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Bill Prohibiting Genetic Discrimination Moves Forward

Soulskill posted more than 6 years ago | from the nda-for-your-dna dept.

Privacy 575

An anonymous reader writes "The bill to ban genetic discrimination in employment or insurance coverage is moving forward. Is this the death knell of private insurance? I think private health insurance is pretty much incompatible with genetic testing (GT) for disease predisposition, if said testing turns out to be of any use whatsoever. The great strength of GT is that it will (as technology improves) take a lot of the uncertainty out of disease prediction. But that uncertainty is what insurance is based on. If discrimination is allowed, the person with the bad genes is out of luck because no one would insure them. However, if that isn't allowed, the companies are in trouble. If I know I'm likely to get a certain condition, I'll stock up on 'insurance' for it. The only solution I can see is single-payer universal coverage along the lines of the Canadian model, where everyone pays, and no one (insurer or patient) can game the system based on advance knowledge of the outcomes. Any other ideas? This bill has been in the works for a while."

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575 comments

Genoism... (5, Insightful)

Adambomb (118938) | more than 6 years ago | (#23189666)

they call it.

But no one takes the law seriously.

Re:Genoism... (1)

swimin (828756) | more than 6 years ago | (#23189924)

People in certain communities definitely do take it seriously. Right now, there is a penalty (future discrimination) for proactive genetic testing if you believe you may have a gene (say one that caused a late onset heart defect in your brother).

Many different groups advocating for patients for various genetic disorders and diseases are very interested in the progress of this bill.

Re:Genoism... (4, Insightful)

Adambomb (118938) | more than 6 years ago | (#23189990)

heh just for clarity's sake, that was a quote from the movie Gattaca [wikipedia.org]

Re:Genoism... (0)

Anonymous Coward | more than 6 years ago | (#23190510)

Stop trying to protect the invalids. I really wo

SLASHDOT SUX0RZ (-1, Troll)

Anonymous Coward | more than 6 years ago | (#23189678)

_0_
\''\
'=o='
.|!|
.| |
stamp out goatse discrimination [goatse.ch]

what? (2, Insightful)

Mr. Slippery (47854) | more than 6 years ago | (#23189702)

We've had private insurance with no genetic testing for a long time how.

How is keeping the second condition going to mandate the end of the first? It's ridiculous.

Re:what? (1)

Anonymous Coward | more than 6 years ago | (#23189762)

Did you even read the whole summary?

Re:what? (5, Interesting)

Adambomb (118938) | more than 6 years ago | (#23189764)

Because insurance companies manage their rates based on trackable probabilities and their claims history. If an insurance company a show that those with genetic pre-dispositions for certain conditions have higher claim rates, this will become a metric for increasing prices without actually having a diagnosis for the conditions in question.

Trust me, this is not a good thing for the consumer if such data becomes a standard part of ones medical history and I SELL travel medical insurance.

Re:what? (5, Insightful)

Mr. Slippery (47854) | more than 6 years ago | (#23189894)

Because insurance companies manage their rates based on trackable probabilities and their claims history.

Yes, of course. But what does that have to do with the submitter's claim that banning genetic discrimination means the end of private insurance?

We've had private insurance for a long time without genetic discrimination, because genetic discrimination wasn't possible. This legislation bans genetic discrimination, thus keeping the status quo on this issue. How does that mean the end of private insurance?

Re:what? (2, Insightful)

Adambomb (118938) | more than 6 years ago | (#23189958)

Because if you reduce the margins enough, you end up with a scenario where ones premiums equal exactly the cost of ones expected medical treatment. If your premiums for insurance are equal to your cost of medical care, what the hell is the point of insurance?

at least thats the way i see it as a medical insurance salesman.

Re:what? (1, Interesting)

timmarhy (659436) | more than 6 years ago | (#23190482)

then you don't understand your own industry very well. insurance companies are actually a FUND. they take your payments and invest the money and make MORE money on it that way, and when the time comes and you need to draw on that fund, then they pay out (and not very much i might add)

i don't have the link but i seem to remeber the top fund in australia pays out more then 90% of it's memebers fee's in health care.

i'm young and fit and i hardly have any need for health cover, but i could do and i WILL need it when i'm older. So i pay into my fund now which means my premiums stay lower, and the industry benefits from it as a whole.

Re:what? (5, Insightful)

aardvarkjoe (156801) | more than 6 years ago | (#23190524)

Your comment illustrates exactly what is wrong with the medical insurance system we have today: the idea that the purpose of insurance is to save everyone money.

With a properly functioning insurance system, you would expect to probably pay a bit more for your premiums than you would for the medical care that you actually receive. In return, you would be protected from having to foot the bill for an unlikely catastrophe.

Instead, modern medical insurance has degenerated into a sort of payment plan for routine medical expenses.

Re:what? (1)

Adambomb (118938) | more than 6 years ago | (#23190072)

Gah i misread what you meant, you're exactly correct that if this data is kept AWAY from insurance companies, it will NOT mean the end of private insurance.

I completely agree that if this kind of detail is commonly available that THAT scenario would eventually lead to the end of private insurance.

My bad, i'm on vacation =).

Who's going to keep it away? (2, Insightful)

RingDev (879105) | more than 6 years ago | (#23190458)

Just remember, the 'P' in HIPA stands for Portability not Privacy or Protection.

-Rick

Re:what? (4, Insightful)

bunratty (545641) | more than 6 years ago | (#23190098)

It's just like counting cards in blackjack. If you the dealer is not allowed to change strategy on knowledge, players that place their bets according to the cards left in the deck can make a killing. Likewise, if the insurance company is not allowed to charge you according to how likely to you are to get a disease, people who buy insurance with full knowledge of their genetic predispositions will tax the insurance system by making sure they are fully insured for the diseases they will likely get.

The proposed solution of universal coverage would remove this problem.

Re:what? (5, Insightful)

evanbd (210358) | more than 6 years ago | (#23190162)

It's not the end, but it is the first step on that road.

How long until we see companies that offer policies that don't cover specific highly testable conditions? Sure, they can't test for the condition, but you can -- and choose the policy accordingly. Then the "generic" policies cost more because all the people *with* the genetic markers buy those, and the people without buy the other policies. If the consumer has access to the information, they will try to use it to reduce their insurance costs. You can't put the genie back in the bottle, useful information like this *will* get used.

