ssentially, there is a "genetic underclass" (to phrase this provocatively) more prone to disease, and you might well be part of it. Importantly, this categorization cuts across traditional boundaries of class-- while certain diseases might be associated with poverty, there will be people in all classes of life who are genetically prone to obesity, for example, and who will be forced to pay more for insurance.

don't you think that the more 'traditional' upper class will likely be affected by similar diseases and that they will pay to see to it that those diseases are 'solved' in a satisfactory manner faster than those that affect the traditional underclass? so by the time the insurance companies start charging people more who have susceptibility for incurable diseases only the poor folks will fit in that class..

If there is significant 'asymmetry of information,' in this case genetic background that the customer knows but the insurers don't, the insurer could go bankrupt, due to adverse selection and such.

I think, if you argue for a nationalized social healthcare system or some shadow thereof, the government should also then heavily subsidize the solution, pre-implantation genetic diagnosis. If we're lucky, it may be a 'one-off' solution. The NHS agrees with me.

One could argue that, while one can't be culpable for one self, he could, in light of current or coming technologies, be responsible for his offsprings'. Of course, ethical arguments tend to inveigh against PGD (without much reason as far as I can see).

Best to preserve the pool solution whilst minimizing government intervention and perhaps retaining/creating incentives for scrubbing your offspring of these costly diseases.

This truly is feascinating. The killer is that one genetic underclass is going to get thumped, and they are going to find it difficult to challenge the logic.

First, consider how colleges with AffAm are race biasing education: don't give benefits to those who are minorities, give "diversity" credits: 5 points if you are poor, 2 points if you listen to rap, 7 points if you grow up in Compton, etc.

Not a single diversity factor has a one-to-one identity to race, but collectively the racial effect is clear and strong (and in this case intentional): get fewer whites and more blacks and Hispanics. Their argument against allegations of racial bias against whites is "we are not race biasing, we are seeking diversity. No single factor is race determinative."

Now consider genetic screening: don't charge for insurance based on race but on risk factors. $5 for having the XYZ1 impulsiveness gene, $2 for having the ABC9 dumbness gene, $7 for the PQR4 sickle cell gene, etc.

Not a single genetic factor has a one-to-one identity to race, but collectively the racial effect is clear and strong. And the argument in defense of this practice will be the same as AffAm(and in this case an honest argument, unlike the AffAm folks).

Lefties will simultaneously undercut the bases of their own (covert and deliberate) race biasing in education and hiring in order to challenge the (completely inadvertent) race biasing in genetic screening .. and how are they going to claim that genes are a "legacy of slavery"?

"some version of socialized health care"

More like socialized health insurance.

If there is significant 'asymmetry of information,' in this case genetic background that the customer knows but the insurers don't, the insurer could go bankrupt, due to adverse selection and such


Well, of course, because of that, the price of general insurance will rise, to cover for the adverse selection cost.

The other effect that might happen is this: people who have the "good" genes (rather, no known bad genes) will want to advertise that to the insurer; implying that someone who actually buys insurance without providing the genetic map is going to be charged even more. (I think this last point is included in the adverse selection issue mentioned above)


One way to ameliorate (not eliminate) the insurance premium issue would be to buy insurance for the unborn child. Adds a little bit more variance to the predictions.

Hmmm... as a general approximation, Americans get health insurance as a benefit from their employers, and only those who have to buy individual coverage end up paying more for obesity and the like. Sure you weren't thinking of life insurance? Same factors apply there, of course, but individually acquired coverage is a bigger chunk of the business I believe. The health-insurance-through-employer thing is actually an interesting kludge to mitigate the asymmetrical information problem IMO. Force everyone to take the benefit instead of the premium money, while offering the insurance company a pool of people with a presumably random distribution of health issues; it's like a miniature version of the national solution you mentioned.

