"Genetic Discrimination: Unfair or Natural?"

Michael Kinsley on the recent vote in congress to ban genetic discrimination by employers and insurance companies:

Genetic Discrimination: Unfair or Natural?, by Michael Kinsley, Time: Last week, with little attention or fanfare, the U.S. House of Representatives voted 414 to 1 to outlaw genetic discrimination. The only dissenter was the irascible libertarian Ron Paul. The Senate passed the same bill unanimously, and President Bush is ready to sign it. The bill tells employers and insurance companies that they may not use the results of genetic tests in choosing their employees and customers. One purpose of the bill is to encourage genetic testing. But the more important reason for it is to uphold a sense of fairness. Just as the law forbids discrimination against a person because she is black or a woman, it will henceforth forbid discrimination against her because she carries a gene that makes her more likely than average to get cancer. And the logic is similar: Why should she be punished for something completely beyond her control?

That's a good instinct... But how far should we take it? ... To avoid all the controversy around the concept of "intelligence," let's consider a slightly different concept called "talent." Is it unfair that Yo-Yo Ma can play cello better than I can? Or that people hire Frank Gehry instead of me when they want a beautiful building, or that Warren Buffett is a better stock picker? Sure, it's unfair. And it's unfair in precisely the same way..: my lack of talent at playing the cello is something I was born with and beyond my control. Could I have overcome my lack of talent through discipline and hard work? Maybe, but not enough to scare Yo-Yo. ... But we can't outlaw discrimination on the basis of talent. We don't want to. Discrimination in favor of talent--rewarding a talented cellist over a lousy one--is how we get talent to express itself. ...

The very appealing notion that genetic discrimination is unfair looks especially odd in the context of insurance. The idea of insurance is to protect against the unexpected or unlikely. Forbidding insurers to take predictable risks into account ... is asking them to ... make bets they are sure to lose. ... To truly apply the appealing principle that people should not be discriminated against because of their genes would be a leveling experiment, like something out of Stalinist Russia or China's Cultural Revolution.

Of course, there is no reason we have to follow an appealing principle off a cliff. We can have a bit of genetic justice without much risk of tumbling into Stalinism. ...

Nevertheless, the near total and uncontroversial agreement among Americans that genetic discrimination is wrong says something important about us: we may be a bit confused about all this, but we are a lot more radical about equality than we think.

Suppose someone would be the best cellist ever, but they have a genetic condition that causes their hands to shake and prevents them from expressing the talent they have. I think it's fair to, as much as we can, give everyone an equal chance to bring their talents to the marketplace and be rewarded for them. In this sense, I see health as different, it is a precondition to being able to contribute to society to the fullest extent possible, it's like education in that regard, and we ought to start out on an equal footing to the extent that we can. After that, though, you are on your own.

In addition, in some cases this is a life and death issue, and that makes it different as well. An individual born with a particular condition may not be able to afford to pay to have it treated on their own, but as a society we may be wealthy enough to pay for it collectively and we shouldn't let people die, or live less than full lives, because we are unwilling to share those risks. Since we do not choose our parents, and do not choose our genes, there is no moral hazard issue here and I have no problems with sharing the risk, i.e. the costs, collectively. We won't, of course, be able to cover everything, there has to be limits, but where we can afford to equalize opportunity by equalizing health, we should do so.

Comments

[Jay]

"The only dissenter was the irascible libertarian Ron Paul."

Remember what is important, what is always the top priority is to use unnecessary adjectives to exude the highest level of meanness possible.

[save_the_rustbelt]

Jay, are you Anne?

[save_the_rustbelt]

Discussing disease and talent in the same article tells me how much Kinsley has slipped since his prime (as most of us do).

I won't be draft by the Steelers, but I hardly consider that an act of discrimination (but they are being discriminating!).

says...

"Since we do not choose our parents, and do not choose our genes, there is no moral hazard issue here"

Not taking any sides here, but just to point out there can be moral hazard - since parents choose to have children or not. Gattaca anyone?

[Mark Thoma]

That's still independent of any choice the kid makes - see no reason to hold kid accountable for parent's choices.

[Dickeylee]

So just why do we think an insurance company would use genetic markers to exclude anybo--never mind.

[Jay]

"Not taking any sides here, but just to point out there can be moral hazard - since parents choose to have children or not."