I predict the next law will be one mandating that any health insurance policy cover certain sorts of conditions, specifically to prevent the above. The collection of patches to the insurance system will grow and grow, until it finally becomes untenable and something major changes.

Re:what? (1)

moderatorrater (1095745) | more than 6 years ago | (#23190424)

it finally becomes untenable and something major changes,
I find that doubtful, because tests are the first step to fixing the problem. If we can specifically identify genes that cause a certain disease, then within a generation or two we'll have a fix, at least one that can be applied to a bundle of undifferentiated cells. When it can be fixed in utero and the only people that can be born with the disposition are those whose parents chose it, the arguments against discrimination will lose a lot of their power.

The other reason I find it doubtful that it will build up that strongly is that insurance inherently doesn't make sense from the perspective of saving money. People don't buy insurance because they expect to pay less, they buy insurance so that they don't become bankrupted on a one in a million chance. Since genetic markers only show a predisposition, these "highly testable" conditions can still affect someone without these markers. So it may be 75% less likely that my son will have leukemia, I'm still going to want him insured against it.

Re:what? (1)

Harmonious Botch (921977) | more than 6 years ago | (#23190174)

Yes, of course. But what does that have to do with the submitter's claim that banning genetic discrimination means the end of private insurance?
The whole idea of insurance is that it is a less-than-perfect information game. If one party gets perfect information ( or even close to perfect ) then the game is up.
That being said, I think that the OP's claim does not hold up. It would if one's health were only influenced by genetics, but there are accidents, and other things that affectone's health also.

Re:what? (1)

erlenic (95003) | more than 6 years ago | (#23189934)

Well, let's look at a hypothetical. Suppose there is some decease that costs a metric shitload to treat, and occurs in 5% of people. The cost of treatment is high enough that this 5% chance increases everyone's monthly premium by $50. If I can prove that I am not genetically predisposed to this decease, then I can lower my health insurance costs by $600/year. Sounds to me like a great benefit to 95% of consumers.

Re:what? (1)

LunaticTippy (872397) | more than 6 years ago | (#23190252)

It's a death sentence to the 5% with the disease. That seems to be OK with you, but most people wouldn't call a system like that civilized.

Not so fast (1)

Jeff Molby (906283) | more than 6 years ago | (#23190576)

Your unjustified assumptions:
1) The disease in question is fatal
2) The fatality occurs at such a young age that it would generally be considered tragic
3) There would be no public or private entities dedicated to helping those people

In short, reliable genetic information could go a looong way to providing society with a better allocation of resources and we could still offer a safety net when we deem it appropriate. If government has a proper role, it's as a laser. When we use it as a sledgehammer, it inevitably causes large inefficiencies and net decrease in the overall standard of living.

Re:what? (0)

Anonymous Coward | more than 6 years ago | (#23190340)

You know, you would be gutted in European politics for a comment like that! ;D Social solidarity [wikipedia.org] is part of the culture here.

Re:what? (2, Insightful)

hurfy (735314) | more than 6 years ago | (#23190368)

As long as you are not in the 5% whose premiums go up $12000 per year to make up for giving everyone else their $600 discount. A reverse lottery where losers go bankrupt?!?

(quickie math, feel free to fix if you are so inclined )

Obviously that means most of those people will not be insured for it, even if anyone is even willing to at any price. They will be the charitable cases that hospitals cover by overcharging those with insurance so your insurance goes up $50 to cover the increased costs.....

Re:what? (0)

Anonymous Coward | more than 6 years ago | (#23190542)

Well, let's look at a hypothetical. Suppose there is some decease that costs a metric shitload to treat, and occurs in 5% of people. The cost of treatment is high enough that this 5% chance increases everyone's monthly premium by $50. If I can prove that I am not genetically predisposed to this decease, then I can lower my health insurance costs by $600/year. Sounds to me like a great benefit to 95% of consumers.
The numbers are probably: $50,000/year increase to the 5% and 95% keep paying the same as usual.

Re:what? (2, Informative)

moderatorrater (1095745) | more than 6 years ago | (#23189804)

If you take any two insurance companies, company one is given the advantage of genetic testing with the ability to discern some general risk factors from it, and company two doesn't have the advantage of the testing. The first will be able to offer lower rates to those with lower risk and higher rates to those with higher risk. If my family's pre-disposed to skin cancer, the insurance company will raise my premium. Now, for lower rates, everyone checks with company one for insurance before trying company two. If they don't get a good rate, then they have to go to company two, who makes their proposal based on less data. Pretty soon company two's rates are going up because they have everyone who dies of heart attacks at 40 while taking 15 prescription medications while company one has every one of their patients live through their 90s without taking more than 2 prescription medications.

Hear hear! (1)

the_skywise (189793) | more than 6 years ago | (#23189838)

Uncertainty isn't what insurance is based on. Insurance is based upon probability of a certain event happening to you. IE If you're a smoker, you are more likely to encounter certain health issues and thus your insurance fees are higher because, duh, your health care costs will statistically be higher. Even the almighty socialized healthcare systems can't avoid this fact and spread the cost among all the people instead of forcing the costs on the person doing the smoking.

Note also that this bill doesn't prevent companies from charging MORE for certain genetic dispositions just that they can't deny you insurance because of your genetics. So you're still free to "stock up" on insurance for your condition (and they'll probably provide incentives for you to take more preventative action.

I've said it before and I'll say it again... those who are willing to give up medical freedom for the sake of medical security deserve neither.

Re:Hear hear! (0)

Anonymous Coward | more than 6 years ago | (#23189972)

I've said it before and I'll say it again... those who are willing to give up medical freedom for the sake of medical security deserve neither.
Which is what most of the people I personally know happen to have. Time for you to start paying for my medical care, up with socialized medicine!

Re:Hear hear! (1)

Digi-John (692918) | more than 6 years ago | (#23190274)

Over the course of a lifetime, the health costs for a smoker are lower. I don't remember what the source was or I'd cite it, sorry. Apparently dying of lung cancer at 70 is less expensive than slowly deteriorating in all ways from age, oh, 60 to 90.

Re:Hear hear! (4, Interesting)

Nuskrad (740518) | more than 6 years ago | (#23190540)

Yeah, a study [iht.com] showed that obese people and smokers generally cost less in lifetime health care because the diseases killed them younger.

Re:what? (0)

Anonymous Coward | more than 6 years ago | (#23189902)

Life-Line (1939) by Heinlein would be an extreme example.

I don't think the insurance companies will go out of business with this though. The price will just go up.

