Genetic Testing and Health Insurance

This Article argues that our growing powers of genetic testing to identify individual health risks threaten to unravel the moral logic of health insurance. Some people are blessed with healthy genes and environments, while others are cursed with ill health. Spreading among groups the unknown risk that any particular individual or group will suffer disease and disability promotes values of social solidarity and mutual support by encouraging people, even if unwittingly, to share their fates with others. But increasingly reliable methods of genetic testing have private insurance providers clamoring for access to new types of predictive health information. The availability of more precise information about health risks that people did not choose and cannot control will make it possible for insurers to more finely disaggregate risk and premium levels among individuals. Smaller risk pools have serious costs: they diminish the incentive to participate; genetic risk classifications will put pressure on providers to deny coverage to those with the worst genetic luck; and fear of genetic discrimination will discourage individuals from reaping the health benefits of genetic testing. I argue that antidiscrimination legislation -- Congress\u27s solution to these problems as of 2005 when this Article was written -- would cripple private insurance providers. I conclude that society should abandon the longstanding system of setting health insurance rates according to individual risk-factors, and, in its place, adopt a community rating system that balances free-market values with those of mutual trust and solidarity