
Employees who decline genetic testing could face penalties under proposed bill - kungfudoi
https://www.washingtonpost.com/news/to-your-health/wp/2017/03/11/employees-who-decline-genetic-testing-could-face-penalities-under-proposed-bill/
======
drawkbox
We've got to separate healthcare from employers before this goes to far.
Companies have no business in your health and we still tie health insurance to
employment as a legacy error not a benefit. Many problems arise from
healthcare provided from the job such as ageism, culling the sick, making it
harder to change jobs or start companies, and losing healthcare as you change
jobs, not to mention helping the fixed price / backroom market that is
healthcare. We'll never fix anything until we unbind healthcare from employers
and make it more consumer focused independently (single payer or completely
independent/private).

We don't get any other personal insurance from work. We need to outlaw
allowing companies to facilitate the healthcare plans and go fully independent
like all other insurance (auto, home, life etc). Benefits can be paid in extra
money not false benefits that lead to invasions of privacy.

Why would you want your company knowing anything about your health? We
supposedly live in a free society but then work at mini feudal/sharecropper
empires with dictators and barely any say in what is acceptable.

~~~
programmarchy
The history behind our current nonsensical scheme started with FDR capping
wages during the great depression, which spurred companies to offer "perks"
like healthcare to recruit talent. An example of one market intervention
leading to another, and another, ad nauseam.

Totally agree that insurance should be decoupled from corporations. The way
the "market" is regulated hampers people from working independently or
starting small businesses because it's so damn expensive for individuals to
pay for healthcare themselves.

~~~
AbrahamParangi
The specifics of the American healthcare system aside, what leads you to
believe that the problem is regulation? By essentially any metric, state
provided (single-payer) healthcare is the best-known solution to the
healthcare problem. Why is there any reason to believe that there's too much
state intervention as opposed to, say, too little?

~~~
wyager
> By essentially any metric, state provided (single-payer) healthcare is the
> best-known solution to the healthcare problem.

Except things like, you know, quality of care or satisfaction.

Single-payer healthcare beats the _American_ implementation, which is _not_ a
high bar to clear.

There's a reason medical tourism to Mexico and India is so prevalent. Totally
deregulated private doctors seem to kick the ass of state healthcare (in
quality and wait times) and American healthcare (in cost). I wouldn't want to
get, say, complicated brain surgery in Mexico; in that case, the tens of
thousands of dollars premium you would pay, uninsured, for US care is probably
worth it. But for routine medicine (dental care, minor surgery, etc.) it's
medical tourism all the way. For certain kinds of medicine, people will even
make medical visits _to the US_ from socialized countries like Canada or
France.

~~~
kolinko
The problem is that you cannot have any sort of sensible health insurance on
an unregulated market.

On an unregulated market, insurers would begin to drop people who get
chronically sick, or land in risk groups.

Before you can say: "so just forbid dropping insured people" \- that's what US
initially did. But there was a simple loophole around that - you don't drop
people per se. You just start a new insurance company, and offer a lower rate
to the healthy people who want to sign in.

The healthy go to the new one. The sick stay with the old one. Old one's costs
increase, they get pushed to the everyone who was left, to the level that is
unsustainable, and either the sick leave too, or the company dissolves.

So you need more regulation preventing companies from only taking up healthy
people. But you can't go overboard, because if a sick person can sign up at
will, people will only seek insurance when they get sick.

And you end up with the clusterfuck that US is right now. Which they are
exactly for the reason of trying to avoid government intervention and
government-set prices for services.

And then you have medical companies and doctors, who invent a new treatment,
and the insurance is obliged to cover that treatment. So it's complicated
negotiations there too. Without government interference, the medical companies
have no incentive to keep the costs down really.

On the other hand, you - as a patient - probably don't want the government to
tell private medical companies how much to charge for what. That's a new kind
of problem altogether.

~~~
wyager
You don't need industry-specific regulations to prevent insurance fraud; you
just need to enforce insurance contracts. If you're worried about becoming a
huge medical cost in 20 years, find an insurance company that's willing to go
into an n-year preset-rate contract. You might pay a premium corresponding to
the increased risk on the part of the insurance company, but if insurance
companies were allowed to do this and people wanted it, the correct price
would be found sooner rather than later.