Re:what? (1)

alan_dershowitz (586542) | more than 6 years ago | (#23189942)

Because when everyone can get a test to find out all the illnesses they are likely to get, they are going to take out mucho insurance to cover those things, while the insurance company is not going to have access to the same information in order to deny coverage. Because, as an insurer: if you know someone is very likely going to get breast cancer, why would you give them coverage that's going to cost you more money than they put in in payments? You are a business, not a charity. The insurance company wants the same medical information you have access to. What it comes down to is that if the consumer via routine health checkup has access to information that can enable them to take out an insurance plan that in the long run will pay out more than they put in, if the insurer doesn't have the same access to that information then the health insurance business potentially isn't viable anymore.

Re:what? (0)

Anonymous Coward | more than 6 years ago | (#23189946)

I have actually been denied private health insurance coverage in the U.S. due to a genetic test. I have a genetic predisposition for blood clots. Golden Rule (part of United Healthcare) decided that I was too risky and refused to cover me.

HIPAA prohibits genetic discrimination if you are insured through a group plan, but says nothing about private insurance.

Yes, some companies have taken advantage of this.

Re:what? (1)

RobertB-DC (622190) | more than 6 years ago | (#23190008)

We've had private insurance with no genetic testing for a long time how. How is keeping the second condition going to mandate the end of the first? It's ridiculous.

Did you read the summary? We're not keeping the second condition -- if this bill passes, millions will start getting tested so that we'll know what wonderful surprises await us in our waning years (or months, depending on the results).

The problem, according to the OP, is the same as the one we already have. Healthy people will self-select *out* of the private insurance system. The only people who will buy insurance will be the ones who already know they'll get sick. But again, that's already the case. Young people don't buy health insurance, because they don't get sick as often. Older folks are more interested, because they DO. So we *already* have a broken system.

It's also broken because of money. If you have it, you get insurance, but you'll likely be healthier because you have enough money to take care of yourself. If you don't, you can't get insurance even if you want it, and the hospital is stuck with the bill when you die in the ER. That expense doesn't just go away; it's passed on indirectly to those who do have insurance. So fewer people can afford it. So there are more ER visits. So fewer people can afford insurance. Lather, rinse, repeat.

Risk-based health insurance is an outdated model, a relic from an era when Social Darwinism dictated that those who deserve to live will find a way, and those who don't will no longer be society's problem. Our society, however, has decided to reject the notion that it's ok for people to die on the side of the road. The insurance industry needs to change to reflect this new moral choice.

The insurance industry is like an old classic car. It looks great on the outside, but the suspension is shot and the frame has rusted through. Preventing genetic discrimination will prove to be a curve that the old car just can't take. It's time to put it in the garage -- so that we can build a new system that is compatible with our values. Or they can keep driving the old car... right off the cliff.

Re:what? (1)

strech (167037) | more than 6 years ago | (#23190222)

The issue is "Adverse Selection [wikipedia.org] ".
Essentially, while the insurers aren't going to have any more information, people will. So the people that know they're going to need insurance are more likely to buy it and buy more of it, and the people that are less likely to need it will buy less of it.

This makes the insurance more expensive and less profitable; it can also put companies out of business by making insurance so expensive it won't sell, or by paying out more fees than you take in via premiums.

An example - I work for a company that (among other things) builds websites that sell insurance for other companies. One of the life insurance products we built a website for a while back fell victim to this - because it was an automatic approval product and lacked a few safeguards, it tended to get bought by adults buying out insurance on their old, sick parents. As a result, they paid out more than they got in premiums and had to replace the product. This wasn't any big trouble for the insurance company or us - it was one product out of many, and it was a fairly big insurance company - but it's a threat.

I don't think it's a big threat for health insurance, however, and I support the bill. Health insurance is broad enough that almost everyone wants coverage (the number of people who don't have health insurance that don't want it is small) and testing won't reveal risk factors for everything, so I don't think Adverse Selection will have that much of an effect. Also, the alternative of allowing them to use genetic information to discriminate is likely worse in terms of making it extremely hard for some groups of people to get health insurance.

Re:what? (2, Insightful)

ajs (35943) | more than 6 years ago | (#23190288)

We've had private insurance with no genetic testing for a long time how.

How is keeping the second condition going to mandate the end of the first? It's ridiculous.

It's not ridiculous, it's just that the summary really, really sucks. What the summary author is trying to say is that if the consumer can use GT to decide if/when they should buy insurance, but the insurance companies can't use it to determine rates/coverage, then the insurance companies will no longer be able to keep their margins up, and will ultimately fail.

Of course, that's only true in a world where insurance companies don't adjust rates to reflect their actual profit/loss AND the primary reason that people get insurance is for genetically predisposed diseases. In fact, the primary reasons that most people get insurance is in case of serious and unforeseeable events such as communicable diseases and accidents and of course simple aging-related conditions.

Ask 10 people if they would not get insurance if they had a guarantee that they would never get a heart attack or diabetes. I'm quite certain they'll say that they still would.

So, the summary makes sense as far as it goes, but almost certainly doesn't map to reality.

and thats different from today how? (1)

QuantumRiff (120817) | more than 6 years ago | (#23189768)

However, if that isn't allowed, the companies are trouble.

How on earth would that be different than how health insurance has worked since it was created? Your company now has no idea if you are more likely to get cancer. Now it might now that you had cancer within the last 6th months, but not that you might get it in 10 years. I don't understand what the submitters counter argument is?! How can you "stock up" on insurance?

Re:and thats different from today how? (2, Informative)

Adambomb (118938) | more than 6 years ago | (#23189858)

How can you "stock up" on insurance?
By purchasing coverage for a period of time further into the future such that medical conditions that arise mid-policy do no have an overly long stability requirement.

those that can and know, do.

pricey capital investment though.

Re:and thats different from today how? (1)

mea37 (1201159) | more than 6 years ago | (#23190074)

Well, if the OP's dichotomy -- either the information can be used in any way the company sees fit, or it can't be used at all -- were valid, then the difference would be this:

The consumer would know if he/she's more likely to get cancer.

So there would be a bias in the market from the buyers' end -- those who seek coverage would be disproportionately expensive to cover.

Even that needn't be the end of private insurance, though. It would probably result in insurance carriers getting more clever about the packages they offer; and it would probably drive rates up, but by how much (and whether by enough to end private insurance altogether) would depend on numbers we can't really predict.