We have that already, it is called fully subsidized education from age 5ish to 18ish.

[Noni Mausa]

Is it just me, or is this nearly unanimous, quietly passed legislation wildly out of place with the usual BushCo approach to public benefit? (i.e. "give it another kick, it's still wiggling")

What effect besides protecting genetically at-risk people does this bill have? What else is attached to the bill? anything? Why aren't the health insurance people squealing like abandoned puppies?

I smell a genetically-engineered rat.

Noni

[Patricia Shannon]

To avoid all the controversy around the concept of "intelligence," let's consider a slightly different concept called "talent." Is it unfair that Yo-Yo Ma can play cello better than I can? Or that people hire Frank Gehry instead of me when they want a beautiful building, or that Warren Buffett is a better stock picker? Sure, it's unfair. And it's unfair in precisely the same way..: my lack of talent at playing the cello is something I was born with and beyond my control. Could I have overcome my lack of talent through discipline and hard work? Maybe, but not enough to scare Yo-Yo. ... But we can't outlaw discrimination on the basis of talent. We don't want to. Discrimination in favor of talent--rewarding a talented cellist over a lousy one--is how we get talent to express itself. ...

This is ridiculous. Even if we could identify the genes that enable a given talent, that doesn't mean the person has developed their talent. The way we judge whether someone is good at something is by looking at their actual performance.

[robertdfeinman]

Seems sort of ironic coming from Kinsley who is suffering from Parkinson's disease. How would he feel if his last three employers refused to hire him because his known condition was going to push up their group rate for health insurance.

[anne]

http://krugman.blogs.nytimes.com/2008/05/09/avoiding-moral-hazard/

May 9, 2008

Avoiding Moral Hazard
By Paul Krugman

Plus the magic of the marketplace [Cartoon]

I love The New Yorker — for the wonderful writing, the reporting, the poetry — oh, who am I kidding? Like everyone, I start with the cartoons.

[anne]

"Rescue be damned! Our conservative principles will see us through."

[Cartoon]

[RW]

"I smell a genetically-engineered rat."

I do too.

There are doubtless the usual slabs of pork, set asides and other congressional detritus attached to the bill -- one could hardly imagine congress-persons ignorant of all but their most pressing need to be re-elected waxing enthusiastic otherwise -- but the primary thrust of the bill appears to be encouraging genetic testing and, one must suppose, the ability to create databases; outlawing genetic discrimination appears to be the sop that makes this less threatening.

I say sop because maximizing profit in a for-profit health delivery system requires discrimination by definition; the god is actuarial not Hypolytian. Therefore, rather trivially, it is essential to cherry pick those less likely to become ill while excluding everyone else and then develop methods to deny payment to the insured should they be socialistic (AKA unAmerican) enough to become ill; there is a reason average health insurance overhead in the US is nearly 3-times higher than the overhead of a health agency such as the Veterans Administration that can not exclude and 4-times higher than agencies in single payer systems such as France: It takes a fair amount of manpower to exclude, particularly when tort and contract law interfere in free markets and the god-given right of a corporation to make its numbers.

But less manpower would be required and a more refined selection and exclusion system would be enabled with deeper genetic information and the ability to refine that selection process would not only improve profit margins but, even more tempting, allow an increase in market share by enabling: (a) profitable insurance policies to be underwritten to individuals for everything BUT the disease they are genetically predisposed towards and (b) policies at considerably higher premia for those whose genetic predisposition towards disease was either not too severe or so catastrophically fatal as to make the coverage bet a winning play either way.

Shorter version: No one should fool themselves that increased genetic testing will not lead to discrimination on an ever escalating scale as long as we keep the health delivery system we currently have in the US; it will simply become too profitable to tap that information and laws permitting "appropriate" access will eventually be passed. I suspect such laws will allow the usual option in vs. out deal but if insurance companies refuse to cover you unless you give them permission to access that information what options do you think you will really have, eh?

[Dickeylee]

The truth is simply devastating in it's simplicity as presented by RW, thank you.

[Alec]

So if a couple decides to have their future children covered by insurance and both parents have a family history of, say, cystic fibrosis or tay sachs shouldn't they asume some of that burden if things go wrong?

Doesn't a blanket ban like this encourage free riding?