~~~
nikdaheratik
Insurance companies already do something like this. It's called "long term
care insurance" and it is entirely separate from normal health insurance which
they don't want to place on a multi-year contract because the health care
costs themselves are changing too much year-to-year for it to be viable.

------
apathy
This is severely fucked. Wellness programs do little or no good but do allow
employers to offer incentives for participation. This on the other hand is
GATTACA level fuckery. GINA took many years to be put in place; now the
proposal put forward will potentially cause people to lose health coverage or
their job based on things they cannot control. Potentially their kids, too,
since these idiotic "wellness" programs are administered by poorly regulated
third parties.

This is very, very bad stuff.

~~~
M_Grey
To be fair, kids born today are pretty fucked for so many reasons. In a way,
this kind of dystopian future is averted when you consider the rate of
accelerating ocean warming, permafrost melting, etc. It seems likely that all
problems short of that which is going to end us, sort of gets subsumed.

All of these social problems are in the context of a failing ecosystem that is
being increasingly overtaxed. So... the kids never had a chance.

~~~
ryanwaggoner
Is there any credible research that climate change is going to "end us"?

~~~
M_Grey
By "end us" I mean end our civilization... extinction is unlikely.

~~~
ryanwaggoner
In that case, my question still stands.

I'm asking because I frequently see this kind of climate change alarmism on
forums (it's the end of civilization, billions will die, etc) but my _sense_
from an admittedly cursory reading of the estimates is that the dangers of
climate change are likely to be an epic refugee crisis from coastal flooding,
famine, and war. Hundreds of millions will die, and many more will see a
substantial decrease in quality of life for generations.

So, horrible. But I think it's wrong to say that it represents the end of
civilization. For one thing, like most things, the consequences of climate
change will be felt very unequally. The richest countries of the world are
likely to see a much smaller impact in terms of famine and death.

Granted, no one knows for sure, but as someone who is NOT skeptical of the
cause and effects of climate change, I am somewhat skeptical that in 100 years
it'll be as bad as many internet chicken little types seem to think.

I probably sound more dogmatic than I am though, so please do share some
research and change my view :)

~~~
adrianN
I also don't think that global warming will end civilization for the same
reasons as you. However, a refuge crisis, wars over food and water and
hundreds of millions dead will be a heavy blow that might set us back for a
long time. There is little money for colonizing Mars when you have to spend it
all for killing revolutionaries.

~~~
ryanwaggoner
Agreed. This is not an argument for not taking climate change seriously and
doing all we reasonably can.

------
state_less
We need to get some people to the nascar track, put the foam hats on folks,
it's time to start yelling fire! This is Republican policy taxing your family
unless you give your family's bloodline to the corporation.

Insurance company: Looks like you might have an elevated risk of heart attack.
Your premium will be half your paycheck. Sorry about the bad luck, buddy. God
bless and send our love to your defective children.

------
adolph
At some level I think to myself "first they came for the druggies and I was
too young to say anything, just pissed in a cup like everyone else, then they
came for smokers and I didn't say anything, then they. . . ."

Where is this all going and in what combination of futures does it turn out
well?

------
woogiewonka
I would have never imagined it would come to this. Now I'm reading about it
and can't believe what I'm seeing. This is worrisome on a whole new level.

------
greglindahl
Recent discussion with 87 comments:
[https://news.ycombinator.com/item?id=13843364](https://news.ycombinator.com/item?id=13843364)

------
brokenmasonjars
I suppose if this is passed it goes to the many reasons why I enjoy living my
life trading with my own funds without the stability of holding a career with
an employer. So far no drug tests is pretty much the winner but if genetic
testing bill becomes law then I'm pretty sure that tops drug testing. I'm not
a fan of background checks and I refuse to give references..but that's easy
for me since I'm not applying to jobs. I wish more people collectively refused
to participate in the whole reference thing as well. Nonetheless, I suspect
this bill will become law and more things to occur to make working for
employers even more invasive.

~~~
Buge
Why are you against references?

My current job didn't require drug tests or references. Just resume +
whiteboard coding.