Note that many Americans (like me) are covered under group plans. This means limited choices for me (those choices being the result of negotiation between my employer and the insurance company) and limited information for them (I think maybe they get to know that I'm not a smoker; other than that my premiums are based only on group rates).

So, no... by no means is the OP's thesis correct. Non-socialistic models can still work even with greater predictive medical information.

Re:and thats different from today how? (1)

Ossifer (703813) | more than 6 years ago | (#23190500)

How can you "stock up" on insurance?

I think the OP is mixing health insurance and life insurance. You can't "stock up" on health insurance, but you can with life insurance.

Good (5, Insightful)

kurt555gs (309278) | more than 6 years ago | (#23189794)

There are very few businesses that as a rule are genuinely evil, but insurance companies are one in that category. The whole idea of the entity that has to pay for your health only benefiting when they do not is morally flawed.

Health care needs to be a right, and the risk or cost spread over everyone, with no one excluded. This also means that any benefit in savings must be good for the whole. Private profit making business can not be part of this for it to really be fair to all.

We could have had really top notch health care for everyone for less than we have spent on this silly war in Iraq, and with the give away's big political donors in the name of 911, we could all have our own Doctor.

Health care just needs to come from general revenue, like the Military, and cover every one. We spend more on weapons than the rest of the world combines, and most of that is greedy contracters gouging us. Just the waste in the Pentagon budget could cover everyone.

I really think it is time to take our government back and have it serve us.

So There
 

Re:Good (1, Flamebait)

techno-vampire (666512) | more than 6 years ago | (#23189914)

Private profit making business can not be part of this for it to really be fair to all.


Life is not fair. Deal with it.

Re:Good (3, Insightful)

khallow (566160) | more than 6 years ago | (#23189994)

Indeed. If life were naturally fair, then everyone would have the same disposition to illness and there'd be no benefit to genetic testing.

Re:Good (1)

colmore (56499) | more than 6 years ago | (#23190036)

Yes but isn't it the goal of organizing as a society to improve the lives of citizens? If this is the attitude we're going to take, we might as well dissolve the government and the cops and have Mad Max rule of the strongest.

This would also dissolve the Corporations. That manner of collective property is held together by a highly elaborate set of economically invasive (anti-invisible hand) laws.

Re:Good (4, Insightful)

techno-vampire (666512) | more than 6 years ago | (#23190196)

Yes but isn't it the goal of organizing as a society to improve the lives of citizens?


Here in America, that's what the goal is supposed to be. Over most of the world, during most of history, the goal has been to improve the lives of the leaders at the expense of the rest of the people.

Re:Good (1)

subl33t (739983) | more than 6 years ago | (#23190436)

Yes but isn't it the goal of organizing as a society to improve the lives of citizens?



Here in America, that's what the goal is supposed to be.

supposed to be - but it isn't

Over most of the world, during most of history, the goal has been to improve the lives of the leaders at the expense of the rest of the people.

and that is different from the USA how?

Re:Good (1)

colmore (56499) | more than 6 years ago | (#23190472)

Well, according to Hobbes, even under tyranny, people accept their fate because without their dictator, neighboring dictators would treat them even worse as nationless people sitting on valuable land (like say the Native Americans).

Anyway, if a huge chunk of the population of the richest nation in the world is unable to access modern medicine, something is seriously wrong.

The people most hurt by the current system are not those at the bottom of the social ladder, but rather those who have struggled to work their way up a few rungs. Emergency rooms aren't free if you own any kind of property at all, and they can wipe out someone who is trying to start a business or use their free time for nightschool etc.

The healthcare problems of this country are hurting our ability to generate new businesses.

Re:Good (3, Interesting)

alan_dershowitz (586542) | more than 6 years ago | (#23190494)

In America the goal was supposed to be to protect the rights of citizens so they could live their lives as THEY see fit, not to improve their lives according to some government-defined criteria. Anyway, health care could never be a right in the same manner that for example the right to free speech is, because my right to free speech doesn't obligate anyone else to listen. My presumed right to health care would require other people to pay for it, however, which makes it a peculiar sort of right that takes from someone else in equals amounts as it gives to me.

Re:Good (1)

Mordok-DestroyerOfWo (1000167) | more than 6 years ago | (#23189926)

This whole thing makes me really nervous. I used to have a hard time getting insurance because of a family history of heart disease. I shudder to think what my kids will have to go through (assuming I ever have any).

The question is what do we allow? Discrimination against obese people, smokers, alcoholics? If we start allowing insurance companies to do that, then genetic testing is just a hop, skip, and a jump away.

That said I agree with the parent that insurance companies belong in that special hell reserved for domain squatters and people who talk during movies.

Odd comparisons... (2, Informative)

Animaether (411575) | more than 6 years ago | (#23190556)

"The question is what do we allow? Discrimination against obese people, smokers, alcoholics?"

I don't see how it is a hop/skip/jump away from afflictions of -choice- (obesity is debatable, as that can have medical and heck, genetical, factors) to afflictions in which you, at least, had no particular choice. Perhaps your parents did (did your mom booze up during her pregnancy - d'oh?), but you yourself didn't get a whole lot of say in that and shouldn't become a victim of it.

Insurances already 'discriminate' against so many things. Didn't wear your seatbelt? There goes a good chunk of your payout, if not -all of it-. Over here in NL, smokers -do- pay a higher premium as well.. why not? Not only are they at a higher risk of cancer (insert "my grandfather smoked 3 packs a day and lived to be 94!" anecdotal evidence here), but they're putting everybody else at that higher risk as well (or, if nothing else, afflict those with asthma and generally stink up the place).

On the flip side - There's a life payout company in NL that gives a -higher- payout to smokers. Why? Because smokers do pay a higher premium, while they live less long. So they figure they should get a higher payout each month than non-smokers. Makes sense to me.

Re:Good (2, Insightful)

evanbd (210358) | more than 6 years ago | (#23189960)

At some point, there is a fundamental problem. Even after you magically remove all the various waste, corruption, and frivolous lawsuits, you get to a point where we know how to spend more money keeping people alive in the face of nast diseases than we can afford to, at a national level. When that happens, you have to either start rationing healthcare in some fashion, or the country *will* go bankrupt.

That's not to say we shouldn't have national healthcare; I think it would be an improvement, and that we should do it. But it is in no way a complete answer to the problems.