Yep, adverse selection is the big issue here. If I can spend my own money for confidential genetic testing and discover my risks for, say, cancer and heart disease, this will surely affect my insurance choice. That won't just be about health insurance, though--life insurance, long-term care insurance, and disability insurance are all also affected. I mean, suppose I discover that I've got a 60% chance of having some kind of incurable cancer in the next 10 years. Time to load up on the life insurance! Or suppose I know I'm likely to develop debilitating arthritis in my 50s. Well, I guess I'll be needing the disability insurance.

Americans get health insurance as a benefit from their employers, and only those who have to buy individual coverage end up paying more for obesity and the like.

ah, well, I was basing some of this off my experence shopping for insurance when I was unemployed. but even now that I'm employed, I had to choose among a couple plans, which brings into play the assymetry of information again.

I think, if you argue for a nationalized social healthcare system or some shadow thereof, the government should also then heavily subsidize the solution, pre-implantation genetic diagnosis.

I'd certainly be willing to consider that, but I'm not sure that's politically feasible in the us. it's also possible that the government could just accept on principle that telling people which alleles to pass on is not acceptable, even at the cost that would entail.

It seems obvious to me that there is an important overlapping between health and money. Classical underclass is always in poor health. Advances in genetics only confirm what we already more or less know. Society will adapt to newer and more reliable knowledge by (a) ignoring it, or (b) rounding the edges. I am saying this on the basis of what is happening in Israel. The Rabbanut (the chief religious authority - in Israel it is a State dependency) ignores and does not consider genetic information, and keeps using the ancient and wrong systems to attribute legal paternity. The Judicial authority is more modern and takes into account genetic information, but if it harms children it ignores it saying that is only 99% reliable and there is always a doubt and in special cases, they prefer to believe the doubt. It is the same in the medical profession: when in genetic councelling it become evident that the child is not genetically from the "father", the councellor will obfuscate the issue. The wonders of one's and society's powers of self-delusion are boundless. I assure you, Razib, the insurance industry will adopt to the new situation very smoothly.

don't you think that the more 'traditional' upper class will likely be affected by similar diseases and that they will pay to see to it that those diseases are 'solved' in a satisfactory manner faster than those that affect the traditional underclass?

I'm not sure what you mean. let's take heart disease and diabetes, two diseases that affect both the upper and lower classes. do you mean that the upper class will cure those diseases sometime soon, and thus will not have to pay higher premiums for succeptibility?

"don't you think that the more 'traditional' upper class will likely be affected by similar diseases and that they will pay to see to it that those diseases are 'solved' in a satisfactory manner faster than those that affect the traditional underclass?"

I'm not sure what you mean. let's take heart disease and diabetes, two diseases that affect both the upper and lower classes. do you mean that the upper class will cure those diseases sometime soon, and thus will not have to pay higher premiums for succeptibility?


One of the benefits of being a member of a social species is that you do not need to be super intelligent, alert, etc, since you get the benefit of all those other eyes, brains, and so on. In some sense, you only need to be alert to what is going on around you.

Another benefit is the drag-along effect. As the group's situation improves, yours improves as well (although, perhaps not by as much as the mean or those who can claim the greatest part of the benefit).

This tends to mean that solutions to diseases are eventually available to all.

Of course, your genes might not remain in the gene pool long enough to benefit, especially if your intelligence (social and otherwise) are in the lowest quartile.

Albatross: “suppose I discover that I've got a 60% chance of having some kind of incurable cancer in the next 10 years”

An incurable cancer today might be very curable in ten years. Same for heart disease, diabetes, Alzheimer’s disease, etc. Establishing genetic susceptibility for a disease is a major step toward preventing that disease.

Insurance companies may not be able to predict expected lifespan or health costs because historical data may no longer predict future outcomes.

I'm not sure what you mean. let's take heart disease and diabetes, two diseases that affect both the upper and lower classes. do you mean that the upper class will cure those diseases sometime soon, and thus will not have to pay higher premiums for succeptibility?

i wasn't thinking of heart disease and diabetes. i don't know of any particular diseases with higher prevalence among whites, but i assume there are some, and it seems likely that research into treatments for those would be better funded than for sickle-cell anemia.. so if insurers are charging higher premiums for diseases that don't have easy treatments i would expect that people with sickle-cell would get hit more..

i agree that for diseases that affect all equally this won't be the case..