~~~
brokenmasonjars
It's more of a personal preference than overt philosophical stance. I just
don't think it's anyone's business where I'm applying or may end up working (I
don't want the references to know where I'm applying or may end up working).

Edit: switched "stance" for "preference"

------
nthcolumn
Given her own lowly origins Virginia Foxx (opposed aid for Katrina, a bill
against hate crime, hates gays - nice) you'd think someone like her would be
against such forced disclosures. It won't affect her because she is nearly
dead but her grandchildren will almost certainly carry defects causing
hemoglobin mutations for sickle cell anemia, neurogenetic disorders and have
increased risk for chromosomal disorders such as Downs. Republicans voting for
this kind of widespread intrusion is like turkeys voting for xmas.

------
quantum_state
It's simply insane to propose such a bill ... they may as well as people to
sell body parts to cover healthcare costs ... it's simply not acceptable!

~~~
witty_username
What is wrong with people selling their organs?

~~~
nisa
Almost 50% of US citizens don't have enough money on the bank to replace a
broken 400$ item.

How many would out of desperation i.e. healthcare costs for relatives sell an
organ?

1: [https://www.theatlantic.com/magazine/archive/2016/05/my-
secr...](https://www.theatlantic.com/magazine/archive/2016/05/my-secret-
shame/476415/)

~~~
witty_username
You seem to be implying that is a bad thing.

What is wrong with that? Allowing them to donate organs gives them more
choices. Who owns a person's body?

And donating the organ helps people who needs organs. The person who donates
and the person who receives do this voluntarily if they feel they benefit.

I think it's deplorable that people are dying from lack of organ donations
while there are people with healthy organs who are poor. Legalizing organ
donation would help both groups.

See [https://blog.jaibot.com/the-copenhagen-interpretation-of-
eth...](https://blog.jaibot.com/the-copenhagen-interpretation-of-ethics/) .

~~~
kwhitefoot
Having a compulsory 'lottery' for organ donations for all would help both
groups too.

~~~
witty_username
How would you incentivize donors? Are you saying we should force people to
donate organs? That is horrible.

------
moonshinefe
This article is very scant on details and seems to muddy the waters by
comparing things like cholesterol and smoking to genetic screening which
doesn't seem to help things.

If how they've framed it is true however, and this may become law, that's the
final nail in the coffin for the GOP isn't it? What an absolutely nasty piece
of legislation. I feel like the GOP got so much power since it's the usual
"sick of the last 8 years" thing--but I think that may reverse fast if laws
such as this start hitting people.

Then again, I've unfortunately overestimated the US voters in the past. Please
don't let it happen.

------
emodendroket
Absolutely insane policy.

------
andrepd
Compare with [https://www.thestar.com/news/canada/2017/03/08/genetic-
testi...](https://www.thestar.com/news/canada/2017/03/08/genetic-testing-bill-
up-for-vote-is-constitutional-trudeau-says.html)

------
westmeal
>A BILL: To clarify rules relating to nondiscriminatory workplace wellness
programs.

>prevention programs that provide incentives, rewards, rebates, surcharges,
penalties, or other inducements

How on earth is any of this nondiscriminatory?

------
vkreso
Gattaca?

I must say that I am extremely interested in the forthcoming genetic policy
debate.

~~~
quickben
From the outside, this whole thing appears completely SNAFU.

It's right up there with gender/religion/race discrimination, but, everybody
is discussing is calmly.

------
chimen
Employers collecting on death insurances might get a higher ROI now with
access to such information isn't it? This gets too far.

------
throwaway198743
Wow! I wonder how long it will be before genetic tests become as pedestrian as
finger prints.

------
I_am_neo
With logic like that, forced abortions could be "workplace wellness" programs.