Re:Good (0)

Anonymous Coward | more than 6 years ago | (#23190134)

or the country *will* go bankrupt.
Is that possible. Because the current government is able to pull money out of their asses to afford a war bill and at the same time a tax-cut that doesn't make sense. If they stopped spending the money in places that aren't needed and if people are willing to help others by giving a bit more then maybe it isn't so hard.

Re:Good (0)

RiotingPacifist (1228016) | more than 6 years ago | (#23190308)

you get to a point where we know how to spend more money keeping people alive in the face of nasty diseases than we can afford to, at a national level. When that happens, you have to either start rationing healthcare in some fashion, or the country *will* go bankrupt.
Just because you give everybody healthcare doesn't mean you treat every condition, sometimes treating somebody isnt economically viable, and they die. Thats what happens under all systems, but by removing the insurers, you immediately cut out so much profiteering that you can easily allow for wasters, and nothing else changes.

Re:Good (1, Troll)

erlenic (95003) | more than 6 years ago | (#23190002)

Health care needs to be a right, and the risk or cost spread over everyone, with no one excluded.

What if I don't want health insurance, and am willing to run the risk of getting cancer and dieing because I can't get it treated? Why should I be FORCED to pay for it?

Re:Good (1)

eln (21727) | more than 6 years ago | (#23190244)

You and the other two people in the country that would actually be happy to sit in a shack in the woods and die a horribly painful death over months or years because you don't want to see a doctor can do so. However, for the rest of us, if we have a serious disease, chances are we're going to want to get some treatment for it.

Or, if you choose to seek treatment, you had better have the money to pay in advance so you don't leave the rest of us with the burden of the cost of your medical care after you die.

Re:Good (2, Insightful)

LunaticTippy (872397) | more than 6 years ago | (#23190466)

I don't want a fire department. Why should I be FORCED to pay for it?
I don't want police. Why should I be FORCED to pay for it?
I don't want a standing army. Why should I be FORCED to pay for it?
I don't want schools. Why should I be FORCED to pay for it?

I don't want roads, clean water, clean air, FAA, FCC, or any of that other bullshit. Yet I am FORCED to pay for all of it.

There are lots of things that we as a society have decided are essential. I think that medical care is pretty important, and dealt with more efficiently by the government than the private sector. The US spends a lot for pretty poor results. Why not try something else? It can't be worse than the current elaborate fraud.

Breaking Bad (0)

Anonymous Coward | more than 6 years ago | (#23190520)

Because when/if you do get cancer, you will likely choose to screw society over rather than die. The concept of "free choice" in health care is an illusion, because when it comes down to it nobody wants to suffer/die and nobody with a conscience wants to watch others suffer/die for their lack of foresight (or quite often, the lack of foresight/caring of the parent(s)).

Re:Good (0)

antirelic (1030688) | more than 6 years ago | (#23190102)

Huh? "Health care needs to be a right." How does this need to be a right? Who needs to pay for your "right" to health care? The more incentives we give people to sit on ass and do nothing, the more people are going to "sit on ass and do nothing". Look, I know there are already alot of people out there "sitting on ass" without health insurance, but do we need to reward them for "sitting on ass" even more? I'm all for taking care of people who are "actually" unable to care for themselves, but making such bold statements that we need to "take our government back"... is asinine. Our government wasnt founded on giving handouts to the public. Where are our EU members when we need them. Can someone from Denmark, Netherlands, or one of the smaller socialist countries come out and explain what happens to elderly people who are diagnosed with fatal diseases? Do they still get really expensive treatment at the tax payers expense or do they get told "no"?

Re:Good (1)

grommit (97148) | more than 6 years ago | (#23190186)

It's true that most insurance companies try to find loopholes to keep from having to pay beneficiaries but they probably wouldn't be so bad about it if people didn't commit so much insurance fraud. Fender benders turning into massive medical bills that just so happen to amount to the total medical coverage that the at fault person has on their insurance coverage is no coincidence and happens all too often.

Re:Good (2, Insightful)

digitalvengeance (722523) | more than 6 years ago | (#23190230)

You would run into the same issues with socialized medicine as you are complaining about with the military.

Unless we nationalize every supplier needed to run a healthcare system, there is the chance (and I'd argue the likelihood) of private companies gouging the government for supplies, services, etc. In fact, I'd say that this is considerably more likely to occur with a government health care system because private institutes typically make decisions on who to purchase from based on profitability and price is a factor in that. In a government system, profitability is a non-issue and political weight becomes much more important. We as taxpayers will start paying $20 for a band-aid because ReallyBadBandaids, Inc. happened to back the right candidate at the right time in a recent election. We could legally mandate the low-bid system, but then we are essentially guaranteeing that we will all receive the lowest quality of health care legally allowed.

The alternative is to give the government control of huge sectors of the economy so that they don't have to depend on private contractors. This is, of course, the first step toward a socialist society and the loss of our rights.

I agree that its time to take our government back and have it serve us, but I have a different viewpoint on what the government should be. The government has grown far too large and controls far too much of our lives; we need to get back to the original intent of the founding fathers and focus on a small federal government that honors the constitution.

Re:Government run anything equals bad (0)

Anonymous Coward | more than 6 years ago | (#23190236)

I can't think of anything the government runs beyond small communities that works well. I can think of plenty of national servicing companies that provide excellent service. Ok sorry our military can destroy anything to a degree of excellence that many fear. With that said the government should not be involved in the health care system. They have tons of money already in the research of medical drugs and fail to produce even ONE viable molecule on their own. Personally I would like to see people be responsible for your own health.

If you smoke, sit on your rear and generally live a poor lifestyle I would like you see you kicked off my insurance plan, government or not. You live a lifestyle that leads to diabetes and you get diabetes I see no reason why your insurance company(ie me) should foot the bill. Make sense. 90% of fat people claim its genetics yet research shows that 98% of fat people are fat due to lifestyle. Again stop wasting my money.

Insurance would generally not be needed if at the medical level if people could keep money in a rainy day fund...but they don't thus insurance is needed. The idea is not evil in itself but as with any business greed can take over.

Sorry but no i doubt the government could provide good health care. I fail to see on example of how they have done or could provide this level of service to a degree of excellence. Until that time keep it in the hands of private companies that know what they are doing.

Re:Good (2, Insightful)

j0nb0y (107699) | more than 6 years ago | (#23190350)

Health care can't be a Right. How are you going to decide what treatments are included in this mythical "Right," and which ones aren't? What if there isn't enough supply of medical care to meet the demand? Are you going to force people to become doctors? Are you going to force doctors to work more hours? If there is a limited supply, how are you going to decide who gets treatment, and who doesn't?

