Genomics and Universal Healthcare
October 01, 2009
If the US enters the genomics-based medicine age without universal healthcare, Jeremy Grushcow at The Cross-Border Biotech Blog says that "it will exacerbate existing inequalities and create new ones we haven't even imagined." As an example, Grushcow draws on new guidance from the UK's General Medical Council that says if a patient is found to have a genetic disease, then doctors must inform relatives of their risk. Grushcow says that such notification is only possible with universal coverage. "People with genetic diseases can be informed of their risk because they won't lose their insurance or be forced into a high-risk high-cost pool as a result," he writes.
For more information on how genetic testing can play out in our health care system, please see these stories: New York Times editorial from October 4th and NPR story on Lewiston Maine.
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I guess I'm just confused as to why entering the genomic-based medicine age without universal health care will exacerbate existing inequalities. It seems that the relatives of people who have these genetic diseases would be most affected than a specific class of people. These relatives could be anyone in any socioeconomic status and would not simply target the poor and those who cannot afford medical health care.
ReplyDeleteHowever, I agree with Grushcow's statement that without universal health care, many new inequalities would develop simply because people would be categorized as high-risk individuals. Without universal health care, more people would be denied an affordable health care due to extraneous circumstances. Originally, many people who would normally receive a generally low cost health care, would now have to pay high premiums due to potential risks out of their control [their relatives being sick etc.]
While putting such people into high-risk categories might make sense in an actuarial fairness perspective [and also for the benefit of insurance companies], there seems something inherently wrong with doing so. You cannot deny certain individuals the right to health care simply because they have a higher risk of having a disease. It's important to recognize that although their relatives have the disease, the people themselves have shown no signs or symptoms. Overall, it seems wrong to deny such individuals health care; universal coverage should be given if the threat of denial of health care is possible under the new idea that doctors must inform relatives of their risk.
I agree with Grushcow’s statement. Without universal healthcare, genomics-based medicine age will not benefit people in the US. It will indeed, as Grushcow notes, exacerbate existing inequalities as well as creating new ones. The new guidance in the UK says that if patients are found to have a genetic disease, doctors must inform relatives of their risk. In the UK, where universal health care exists, this is possible and works in the advantage of the people. If an individual is found to have a certain genetic disease, informing relatives will only ensure that earlier detection and treatment is done. If the US established the same guidelines, people would not perform the same actions as people in the UK, meaning many Americans will not rush to their doctors to get tested. This is because of the insurance coverage that people in America receive. Many insurance companies will no longer cover an individual if he/she is found to have a genetic disease.
ReplyDeleteIn an op-ed article, columnist Nicholas Kristof gives an example of David Waddington, a 58-year-old man from Dallas, that was diagnosed with PKD. In order to treat this disease, doctors needed to find a kidney transplant for Waddington. The doctors told Waddington that his sons would be the perfect match for this transplant but Waddington and his wife refused for this to happen. This was because if pre-donation testing detected that either of Waddington’s sons had the genetic predisposition to PKD, the insurance by which they were covered would no longer cover the son who could eventually have PKD. This raised a major ethical issue. Both of Waddington’s sons were more than happy to donate a kidney to their father, but the chance of not having medical insurance prompted the Waddingtons to seek alternative donors. Although his sons could have instantly provided their father with a new kidney, which in turn would have cured his disease, the idea of having no health insurance made the family decide to wait for a random kidney that was a good match.
Another problem also arises in the Waddington case. The doctors on the case knew that the sons would be the best matches for the kidney, but because of the threat of no health care for the sons, the doctor continued to search for a different transplant match. Had this family lived in a country with universal health care, this would never have been a problem. Instead of having to wait for a potentially long time until another kidney was available, (which could plausibly mean waiting so long that the condition worsens) universal health care coverage would enable the sons to be the kidney donors, without threatening their medical insurance coverage.
