
Don’t Discriminate Against Mutants Like Me - fasteo
https://www.nytimes.com/2017/03/23/opinion/sunday/dont-discriminate-against-mutants-like-me.html?_r=0
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peatmoss
If this isn't a ringing endorsement for single-payer "medicare for all" health
insurance, I don't know what is. As a society we're aghast at the notion that
people might be discriminated against due to their genetic pre-conditions. Why
the heck do we let our values slug it out in an inefficient, non-competitive,
quasi-market?

Also, because it's Hacker News and a lot of folks here are engaged in start-
ups, I wonder why I hear relatively more from tech about basic income than
single-payer health. While basic income goes further, single-payer health
removes a major burden / friction for creating a start up.

Also, from a labor standpoint, decoupling health benefits from work allows
start-ups to play with less-than-full-time employment arrangements. Having
more people fractionally employed might be just the safety valve we need until
automation job loss is more comprehensively addressed. But I digress.

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IncRnd
Why do you believe that the possibility that people may be discriminated
against due to their dna is a ringing endorsement for single-payer "medicare
for all" health insurance?

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tghw
Because a single payer would, by definition, cover everyone.

Private insurance companies and employers (the two places most Americans get
their health insurance from) may not want to pay for the higher costs
associated with higher risk people like this. Employers would be especially
susceptible to this sort of discrimination if proposed legislation allowing
employers to demand genetic tests of their employees passes.

[https://www.washingtonpost.com/news/to-your-
health/wp/2017/0...](https://www.washingtonpost.com/news/to-your-
health/wp/2017/03/11/employees-who-decline-genetic-testing-could-face-
penalities-under-proposed-bill/)

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vonmoltke
The discrimination referenced in the article is not just about insurance
costs. Even if health care costs were totally removed from employees they
would still have reason to discriminate on genetic factors.

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kcorbitt
Being born with this type of genetic predisposition is unfair, but passing
that risk on to an unknowing employer is also unfair. For a medium-size
business that underwrites its own policies (very common), a few employees with
multi-million dollar medical needs can easily make the difference between a
modest profit and bankruptcy.

If we care about equal protection of all American citizens -- and I believe
that we should -- the solution is _not_ to legally prohibit employers from
performing genetic screenings, it's simply to cover healthcare for high-risk
individuals, or ideally everyone, at the national level with single-payer
care. That way there's no incentive to cheat anti-genetic-discrimination laws,
business don't have to worry about getting hit with an unexpected multi-
million dollar expense, and the cost of coverage to everyone shows up on the
national ledger, where it honestly belongs.

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reverend_gonzo
What companies underwrite their own health insurance policies?

I would find that to be a ridiculous risk for those not actually in the
business. The whole idea behind insurance is to spread the risk among lots of
people. If a medium-sized business is underwriting their own policy, I would
think they would quickly go bankrupt more often than not.

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wincy
My company has about 1,000 employees and underwrites its own insurance. They
allocate a pool at the beginning of the year and anything that isn't used is
written off as profit at the end of the year. I don't know anything more
specific than that, but our medium sized, successful company does do this.

~~~
pnutjam
Isn't this usually coupled with some sort of insurance that covers a major
cost overrun? That secondary insurance might get skyrocket if it gets hit
repeatedly.

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pdelbarba
It seems we're racing towards the events of Gattaca. It's easy to dismiss the
movie as being similar to the far fetched distopian depictions in Minority
Report, but in this case we actually have the technology to make it a reality.

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Afforess
I might be alone here, but I always felt Gattaca was misunderstood. The
dystopia was that society _allowed_ non-enhanced humans to be born. Allowing
an underclass to exist, voluntarily, was the mistake. Genetic-engineering
healthier, better people sounds great. Let's just make sure everyone has
access.

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rhcom2
I could be misremembering but I thought the character who was non-enhanced was
born that way on purpose due to the choice of the mother. Gets a lot more
ethically dicey when you start talking about forcing people to genetically
engineer their children or face them being forced into a underclass.

~~~
pdelbarba
You're correct. I think the other point is that regardless of the path we
choose, there will be a period where not everyone will be genetically
engineered due to availability (older people who were born before it was
invented, people born to poor or conservative families)

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fasteo
OP here. Pure corporativism. I am a mutant too. Didn't get any superpower
though.