Suppose that a new treatment was invented that allowed people to live healthy lives indefinitely, but the treatment cost a million dollars a year. Are you going to exclude this treatment from the "Right"? Simple economics dictates that everyone cannot have access to it. So will you ban it outright? That ignores the possibility that if you allow wealthy people to fund the treatment right now for the expensive price, that funding could allow further developments that decrease the cost of the treatment, thus allowing more people to have access in the future. Are you willing to stunt the development of new healthcare technologies in order to have this supposed "Right"?

Keep in mind that I have already heard pundits on financial oriented tv shows warn against healthcare investments for fear that a democrat will be elected and harm the healthcare industry. Arguably, the rhetoric has already harmed healthcare in this country by discouraging investment.

The United States currently has the best healthcare system in the world. Why do you want to destroy something that at most needs a little tweak?

Remember that hospital in Cuba that Michael Moore visited in his film? Contrary to what Michael Moore would have us believe, that hospital is actually not available to the average cuban. That hospital is primarily involved in the business of health care tourism. Wealthy europeans escape the socialized medicine of Europe by seeking care in Cuba. If socialized medicine is so great, then why do europeans feel the need to leave the continent to seek medical care?

All of this without even getting into any of the problems that central control of any economic activity brings. Essentially, central control eventually leads to a single point of failure. Sooner or later, that point of failure fails, and bad things happen.

I find it telling that most of the people in favor of greater government interference have a great distrust of our current President. I have no doubts that Obama would do a great job running all the socialist programs he wishes to put into place. But it's not Obama I'm worried about. It's the moron who follows him. It will only be a matter of time before we have a terrible President. Do you really want to maximize the powers of the federal government that terrible President will have control of?

I'd rather trust the free market. Any governmental interference should be (1) minimal AND (2) targeted to fix a specific problem. Also, time limits on government exercises of power are generally a good thing. Otherwise government power tends to just grow and grow... ultimately the people pay the price...

Re:Good (1)

qoncept (599709) | more than 6 years ago | (#23190468)

You state a lot of things as fact without any evidence there, Che. Sure, the government is incredibly wasteful, but not only would you be unable to put a definate number on just how wasteful they are, you probably have even less of a clue what it would cost to provide this perfect health care. The fact that you think a (completely off-topic) war has cost us the silver bullet for eternal life is pretty naive.

Re:Good (0)

Anonymous Coward | more than 6 years ago | (#23190502)

ARGHHH!!! Words matter. It can't be a "right" if it requires that you take something from someone else to pay for your "right". Call it an entitlement if you must, but healthcare can NOT be a right.

"Any alleged 'right' of one man, which necessitates the violation of the rights of another, is not and cannot be a right."
- Ayn Rand

Gattaca anyone? (3, Interesting)

Swizec (978239) | more than 6 years ago | (#23189798)

Wasn't there a movie about this?

Because genetic planning, or whatever, exists it doesn't really matter whether genetic discrimination is allowed or not. It is simply the fact that genetically better people are more suited for things than genetically worse people. It's no more a matter of discrimination or not, but simply a matter of objectively looking at the attributes of each person.

Re:Gattaca anyone? (1)

Naturalis Philosopho (1160697) | more than 6 years ago | (#23190024)

If you remember that movie, the whole point was that there are some attributes of a person which can NOT be measured.

Re:Gattaca anyone? (1)

Swizec (978239) | more than 6 years ago | (#23190152)

And since when has the big money shown any indication of caring about that?

Re:Gattaca anyone? (1)

Naturalis Philosopho (1160697) | more than 6 years ago | (#23190434)

Oh, fine, bring reality into the discussion...

Private Insurance not quite dead (2, Interesting)

oodaloop (1229816) | more than 6 years ago | (#23189824)

The health insurance I pay is probably based more on phenotypic differences rather than genotypic. I don't smoke, but I do ride a motorcycle. Maybe I have the genes for some disease or another, but it's far from certain that I will develop it. OTOH, the fact that I don't smoke (or work in a popcorn factory, etc) means I am virtually assured of not getting lung cancer, and if I continue to ride often I am virtually assured of sliding down the highway at least once. The way we choose to live our lives will probably weigh more heavily in the way we continue to pay for health insurance than a nascent science whose findings will change year to year.

Re:Private Insurance not quite dead (1)

colmore (56499) | more than 6 years ago | (#23190364)

I know a lot of 20somes who live... well, not safely.

Between all the stupid things people do, the one I've seen fuck up more people is riding a bicycle without health insurance.

A sudden accident and you're tens of thousands of dollars in debt.

Sophistry (0)

Anonymous Coward | more than 6 years ago | (#23189826)

>If I know I'm likely to get a certain condition, I'll stock up on 'insurance' for it. The only solution
>I can see is single-payer universal coverage along the lines of the Canadian model, where everyone pays,
>and no one (insurer or patient) can game the system based on advance knowledge of the outcomes

This is sophistry: good predictive knowledge does not make disease more prevalent in the population, just more individually predictable. Insurance companies will adjust rates, and level out coverage so that even if people try to "game" their particular pre-disposition, the risk is still spread onto those without that pre-disposition. Those with few pre-dispositions will still need insurance to cover accidents, and to provide peace-of-mind. Sure, a few will pull out, but they won't be able to go shopping for cheaper policies because positive discrimination would also be prohibited.

uh... (0)

Anonymous Coward | more than 6 years ago | (#23189860)


"if said testing turns out to be of any use whatsoever."

uh... what does that mean? Physicians make diagnoses everyday based on genetic testing.

Legal Authority? (1, Interesting)

Thunderstruck (210399) | more than 6 years ago | (#23189868)

I've often wondered how a universal, single pay system could legally be created within these United States. It seems to me that the Federal government may not have the authority to create a workable system for universal coverage. It can regulate most forms of employment and most commercial activity, but a lot of the people who need coverage are retired, unemployed, or children.

Each state certainly has the authority to do this, but I suspect some states will lack the resources or desire. This would probably make it possible for folks to "game the system" by moving between states depending on their health needs.

So, how could this work? Or would we HAVE to stick with private insurance, and just assume the rates will go up to compensate for people who game the existing system?

Re:Legal Authority? (0)

Anonymous Coward | more than 6 years ago | (#23190354)

a constitutional amendment?

