Decoding Health Insurance
By Robin Cook
The New York Times
May 22, 2005
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.
As a doctor I have always been against health insurance except for catastrophic care and for the very poor. It has been my experience that the doctor-patient relationship is the most personal and rewarding for both the patient and the doctor when a clear, direct fiduciary relationship exists. In such a circumstance, both individuals value the encounter more, which invariably leads to more time, more attention to potentially important details, and a higher level of patient compliance and satisfaction – all of which invariably result in a better outcome.
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. (Under the rubric of health care I mean a comprehensive package that includes preventive care, acute care and catastrophic care.) 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.
There are plenty of compelling arguments for a national, single-payer, universal access plan – like every developed industrialized country has one. But those arguments have so far seemed insufficient. And none of them is nearly as cogent and persuasive as the growing impact of genomics and bioinformatics. Of course, far too many wealthy stakeholders in the current system (thanks to 15 percent of our gross domestic product being thrown at health care) are eager to lobby members of Congress to keep things as they are. The basic challenge is to blast the public and their elected representatives out of their shared apathy toward what the decipherment of the human genome has brought.
Robin Cook is a medical doctor and the author, most recently, of the novel “Marker.”
http://www.nytimes.com/2005/05/22/opinion/22cook.html?pagewanted=all
Comment: Every time that reason is introduced into the national dialogue on reform, the arguments for a single payer system become ever more compelling.