HIV seems like an obvious counterexample here. Though there's a big visible group (gay men) who have campaigned hard for funding for AIDS research, AIDS hits blacks quite a bit harder than whites, and there is lots of money spent on research on treatments for AIDS.

What process do you imagine occurring that would lead to diseases of the poor remaining untreated? The only plausible one I can think of would involve simply not being able to make any money treating the poor-peoples' illness. But it seems like this gets washed out because of medicaid, which does spend money to treat poor peoples' illnesses. Are there existing examples of illnesses that mainly hit poor people or mainly hit blacks, and that are just not the subject of substantial medical research?

The wonders of one's and society's powers of self-delusion are boundless. I assure you, Razib, the insurance industry will adopt to the new situation very smoothly.

we shall see. and by the way, I'm not razib.

Isn't insurance kind of pointless if someone decides you are extremely high risk? I mean, if the insurance company knows, with (say) 95% confidence, that you will have $200,000 of medical costs in some amount of time, it's kind of pointless to get insurance. Isn't the whole point of insurance to protect you from any dangers you may face that you cannot afford? Essentially, the more insurance companies know, the more useless insurance is. It's like playing poker with someone who already knows everyone's hand--after some time playing with this person, you are virtually guaranteed to get screwed.

Don't worry about whether you have a propensity for some genetic disease or not, the key thing is can you get into the insurance pool. People who cannot afford insurance in a future with genetic data will likely be the same people who can't afford it right now. In Europe and the U.S. the percent of people holding insurance and reaching age 50 plus is increasing. Those individuals put a greater strain on insurance costs than the odd individual prone to herart disease. The best analogy is the increase in severe weather damage and claims made by those affected in recent years. Rather than socilaizing healthcare, government will likely continue in preventitive programs--restricting smoking, no trans fats etc., and supplement Medicare costs by additional taxes imposed on "sin" goods--so that bag of chips may increase by 20 cents or more over time.

i was trying to find information to evaluate the way i'm thinking with numbers.. seems like you'd need to know the amount of research spending on different diseases.. i found something like that here.. then i need to know the prevalence by SES and race.. in my search, i came across an interesting abstract:

Ashkenazi Jews and Breast Cancer: The Consequences of Linking Ethnic Identity to Genetic Disease

We explored the advantages and disadvantages of using ethnic categories in genetic research. With the discovery that certain breast cancer gene mutations appeared to be more prevalent in Ashkenazi Jews, breast cancer researchers moved their focus from high-risk families to ethnicity. The concept of Ashkenazi Jews as genetically unique, a legacy of Tay–Sachs disease research and a particular reading of history, shaped this new approach even as methodological imprecision and new genetic and historical research challenged it.

Our findings cast doubt on the accuracy and desirability of linking ethnic groups to genetic disease. Such linkages exaggerate genetic differences among ethnic groups and lead to unequal access to testing and therapy.

we shall see. and by the way, I'm not razib.

we are all razib now....

In the US insurance is regulated by the states. A number of states have long had law or regulations concerning use of the results of genetic testing. If you google for the National Association of Insurance Commissioners web site you can search their data base for state laws concerning "genetic testing" or "genetic screening". It's a back burner issue for the insurance regulators right now but they could bring it up to the front and turn up the heat fairly quickly.

A lot of this debate assumes the American medical system, which almost everyone agrees is a mess. Some form of socialized medicine would eliminate a lot of the insurability questions. There's a social downside to pooling risk nationally, but there's a big upside too.

Socialized medicine or other involuntary risk pooling will eliminate the health insurance problems, but not the life insurance, disability insurance, lifetime annuity, etc. problems. To the extent that individuals can have a much better picture of their risks than the insurers, we get the joys of adverse selection.

"including (dare I say it?) the French one"

Is it "daring" because their system involves government intervention, or because you have something against the French?

Epigenetics might drop a wrench into all of this as well.