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drzaiusapelord
I think Americans are going to realize exactly what "run the government like a
Trump-branded business" really means. The anti-climate change and pro-business
attitude the GOP has doesn't suddenly mean jobs and wealth for all. It means
rolling back protections like these. We just saw our browsing data privacy
taken from us and now this is probably going to happen. Not sure what Trump
voters were expecting, but this is it. I hope they're happy with it.

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nkrisc
This is why I never understood the "run the government like a business"
concept. Business and governments do very different things. You wouldn't run a
business like a government and running a government like a business is no
better.

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psj
Indeed. If you were to truly run the government like you'd run a business,
wouldn't you "fire" all the older people who are no longer performing at an
acceptable level i.e. retired?

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VLM
From a .gov perspective performance and production is measured not by working,
but by voting, and voting rates are excellent for older people.

~~~
psj
That's one more way a government isn't a business. Also, didn't Trump campaign
on generally minimizing government? Did (does) he also run his businesses in
such as way so as to "minimize" them?

Obviously there are approaches that make sense to be common to running both
business and government (that probably apply to most everything else as well
because they'd seem like "common sense") but, at a high level, to say "run
government like a business" is one of those things that only sounds reasonable
(possibly) until you think about it.

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hackeraccount
High risk pools are an answer to the questions posed here. A collective will
to ignore reality would not seem to be an answer to me.

~~~
pnutjam
How do high risk pools address this? Will they be subsidized more then others,
passing the cost to taxpayers? Otherwise, they will be unaffordable. The only
way insurance works is to pool resources of people who don't need the service
to cover those that do need the service.

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rsync
"The legislation would enable companies to coerce employees into participating
in wellness programs that could require them to undergo genetic testing and
provide genetic information about themselves and their families."

This is the price. There will be other prices.

So-called "red state morons" who "vote against their own economic interests"
often tout a hazy, poorly thought out rationale of "freedom" as the driving
force behind their choices.

There is, however, a decent heuristic at work here. _They know_ that there's
no such thing as a free lunch.

Just because they have no idea how they'll be made to pay for it doesn't mean
they're wrong.

~~~
drzaiusapelord
> They know that there's no such thing as a free lunch.

I'm already paying for health insurance. Its not, nor has it ever been, a free
lunch. Diving into my genetics is completely uncalled for. Stop calling health
care buyers moochers, thanks.

Also somehow almost all other wealthy western nations do better than us by
almost all metrics in healthcare and they don't need to do this either. What's
wrong with Americans?

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rsync
Covering existing conditions is a _wonderful thing_. And it is a free lunch.

Regular wellness checks, etc., _while wonderful_ , are a free lunch. They are
not insurable. You can't insure for regular, scheduled services. Because
math.[1]

If you see things like this - things that are either exorbitantly expensive
_or_ defy the bounds of underwriting _or both_ you should expect to pay other
prices, elsewhere.

[1] This is insurance 101. You cannot insure against regular, universally
consumed services. There is no underwriting pool there. You cannot buy an auto
policy that includes regular tire replacement - and if you could, the premiums
would include 100% of the tires cost (plus admin).

~~~
tghw
I'm pretty sure most people with an existing condition would prefer not to
have it at all than to cost insurance companies more and have that covered.

It's not a free lunch. They paid the admission fee with their health.

Regular wellness checkups are also not a free lunch. They're priced into the
policies. You absolutely can insure against regularly consumed services, as
long as the premium is enough to cover it and to do the underwriting for the
unexpected expenses. Look at dental or vision insurance. The vast majority of
what they cover are regular wellness visits.

Putting that aside, free wellness visits are also in the interest of the
insurer. It's far cheaper to prevent disease or to treat it early than it is
to deal with it later. Those savings from this so-called "free lunch" ends up
right back in their pockets.

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philh
> It's not a free lunch. They paid the admission fee with their health.

You're using the word "paid" in a sense that isn't relevant in context.

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tghw
Considering it's a debate about health care and insurance, I'd say the health
of the individual is relevant.

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philh
Health is relevant. The sense in which you used the word "paid" is not.

