potential for discrimination in one form or another if confidential health information is released. Unfortunately the chances of such a breach of privacy occurring, despite lip service by politicians to prevent it legislatively, are probably inevitable. Not only is microarray technology easily accessible, but for-profit private insurance companies have strong incentives to use it to protect their bottom lines by denying service, claims or even coverage.
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In this dawning era of genomic medicine, the result may be that the concept of private health insurance, which is based on actuarially pooling risk within specified, fragmented groups, will become obsolete since risk cannot be pooled if it can be determined for individual policyholders. Genetically determined predilection for disease will become the modern equivalent of the "pre-existing condition" that private insurers have stringently avoided."

And if everyone has a genetic pre-disposition for something, then private insurers would have to cover the insured ONLY for conditions they're unlikely to contract. (And don't think it mightn't come to that.)

But with the end of pooling risk within defined groups, there is only one solution to the problem of paying for health care in the United States: to pool risk for the entire nation…Although I never thought I'd advocate a government-sponsored, obviously non-profit, tax-supported, universal access, single-payer plan, I've changed my mind: the sooner we move to such a system, the better off we will be. Only with universal health care will we be able to pool risk for the entire country and share what nature has dealt us; only then will there be no motivation for anyone or any organization to ferret out an individual's confidential, genetic makeup.

So, in addition to being more cost-effective, fairer, and something a nation which thinks itself great should clearly provide its citizens, universal health coverage is an imperative of, if not genetics, genetic science.