Saturday, March 10, 2012

Healthcare Future

Our ability to predict a person's future from their DNA is getting better and better.  There are a lot of really intriguing consequences of this for the way in which our healthcare systems are administered.  As the linked article says I suspect this will herald the end of the American style privately insured healthcare system.  There are two possibilities as far as that goes:

First, that the insurers are allowed to use genetic information when setting policy costs.  If this happens then we will see the 'capitalist ideal' of people paying appropriately for their risk.  This will likely price many people completely out of the health system and will lead to incredible abuses of power as individuals and companies wrestle to taint research results and lab tests in a desperate high stakes bid to arrange premium rates to their advantage.  This seems like an utter disaster that would escalate costs even above their current ruinous levels.

The second possibility is that patients have access to their genetic information but companies will not; this rapidly leads to healthy people opting out of the system as the companies are forced to price for the least healthy people.  Very quickly insurance becomes impossible in this scenario because spreading risk across the whole spectrum is no longer feasible.  Quite simply only the extremely rich would be able to afford insurance against most serious illnesses and ordinary people would be stuck insuring themselves only against things that have no genetic component.

Both of these situations range from disastrous to untenable.  Given that I fully expect that over the next couple decades we will see nearly all advanced countries who aren't already on the universal healthcare program to join up.  In a system fully funded by the government people can safely get their genetic information and use it to try to manage their health without worrying about conflict with insurance companies.  Clearly there is waste and abuse in a fully public health system and people who happen to be healthy whether it be from genetic lottery or lifestyle choice do subsidize those who are unhealthy but the benefits outweigh the cost by far.  Eliminating the excess overhead of private companies and the intense arms race between patients and their insurers is easily a large enough gain to eclipse any additional costs of the public system.

One really troubling trend is that new treatments are becoming so much more costly than before.  As research and new ways of healing people come to rely more and more on extraordinarily expensive equipment I expect we will see that healthcare become gated not by knowledge but by cost.  Every new test that becomes available and every new affliction that we can cure creates additional strain on the system.  Public systems do not have infinite funds and at some point in the near future I think we will see more and more researchers coming up with new cures and tests that work but which will not be funded strictly based on cost limitations.  More knowledge is a wonderful thing but the pace of innovation is going to outstrip our ability to fund everything we discover.  How our governments will deal with that time bomb is a question I have no answers for.

1 comment:

  1. As far as tests and equipment go, I think we spend more time trying to figure out how to cure and diagnose new illnesses rather than trying to figure out how to do the things we can already do cheaper. If this is what we were researching then we would be figuring out solutions.

    I think that universities need to be free to conduct research along lines of their own choosing, but the government needs to find a way to fund research priorities, and if we are going to save more lives by having cheaper MRIs than we are by being able to use MRIs in a novel way, then we should be looking into that. I don't understand the current system or how much of an overhaul this would be.