------
kondro
Can we genetically engineer our kids too so they stand a chance in the future?

------
known
Is it applicable to Law makers?

------
tray5
I'm sorry to all Americans who may read this and get ruffled, but what the
actual fuck is wrong with your political landscape and attitudes towards
workers rights? Why don't you have unions? Why do Americans seem to hate
unions? Why don't you have an active political party representing workers? Why
don't you have an active movement to prevent your employer from becoming
overseer of your entire life? All I see day in and day out from America is
employers and capitalists finding another way to fuck the workers and there is
not one iota of widespread organised resistance to this (or any of your other
disgusting work legislation like "at will employment" or your complete desire
to shoot yourselves in the foot with univ.healthcare) at all.

Seriously what is the problem with your country that you've managed to
manoeuvre yourselves as employees into a position where you are totally unable
to counter the repeated and ceaseless violation of your ability to live with
some sort of security and expectation of privacy against your employer. Your
country is amazing, your people are lovely. But your politics and attitudes
towards work, workers and their rights is abhorrent and disgusting.

The thought of legislation like this arising in my country (Australia), where
your employer is given free range to look into your genetic privacy is just
unfathomable to me, and if it did happen there would be widespread protests
organised by unions and political parties representing workers rights. Truly
the attitude of seemingly the majority of Americans towards themselves and
workers rights is gross, and frankly quite sad. You will only ever stop these
sorts of gross violations of workers rights with even bargaining power between
employee and employer, and there is only one way to achieve that (workers
unionising)

~~~
techsupporter
I hesitate to throw out this quote because it may come across as a "hot take"
but I think that John Steinbeck said it best:

"Socialism never took root in America because the poor see themselves not as
an exploited proletariat but as temporarily embarrassed millionaires."

Another quote I've heard is that "extremists become more extreme, not less, as
problems come closer to solutions."

"Socialism" and "extremists" don't really apply but the sentiments do. Unions
sprang up in the United States as a counterweight to outright and absolute
worker abuse. Things we--those resident in the U.S.--now take as "absolute,"
like child labor laws and the 40-hour workweek, were earned as a result of
those early struggles.

We've had it really good here for really long, comparatively, so I think that
a lot of people see these kinds of abuses as "won't happen to me"-ism so
they're not interested in sacrificing even a little to ensure that the abuses
happen to virtually[0] no one.

Going back to unions, a lot of people I know--in the IT industry, obviously--
flatly refuse to recognize that a union could be a good thing because jobs,
salaries, and opportunities are all plentiful. We're not "abused" because
employers know that we can just hop jobs and recover. (Never mind things like
the gaming industry or the "crunch" period or, say, Uber.) Because of the
illusion of choice, unions aren't valued. (I say "illusion" because witness
what happened in the doldrums of the early 2000s. When every employer, or even
a bunch of large employers, pull back at the same time, there is no choice.)

For others, things like unions or some form of collective action or even just
"group health care run by the government" are seen as impinging on the basic
rights to shoot--metaphor intentionally chosen--our own feet off however we
like, consequences be damned because other countries are just wrong and the
United States is a Special Snowflake.

Or something like that but maybe with a little less bite.

0 - I say virtually because people will always find a way to take advantage of
others but there's a lot to be said for pushing to prevent that as much as
possible. America doesn't seem to do that very much.

~~~
pdkl95
> a lot of people I know--in the IT industry, obviously--flatly refuse to
> recognize that a union could be a good thing

Usually this includes knee-jerk arguments against dues, mandated wages/salary,
and other aspects of existing/older unions. It seems like many people implicit
assume that a union must involve a list a of traditional practices.

A union can be what you want it to be. If you don't want it to cover
something, then leave it out. Charter the union to only address the specific
problems that need to be addressed. Maybe limit "crunch" periods to healthy
lengths of time near an actual product release? Maybe include a specific
deterrent against extreme problems like collusion to fix salaries while
otherwise ignoring salary completely?