[James Killus]

Since the only adjective was "irascible," apparently Jay believes that to be accused of being easily angered is "the highest level of meaness." One can only marvel at the benevolent worldview that this implies, to say nothing of the charming oxymoron shown by the linking of "highest" and "meaness."

I confess that I'm at a loss as to which of the plethora of connections might be used from this point of departure, several having to do with intelligence, reading disabilities, or impulse control.

However, let me retreat to observing more fundamental error in Kinsley's collumn, that Yo-Yo Ma, Frank Gehry,and Warren Buffett are examples of genetically determined talents. That Kinsley can even write such a thing shows a serious deficiency in our educational system (that people can even read the thing as serious commentary) as well as breathtaking ignorance on his part.

Such ignorance can only increase as the system of public education comes under greater and greater attack (see, I can link this back to Jay's version of feudal libertarianism). To tie the ability to develop whatever natural gifts and inclinations an individual might possess to the family connections and wealth of that individual's parents or patrons (which is what occurs in a purely private educational system) is a much more pernicious form of discrimination than anything being described in the legislation in question.

I wonder if it would be possible to turn the thing around and create a system that would discriminate against such things as narcissistic personality disorder and paranoid character disorder in managers and elected officials. Now there would be something I could get behind.

[Patricia Shannon]

Judging by the lack of quality in Michael Kinsley's thinking ability shown by this article, he appears to be an example of someone who was able to achieve a position above his talents because of family background.

http://en.wikipedia.org/wiki/Michael_Kinsley

[Blissex]

«Since we do not choose our parents, and do not choose our genes, there is no moral hazard issue here and I have no problems with sharing the risk, i.e. the costs, collectively. We won't, of course, be able to cover everything, there has to be limits, but where we can afford to equalize opportunity by equalizing health, we should do so.»

This is some kind of Rawlsian demented argument. The fatal flaw with this argument and indeed Rawls is that *voters* decide, and they already know. The fiction of the veil is just delirious fantasy in politics. Politics is decided by those who already know whether they are fully vested. Usually by the fully vested, because it is them that do campaign donations.

«such laws will allow the usual option in vs. out deal but if insurance companies refuse to cover you unless you give them permission to access that information what options do you think you will really have, eh?»

Well, a secondary effect is the underlying reason why conservatives are against either socialized or affordable health care: huge health care risks and costs make employees a lot more scared, a lot more compliant. Live in fear of illness, live in bondage to the boss.

The availability of genetic data means that lots of people would effectively lose their ability to get health care insurance, as a large percentage of people, especially from minorities, have latent health issues.

[Blissex]

«the ability to develop whatever natural gifts and inclinations an individual might possess to the family connections and wealth of that individual's parents or patrons (which is what occurs in a purely private educational system)»

But that is the dream of every middle class (income above median) parent. By and large voters are those sort of parents. In the USA south those parents have worked hard to defund and debase the public education system where it would also benefit the children of the exploitative parasites (welfare queens, strapping young bucks).

In he rest of the USA things like house price booms, zoning laws, have been engineered to make sure that school districts are segregated by income and wealth, so that the quality of public education closely correlates with the status of parents.

[James Killus]

But that is the dream of every middle class (income above median) parent.

Blissex, this was not always the case. There was a time when people generally, and the middle class in particular (BTW, "income above median" is a very peculiar way to define the middle class) understood that a well-educated populace was in the country's best interest, and that when the country benefited generally, individual interests could be well-served.

At some point, however, people became convinced that life is a game of musical chairs and the music is near completion. Self-interest transmogrified into idiot greed, and the rules of the zero sum game became the common culture. I do not know exactly how or why this happened, but I do know that no good can come of it.

[Alex Tolley]

"The idea of insurance is to protect against the unexpected or unlikely. Forbidding insurers to take predictable risks into account ... is asking them to ... make bets they are sure to lose."

The Economist had a special about this many years ago. Their view was that this would eventually drive the insurance industry in the logic of single payer, universal insurance.

BTW - note that the new US law does allow insurers to discriminate under certain circumstances.

In a different sphere, we seem to have little problem providing extra educational help and costs for children with "special needs", even though it does put extra strains on teh public school system and schools try to do as much as they can to deny children as belonging to any category that requires them to spend these resources.

On the other side of the moral coin, how many late stage abortions are influenced by tests showing fetal abnormalities?

And of course the most extreme discrimination of infanticide as practiced predominantly in India and China, both discriminating again XX chromosomes, but for different reasons.