Going back to the main topic, genomics-based medicine will not be able to work efficiently without universal healthcare. Without universal healthcare, people will continue to opt out of testing for genetic diseases in fear of their health care being taken away. The people in society that have lower incomes and lower qualities of living will continue to see their qualities of life lower as they will not take the preliminary steps that will ultimately allow them to live longer. Doctors encourage patients to get tested for genetically predisposed diseases, such as PKD, but unless there is universal healthcare, there is no point for many people to even get this testing, because if the testing is positive, health care will be taken away, meaning the treatment needed for the potential disease will be too expensive. Only the more wealthier people in society will be able to pay for treatments that insurance does not cover. With universal health care, people with genetic diseases will be able to treat these diseases, and will also be able to inform relatives of their risks before it is too late. In conclusion, the genomics-based medicine age can benefit the US extremely if it is paired with universal healthcare. Without universal coverage, people will not even explore the possibilities that the new era will bring.
I agree with Kristof on this issue. As we enter an era where genomic testing can become commonplace and lead to early detection of any potential life threatening medical conditions that we are genetically predisposed to, identifying potential diseases and taking the needed preventitive measures seems like a great way to ensure a healthier life in the future and potentially saving costs of future medical expenses by taking preventitive measures against diseases you are specefically predisposed to early. Unfortunately, this is not possible within the realms of the current healhcare system. The chance that insurance companies will punish you for being predisposed towards some disease or another through sky-high premiums or dropping your coverage altogether may be too risky a chance to take, even at the possible detriment to your personal health.
ReplyDeleteFurthermore, as this case illustrates, instance in which relatives are needed as donors will cause new complications as relatives will be hesitant to undergo genetic testing.
By insuring everyone, including many relatively healthy young adults that do not have insurance today, the insurance system will be able to spread the risk enough so to ensure that it can cover people with pre-existing conditions as well with no added financial burden. Both in a utilitarian sense and in an altruistic moral sense, the US system of healthcare needs to be reformed so that everyone is covered and so that there is more fair system for everyone.
Although this may run against the ideas of actuarial fairness, it is more morally permissible for us to punish individuals for unhealthy actions (such as smoking) than it is to punish them for genetic factors outside of their control.
~Ankit Agarwal
I think that it is easy to come to the conclusion that health insurance agencies will rescind coverage based on genetic makeup. We have all heard of people being denied coverage because of pre-existing conditions. Although I believe there is certainly a risk that genomics based medicine can not work without universal healthcare, I believe that the previously mentioned problems are far from certain. Health insurance agencies clearly prioritize money, so I will present my argument from a financial perspective. Diseases are less expensive to treat if they can be detected early or prevented all together. For these reasons, it makes sense for health insurance companies to reimburse their clients for things such as immunizations and mammograms. Genomics based medicine can be seen to present a similar opportunity to reduce healthcare costs. Consider this: A young (say 28 years old) healthy person unknowingly has a genetic predisposition to coronary artery disease (CAD). He occasionally sees his doctor for checkups, where he finds that his blood pressure is within normal limits. However, his blood triglycerides and cholesterol are high unbeknownst to him. Because he sees himself as being healthy, he does not think to get his blood tested, and he ignores his doctor's occasional suggestion for the test. Until this man realizes he should get a blood test, he will be unaware that he is at a high risk for complications that could eventually become very expensive. In a worst case but not uncommon scenario, this man learns of his risk factors too late and they cause diseases that require expensive procedures to keep him alive. The insurance company takes a loss because the premiums it has collected from this man do not cover his expenses. However, in an alternate case where genomics based healthcare is used, the man discovers his predisposition to CAD and gets a blood test. He is able to restrict his diet to control his cholesterol and triglycerides, and he lives his life without complication. The insurance company collects premiums the entire time, and does not have to pay for any CAD related health issues.
ReplyDeleteMy point is simply this: Insurance companies can use genetic information in two ways. They can use it to cherry pick the people with the best genetics and health, or they can choose to use the information at hand to support primary preventative techniques that can save the company money. Theres is certainly no definite outcome in a relationship between insurance agencies and genomics based healthcare.