As for dues and management costs, isn't that the kind of problem that is easy
with modern computers and telecommunication? How much management is even
needed for an IT union? In the past dues were needed to hire people to do the
paperwork, send out notices, _etc_. Today, that work is a weekend Ruby On
Rails project. After a specific purpose union is setup, are dues even
necessary?

~~~
icebraining
_It seems like many people implicit assume that a union must involve a list a
of traditional practices._

It's not an assumption that it must, it's a recognition that very likely, it
will. Organizations aren't created in a vacuum, they require bringing in
others, and if you're starting an union, you'll attract people who are already
predisposed to all the ideas of what makes up a union, and you'll attract
offers of help from existing unions, which will try to co-opt you. And there's
no valid reason to believe that you'll be able to control that process.
Finally, once that it created, it's not just a matter of distancing yourself;
once a union grows, it affects every worker, even non-unionized - in some
cases, even banning them outright from working.

So it's not surprising that workers which still have it pretty good aren't
interest in opening that can of worms, and you must have a better reason to
convince them why it won't be one.

~~~
pdkl95
> no valid reason to believe that you'll be able to control that process

People aren't interested in small-scale organizing for specific purposes
because strong, traditional unions are too popular? Why aren't the same people
you claim will "control [the] process" making a union _now?_

Yes, just like every other type of organization, a union - or business - can
evolve beyond it's original purpose. There are no guarantees in most
collective actions. However, arguments that assume an inevitable strong union
in industries where unions are very unpopular do not seem to be based in
reality.

> you must have a better reason to convince them why it won't be one

The tech industry has been very successful at inventing new types of
organizations over the last several decades. The "gig economy" and
Bitcoin/Etherium are obvious examples. Silicon Valley is popular because of
how easy it is to invent new businesses. Sometimes this creativity extends to
new ways to fund startups. A lot of the tech itself revolves around new types
of social interaction.

I find it very hard to believe that _unions_ \- or collective bargaining in
general - are somehow immune from "disruption" and creative reinterpretation.

~~~
icebraining
Look, we weren't discussing whether unions were good or bad; we were
discussing why people don't believe it's in their best interest to form or
join one. I'm telling you why I think you are mistaken about their
motivations, not that you are mistaken in your belief that a union would in
fact be a positive thing for tech workers.

------
Exofunctor
While I think health insurance shouldn't be attached to employers, I don't
really have an objection to insurance companies using genetic testing. This is
certainly an unpopular opinion here, but as someone who believes that medical
care is a service, not a right: I think it's unfair to force people to
subsidize the healthcare of other people, regardless of the mechanism used.

When you have car insurance, the insurance companies are allowed to use
statistical techniques to predict how much you are going to cost them.
Competition between insurance companies involves treading the line between
beating the price of other insurance companies while charging slightly more
than the customer is expected to cost.

If we let health insurance companies do this, then yes, healthcare would get
substantially more expensive for very risky/unhealthy people. Of course, it
would also get drastically less expensive for healthy people. From a moral
perspective, I think this is preferable, but obviously not everyone will
agree.

Now, from a utilitarian perspective, these two possibilities seem roughly
equivalent at first glance. However, I'd argue that the latter (where
insurance companies are allowed to set prices like car insurance) has a number
of (significant) positive side effects.

The largest side effect is that it incentivizes customer health improvement. A
lot of health risks, including at least the top 6 causes of death worldwide
(heart disease, stroke, lung infections, COPD, respiratory cancers, diabetes)
can be _substantially_ mitigated by personal choices such as diet and
exercise. If you had to pay an extra $200/mo to your insurance company because
you were morbidly obese, one would expect that this would encourage a lot of
people to start eating better. Let the market do the heavy lifting! This is
_exactly_ the sort of thing that the market excels at. Society benefits from
healthier people, but in almost all countries rich enough to have insurance
(including the US and nations with socialized healthcare), there is no
mechanism to incentivize this! An actual insurance market would do the job.

~~~
electricEmu
> I think it's unfair to force people to subsidize the healthcare of other
> people, regardless of the mechanism used.