Re:Legal Authority? (1)

eln (21727) | more than 6 years ago | (#23190402)

I'm sure they could find a way to finagle this so the interstate commerce clause applies, that's how they do most everything else.

Re:Legal Authority? (2, Interesting)

fahrbot-bot (874524) | more than 6 years ago | (#23190454)

It seems to me that the Federal government may not have the authority to create a workable system for universal coverage.

They don't have to mandate it, just make everyone eligible and the private insurance companies won't cover you as a primary -- just like Medicare.

There already exists "universal" insurance plans for two segments of the population, Medicare for everyone 65+ and one for military personnel (I can't remember what it's called).

There was a great special on Frontline called Sick Around The World [pbs.org] about 5 capitalist democracies (United Kingdom, Japan, Germany, Taiwan, Switzerland) and how they provide universal healthcare. The show focuses on if the US can learn lessons from these countries.

Gaming the system (1)

flaming error (1041742) | more than 6 years ago | (#23189938)

> If I know I'm likely to get a certain condition,
  > I'll stock up on 'insurance' for it

And when AFLAC sees their profits for Spontaneous Big Toe Combustion Coverage drop, they'll raise the price of the policy. Or find some workaround.

The casino will figure out how to tip the odds to work in their favor. Gaming the system is exactly what insurance companies do for a living, and, one way or another, they'll keep their house advantage.

The Insurance Industry really wants this... (3)

iamsamed (1276082) | more than 6 years ago | (#23189948)

Mark A. Rothstein, ... GINA did not cover life insurance and long-term care insurance and that there already were legal ways for prospective employers to gain a job candidateâ(TM)s health information.

The Insurance Industry really wants this because it will eventually destroy them, IMHO.

Let's say the insurance industry has free reign for genetic testing. First, they deny all the people that has "pre-existing" conditions. Now, the folks who are accepted know that they're free and clear and do not buy the insurance (OK, they'll buy the accidental death stuff). Therefore, the insurance industry loses all those folks as customers. Of course, I'm over simplifying but I think you get the idea.

Arrrg, i wanted to say.... (1)

iamsamed (1276082) | more than 6 years ago | (#23189974)

The Insurance Industry really wants this because it will eventually keep from being destroyed, IMHO.

God, I hate editing in these text boxes!

Canadian system? Puleaze!! (1, Informative)

schwit1 (797399) | more than 6 years ago | (#23189964)

"The only solution I can see is single-payer universal coverage along the lines of the Canadian model"


Where a treatable disease becomes fatal because the waiting period for treatment is 18 months.

"Access to a waiting list is not access to health care", Canadian Chief Justice Beverly McLachlin

Re:Canadian system? Puleaze!! (0)

Anonymous Coward | more than 6 years ago | (#23190202)

Which leads to lower child mortality rates and longer life expectancy than in the US, Go Figure...

itsatrap (1)

davidwr (791652) | more than 6 years ago | (#23189978)

The bill passes, everyone gets tested, then The Powers That Be[TM] get new bills passed eroding this protection and eventually genetic discrimination is completely legal again.

What About Genetic engineering? (1)

tradotto (874026) | more than 6 years ago | (#23189988)

Would this law help the rich few who are going to be able to increase their mental capacity and ability using genetic engineering to obtain jobs over the poor/middle class people who can't offered said enhancements?

Re:What About Genetic engineering? (2, Funny)

AioKits (1235070) | more than 6 years ago | (#23190058)

Increase their mental capacity? If I had enough money to be 'rich' I'd be fiddling with the genes to increase the capacity of something else. Porn-stardom, here I come!

"Any other ideas?" Besides your false dichotomy? (1)

J'raxis (248192) | more than 6 years ago | (#23190026)

The only solution I can see is single-payer universal coverage along the lines of the Canadian model, where everyone pays, and no one (insurer or patient) can game the system based on advance knowledge of the outcomes. Any other ideas?

Yeah. It's called paying for your own health care yourself. Not insurance -- the health care, directly. It's was people did up until the 1970s when the health insurance racket took over (the HMO Act) and distorted prices to the point no one can afford it.

Re:"Any other ideas?" Besides your false dichotomy (1)

byersjus (987526) | more than 6 years ago | (#23190302)

Amen to that. I really like the Health Savings Account (HSA) concept. You contribute tax-free to an account, your employer matches (like a 401K), and you pay in cash via a debit card. Some doctors give discounts for cash so its as though everyone is chipping in. Government by NOT taxing your earnings that you spend on health care, yourself and your employer by contributing to the account, and the health care providers by making cost real, not the bloated prices that they charge because the consumer rarely sees the bill. The account collects interest, you can spend the money on health care without penalty or anything else if you pay a penalty on it. You can choose where you want to go for care, or shop around for scheduled (non-emergency) stuff. You still maintain insurance, but its called high-deductible coverage and is for major stuff. That's what insurance used to be for up until the nickel-and-dime, pay-for-everything plans started to be offered by employers to draw talent. After that there was no turning back. I can't imagine how much health insurance will be abused when its "free". If you're using money that you control from an account you can view the balance on, maybe you won't go to the dr. for that sniffle so quickly.

Re:"Any other ideas?" Besides your false dichotomy (1)

dieman (4814) | more than 6 years ago | (#23190414)

Or, how about we take tax incentives out of health care and make everyone just pay for it outright? See the comment you replied to, for instance.

Here's a novel idea (2, Interesting)

SaidinUnleashed (797936) | more than 6 years ago | (#23190040)

Ban insurance completely.

It's a protection racket, under guise of a protection racket. No better than mobsters did in the early 20th century.

P.S. I work in the insurance business.

I've seen some absurd conclusions before... (1)

Guido del Confuso (80037) | more than 6 years ago | (#23190052)

...but this is ridiculous.

As I understand it, the notion is that because of some possible scientific advances looming on the horizon that may or may not affect anything, it's time to scrap our entire health care system and move to socialized medicine. Whether or not you believe that universal health care is a good thing, that's a pretty big leap in logic.

Wow... (0)

Anonymous Coward | more than 6 years ago | (#23190158)

Is this newsworthy? Or is it a transparent agenda post?