~Matthew H
I agree with Grushcow, that if the US accepts this idea of genomics based medicine without having universal health care coverage that it could cause major issues and worsen the existing inequalities. It is frustrating to think that the United States is not driven by the desire to help everyone in need of medical services and that the health care system is simply a capitalist business.
ReplyDeleteThe Sicko video illustrated how people feel very comforted by the health care system in other countries. Many Europeans explained how their health care system works and how it benefits the entire nation rather than just the people that can afford to have decent care. These same people seem to think that the health care system in their country is set up to advocate for everyone, to take care of everyone, to make health care a basic human right. In the United States however, very few people seem to trust the system because it is set up to help people with decent health insurance and limited medical issues.
Regarding the Kristof’s article from the New York Times, I think it is unfortunate that in an effort to save their father’s life, Travis and Michael have to consider the fact that they may never be approved for health insurance. This unethical trade-off is something people should not have to come across, and it could become more of an issue as a result of genomics based medicine. Focusing on preventative care and the medical care of any relatives informed of their risk to a genetic disease is only feasible in a country with universal health care.
Grushcow calls attention to the problem of how advancements in genomics-based medicine may hinder patients from receiving medical care without a universal healthcare system. I think that when Grushcow refers to “exuberating inequalities and creat[ing] new ones we haven’t even imagined” he is speaking of the insurance companies ability to deny health care coverage or increase deductibles until insurance is out of reach for any person they deem too sick or that has too high a potential to get sick. With medical history reports that include information about possible genetic predispositions to certain ailments, even more people will be denied coverage and left with no coverage for reasons such as the disease history of their ancestry, of which they had no control.
ReplyDeleteIt is unfortunate that under the current health care system of the US, people are not able to benefit from the advancements in technology. Genomic testing could help patients detect and even prevent diseases. The fear of losing insurance coverage based on what a genomic test may reveal will prevent patient’s from benefiting from this service. Genomic testing can provide information about one’s susceptibility to any number of disorders but patients feel they should shy away for fear of losing their insurance over some condition that they may be genetically carrying, but may never affect them.
Universal healthcare could protect people from losing coverage based on their genetic predisposition to a certain illness. It would allow people to learn of any predispositions so that they could take precautionary measures to prevent future illness and disease, this would save money on health care in the long run.
-Olivia Thomas
The improvement and expansion of genomic testing and research could be one of the greatest medical tools of our age. The earlier we detect disease, the more capable we are to handle it. In people with hypercholesterolemia, the outcomes are significantly improved the earlier it is detected. Preventative care such as lifestyle changes and cholesterol lowering drugs can add years to each life. More pointedly if done on a large scale, the early detection of hypercholesterolemia could save the health care system billions in tertiary expenditures. It sounds like a good idea from all angles. However, the proper application of this health measure relies on a system that places an emphasis on supportive, preventative care. Unfortunately in the US, without universal health care, many patients may avoid genetic testing all together out of fear of losing their existing health coverage.
ReplyDeleteI agree with Grushcow's statement. It will be too easy for insurance companies to deny health care to people all over the country because of inherited genes. And this begs the question of whether insurance companies will go as far as denying people with the mere potential of inheriting a genetic disease. For example, maybe the company you work for covers you, but the insurance company will not cover your children because they may have the disease. If you give insurance companies an inch, they will take a mile.
ReplyDeleteIf insurance companies can deny health care to those who are pre-disposed to genetic diseases, then I ask, what is the point of testing to find out you have it? In the case of Travis and Michael Waddington, sons of David Waddington who has PKD and needed a kidney transplant, they didn't get tested because they were afraid of being denied health coverage. But when one of them ends up having it, will his coverage immediately become void? Because genetic diseases affect people of all socio-economic statuses, at some point will everyone stop getting tested because insurance companies deny coverage? And then what will happen to funding for the research done to find cures for those diseases, etc? These are questions that can't necessarily be answered right away, but must be considered when looking at healthcare reform. A public option may be necessary if we want to keep people with genetic diseases covered, without blaming them for something out of their control.
-Jessie Kavanagh