This is literally car insurance in the United States. You buy insurance, put
money up front for your own health, or risk paying a penality. It's also
literally the ACA.

> If let health insurance companies do this, then yes, healthcare would get
> substantially more expensive for very risky/unhealthy people.

Unaffordable. My mother in law died from cancer recently. Coverage was
impossible before; in America's free market that constantly pays out
dividends. The ACA was the first time any insurance was affordable.

I'm sorry, but the views you've put forth appear to diminish the plight of
others who aren't young and healthy. Those views and policies would kill my
friend afflicted with an autoimmune disorder.

_Edit: spelling_

~~~
Exofunctor
I can't imagine how people have such an incorrect view of how insurance works.

No, car insurance is not you subsidizing other people. Car insurance is you
_paying in proportion to your own estimated risk_. That means if your expected
costs are 5x higher (nicer car, young driver, etc.) you pay 5x more.

Medical insurance in the US emphatically _does not work this way._ More
expensive people don't pay proportionately more than cheap people, meaning
that the expensive people are being subsizidized. You should be alarmed at the
fact that you apparently fundamentally misunderstood the way insurance works
in an open market, or what the ACA is. The _only_ part of the ACA that is even
_reminiscent_ of car insurance is the individual mandate, which is actually
way worse than car insurance because you don't need to buy car insurance just
for being alive. You only need car insurance if you drive on public roads.

It's too bad that your friend has a disease, but I'd rather have them pay for
it than pass the bill off to a bunch of innocent people who aren't sick. If
you choose to have tunnel vision and focus on health alone, it's worth noting
that the second-order effects of making other people's lives more expensive
will also include worsened health from poorer nutrition, increased stress,
less frequent medical consultation, etc.

~~~
mnm1
"It's too bad that your friend has a disease, but I'd rather have them pay for
it than pass the bill off to a bunch of innocent people who aren't sick."

His friend can't pay for it, so what you're essentially saying is you'd rather
have his friend, and people who can't afford their medical care in general,
die rather than have others subsidize healthcare through their taxes (or any
other way). In other words, because of the current cost of healthcare, only
the obscenely-rich get to live while the rest die off. That's just incredibly
cruel, vile, and disgusting, but sadly, hardly a minority opinion.

------
randyrand
If two consenting adults want to make a agreement that includes exchange of
their _own_ genetic information, I really don't see the issue.

There are plenty of employers that don't require genetic information. If you
don't want to give your genetic information to your employer it's simple,
don't work there. Companies that can't hire employees go out of business. This
is a self correction 'problem'. We don't need legislation here. Legislation
almost always fails edge cases and is not needed for self correcting issues.

~~~
erlehmann_
> If two consenting adults want to make a agreement that includes exchange of
> their own genetic information, I really don't see the issue.

The problem is one of bargaining power: Consent must be given freely – but in
cases where one party in an exchange has a lot more bargaining power, the
other party often will agree to something because of fear of retribution or a
threat of force. Example: If an employee is told by the boss he or she will be
fired if they do not have sex right now, any consent in that scenario is not
given freely, but under duress.

~~~
witty_username
The boss is threatening to abuse their power if they do not have sex. An
employee can sue the boss for violating the contract.

> but in cases where one party in an exchange has a lot more bargaining power,
> the other party often will agree to something because of fear of retribution
> or a threat of force.

You seem to be implying this is bad thing but it makes sense that a company
(could be thousands of people) should have more bargaining power than an
employee (1 person). What is the threat of force here? That is illegal. What
is the retribution here if an employee chooses a different employer because
the employee wants to decline testing?

~~~
throwaway2048
what happens when all insurance plans make this a hard requirement, and you
effectively can not be employed, or insured without it.

Don't think it will happen? Try to get internet access, or medical insurance
without agreeing to mandatory binding arbitration (that is, signing away your
ability to sue).

~~~
witty_username
If it happens, then that's what employees/customers want. It's similar to
democracy.

I do not want to force something on other people.