Genetic discrimination and public health systems? (2, Informative)

FleaPlus (6935) | more than 6 years ago | (#23190184)

Is this the death knell of private insurance? I think private health insurance is pretty much incompatible with genetic testing (GT) for disease predisposition, if said testing turns out to be of any use whatsoever. ... The only solution I can see is single-payer universal coverage along the lines of the Canadian model, where everyone pays, and no one (insurer or patient) can game the system based on advance knowledge of the outcomes.
Of course, it might be nice to have laws against genetic discrimination in single-payer and nationalized health systems as well. For example, the UK's National Health Systems discriminates (some would argue deservedly) against people who are old [bmjjournals.com] , obese [newsvine.com] , or smoke [independent.co.uk] , denying surgeries and placing them at the bottom of wait-lists. It's not too much of a stretch for such discrimination to also be applied to those with particular genotypes, as they may be an inefficient application of the limited health resources of a single-payer system.

That's not insurance, that's welfare. (0)

Anonymous Coward | more than 6 years ago | (#23190192)

Insurance *by definition* only covers unknowns. To the extent that companies are already forced to cover predictable or pre-existing conditions, they are not insurance companies but welfare systems. Or, if it's you with the inside knowledge and you keep it a secret when they ask, they are fraud victims.

As for all the people calling for a big medical welfare system: I simply don't have a responsibility to expend my resources to keep you alive. This isn't a commune. My life and labor are not resources that you get to expend in an attempt to lengthen your own life. Deal.

Just a beginning ... (1)

taniwha (70410) | more than 6 years ago | (#23190200)

forget all that banning sexism or racism .... simple solution is a constitutional amendment banning discrimination based on DNA - all the rest is just a subset

Sharing risk (5, Insightful)

kennykb (547805) | more than 6 years ago | (#23190330)

Sharing risk is supposed to be the goal of insurance, going back to when it was a group of shipowners getting together in Lloyd's Coffeehouse to agree to cover each other if any of their ships sank (they all made a little less profit, but none had to worry about being utterly ruined by a single event. If insurers begin to stratify the clients on the basis of genetic testing, a market will arise to insure the never-tested against bad test results (pay us $xxx up front, and we cover your increased premiums). What the proposed legislation does is force participation in that market, by essentially bundling it with all policies. That may be a good thing, because it's otherwise too easy for the insured to game the system (get a test secretly, buy "testing insurance" only if the test shows that it would pay off). The problem with the whols system is that the market appears to have failed. You can't simply pay a little bit more to find an insurer who won't tell you, go ahead and die! [youtube.com]

Good for patients and insurers (2, Interesting)

macklin01 (760841) | more than 6 years ago | (#23190348)

Without the risk of discrimination, increased genetic testing could be a boon to both consumers and insurers. The earlier we know about a condition, the less expensive and more effective it is to treat, with likely a higher quality of life. Genetic testing would allow us to better assess who to monitor to attain this early detection. Moreover, with increased knowledge of risk factor, a patient could choose lifestyle changes that are preventative. (Even cheaper for insurers and further improved quality of life for patients!)

Take skin cancer: if you know you lack a key tumor suppressor gene that makes you more sensitive to UV damage, you'll be much more likely to use sunscreen and avoid peak sunlight hours (lifestyle/preventative); you'll also know to keep closer tabs on your freckles and moles for melanoma (monitoring).

With a level, non-discriminatory playing field, both patients and insurers benefit from the knowledge, rather than just insurers who want to drop any patient they can. -- Paul

What about other genes? (1)

MozeeToby (1163751) | more than 6 years ago | (#23190370)

So what happens if researchers find a "gay gene"? Couldn't a homosexual who was worried about discrimination run the test on themselves, then make sure thier prospective employer knew what the result was?

Of course, I don't know the wording of the law; this would only work if it was vague enough.

"Is this the death knell of private insurance? " (1)

timmarhy (659436) | more than 6 years ago | (#23190410)

utter bullshit. insurance is a gamble, always has been. the house (insurance companies) are simply trying to load the dice.

oh great (1)

Digi-John (692918) | more than 6 years ago | (#23190420)

Socialized health care denies or delays treatment if you smoke, are obese, forgot the cover on your TPS report. Do you really think that such a system wouldn't do the same thing given information on your likely future ailments? The difference between that and privatized health care is that at least with a private system the only barrier is money. In the socialized system, you've got no chance at all of not being screwed because of your genes.

I for one look forward to microscopic swarms of robots that feed on excess fat and repair any disease or illness. Not holding my breath though; in the meantime, I'll just pay for health care.

Hmm... (1)

kabocox (199019) | more than 6 years ago | (#23190518)

There are days that I think that the government shouldn't allow insurance companies from refusing to insure anyone. I also think that the behind the scenes numbers of how the insurance companies actually determine their rates and such should be required to be released to the government and the public. (I also think insurance companies shouldn't have get out of jail free cards for "acts of god." What a scam that phrase is. Everything can be an act of god. It's an act of god that I pay taxes and insurance, you shouldn't be allowed to use that to get out of paying claims.)

I'm very mixed on DNA tests and insurance rates. The thing is that even if you are predisposed to everything then you should still be able to find affordable insurance. The insurance companies shouldn't be allowed to refuse to insure that person or use crippling rates to prevent them from having insurance that's what this is supposed to prevent. I doubt it will.

The key point is that 5-10% off that those use the DNA testing will get off on their rates will be just enough to drive most those that what to save a buck to ask their insurance companies about if it's an option. Later on, your cheaper rates may come back to haunt your kids or grand kids though.

No, it isn't (1)

mosb1000 (710161) | more than 6 years ago | (#23190544)

Why would this mean anything for private insurance? They don't use genetic testing now.

And if we're talking about making new huge, intrusive government institutions, I would reccomend against a single-payer system. Controlling costs by preventing people from charging mrore just reduces the supply of available health care.

How about instead of calling it universal health care, we just call it wellfare. And how about instead of making all health-care government funded, we just use our well-fare system to provide healthcare to people who can't afford it. I don't think we need eliminate our freedom to access medical care.

If you really want to make health insurance "fair" all you need to do is pass a law saying that health insurance providers can't turn down applicants, and they have to charge everyone the same ammount for the same level coverage, regardless of any risk-factors. This wouldn't sink insurance companies, it would just raise insurance premiums and reduce the ammount of profit they could make.

This law will be defeated or gutted. (0)

Anonymous Coward | more than 6 years ago | (#23190548)

Our overlords will maintain the illusion of middle-class heathcare without having to actually provide service.

Actual healthcare will be provided based on individual abilty to pay. Healthcare is not a right, it's a personal responsibility.
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