[Blissex]

«BTW, "income above median" is a very peculiar way to define the middle class»

In most countries the middle class fall in the 5th to the 20th higher income percentiles, and I meant to write "well above median" instead of "above median".

Middle classness is not about having an income around the median; it is about being in between the upper and the lower class in functional terms ("petty bourgeousie"). So the middle class is a high earning minority. The bottom 80% of the population by income are almost always working class or underclass.

The top slices of the bottom 80% (the median by income) usually are aspirational middle class, in the sense that they describe themselves as middle class, but are usually just the skilled/prosperous working class, and their children often attempt to become middle class (fat chance in the modern USA).

But this is perhaps a very European point of view -- the USA is classless, and everybody is middle class :-).

«At some point, however, people became convinced that life is a game of musical chairs and the music is near completion. Self-interest transmogrified into idiot greed, and the rules of the zero sum game became the common culture.»

You know that my theory is that the middle and upper classes managed to persuade the working class that their enemy is the underclass, or even persuaded that the skilled working class that their class enemy is the unskilled working class.

Not a new strategy. Have a look at this page on the irish famine and in particular the c:

http://www.nde.state.ne.us/ss/irish/irish_pf.html

The cartoon above the string "gleeful Irish peasant carrying his Famine relief money while riding on the back of an exhausted English laborer" and the one aobe the caption "Irish as obese, wasteful, violent, drug abusing monkeys":

Saint Ronald was just a practitioner of a long tradition of preachers against welfare queens and strapping young backs.

«I do not know exactly how or why this happened,»

I suspect that in large part the skilled working class and the middle class felt that they had become fully vested, and could say "F*ck you!" to the less fortunate. After all over the past few decades house and stock ownership have spread to 50-70% of the population and much higher percentages of voters and the near totality of campaign donors.

Put another way at some point the largely irish and italian working class in the north (who cared not much about black skinned people) made common cause with the sourthen elites against the common enemy, the yankee elites, in the pre-Johnson Democratic party, and the deal was unions for the irish and italians and by default for the rest of the working class (except black skinned people, who were often in effect banned from union membership and thus the best working class jobs), and segregation for the southerners.

But as those irish and italian working class were coopted into the middle and upper classes, they came to see the working class they had left behind as the class enemy and moved with the southerners to the Republican party, while the yankee elites become more Democratic. Very broadly speaking.

However the central point is I think the study done by a UK thinktank that showed that people with a car, with shares, and owning/mortgaging a house were overwhelmingly conservative of the "f*ck you! I am fully vested" variety, and thus Thatcher and Reagan engaged in a radical social engineering project, and here we are.

The other problem is of course that of the bottom 50% by income many don't vote, are not much "encouraged" to vote, and because of immigration a rather significant chunk of them cannot vote.

Put another way, a majority of voters are relatively well off, almost all are rentiers and asset owners, and vote their wallets and their HELOCs.

[reason]

James Killus...

At some point, however, people became convinced that life is a game of musical chairs and the music is near completion. Self-interest transmogrified into idiot greed, and the rules of the zero sum game became the common culture. I do not know exactly how or why this happened, but I do know that no good can come of it.

Interesting. I know James Howard Kunstler, wonders why so many communities count on gambling to save them economically. There can be no more zero-sum activity than gambling. And why are some of our best payed people those glorified gamblers who are "traders" for big merchant banks?

[reason]

In a way he has a point, the ability now to identify more and more about human potential at a very early age (and so to descriminate in the provision of insurance) highlights what a big problem we have as a society with inequality. The problem is inequality and what we do about it, not any specific example of inequality.

[Icarus]

The YoYoMa scenario is pathetic. Makes no sense.

A better hypothetical...Assume a couple has a great genetic mapping. And, they can prove it with tests.

Can an insurance company either arise which takes them at very low rates(reflecting their genetic desirability)?

Sure, there is risk, but this is hedging much of it, perhaps.

The issue gets twisted from filtering out the bad genes, to attracting the good ones.

In a 'Free Market', should a person, and a firm, who have a mutually beneficial desire to do business with each other, be legally allowed to? Can I, with my 'great genetic map', get preferential rates?

Is this any different than giving healthy people a discount on their insurance rates? (which is the obverse of charging people for being obese, for example)