Tra poco potremo leggere il nostro futuro nel genoma e la cosa non avrà solo aspetti positivi, con le potenzialità in arrivo molti di noi non potranno più permettersi un’assicurazione sanitaria. Di questi problemi si occupa Alexander Tabarrok nel suo “Gene Insurance” proponendo una soluzione abbastanza sorprendente:
Now, thanks to advances in genetic research, medical practitioners are increasingly able to read your health future from a much more reliable source-your individual genetic code. The correlation between specific genes and some diseases is now well established…However, accurate genetic information also brings fear that health insurance could become unaffordable or even unavailable…
Probabilmente ci saranno discriminazioni sul lavoro, chi desidera assumere lavoratori malaticci destinati ad assentarsi spesso?
… And because most individuals are insured through their employer, some people worry that knowledge of genetic traits might lead to employment discrimination…
Si potrebbe limitare l’accesso ai test da parte di certi soggetti ma si tratterebbe di una soluzione difficile da applicare, oppure si potrebbe ripartire i costi sulla comunità ma si tratterebbe sempre di soluzioni inefficienti:
… Solutions that would maintain access to health insurance have been proposed, but most would almost inevitably lead to antiselection and a disruption of the underwriting process, with potentially dire impact on the solvency of insurers….
In casi del genere la soluzione efficiente esiste, si chiama assicurazione genetica.
Di cosa si tratta? Semplice: ci si assicura contro l’eventualità di geni cattivi.
For a small premium cost, genetic insurance would insure against possessing a "bad" gene. Policies would be sold to all individuals before they underwent genetic testing… For example, if a woman is found to be carrying BRCAI (the gene related to a higher probability of breast cancer), she would be paid enough to purchase actuarially sound risk premiums… We are used to thinking of insuring against sickness; genetic insurance makes it equally possible to insure against a high probability of sickness….
Ci si puo’ assicurare contro un evento negativo ma ci si puo’ assicurare anche contro la probabilità di un evento negativo. Cosa lo vieta?
L’assicurazione genetica porta parecchi benefici: trattamenti mirati, trattamenti anticipati. Se poi è obbligatoria evitiamo dinamiche di selezione avversa.
All the benefits of genetic testing, such as improved treatment and health planning targeted to offset a genetic vulnerability, could be exploited… The single ground rule of mandatory purchase would avoid the problem of adverse selection.
Le possibilità di frode sono comunque ridotte:
… First, most people do not carry serious genetic defects, so the expected gain from concealing a positive result, and thereby cheating an insurer, is small… enforcement would be carried out through medical institutions rather than by individuals… In the near future, genetic testing is likely to be fully integrated into the medical process…
Ma il beneficio migliore riguarda il fatto di avere “geni cattivi” non vi impedirà più di stipulare un’assicurazione sanitaria (paga l’assicurazione, infatti):
Insurance firms, under this proposal, would no longer have an incentive to drop customers with genetic defects… Individuals with serious genetic defects would buy their insurance individually (or as part of a special genetic group) rather than through their employer. Employers also would have far fewer incentives to genetically discriminate….
L’assicurazione genetica potrebbe avere un impatto negativo sulle polizze vita, ma il problema è risolvibile imponendo l’accesso alle informazioni:
Genetic insurance also could improve the life insurance market. Life insurance contracts usually are written for much longer terms than health insurance contracts… If insurance companies have access to information from genetic tests, many people will want to buy long-term life insurance before the tests are taken. Under this scenario, genetic tests will not cause great difficulties for the life insurance market. But if legislation makes genetic information "private," very serious adverse selection problems could occur…. Genetic information should be accessible by life insurance companies along with other types of health information…
L’assicurazione genetica dovrebbe avere costi modesti perché a guardar bene già oggi si paga un premio di rischio genetico, cosicché il costo totale delle polizze dovrebbe restare invariato. Se poi teniamo conto delle cure mirate e della prevenzione si stima un costo inferiore a quello presente.
… It seems likely that everyone who today purchases health insurance also will be able to purchase genetic insurance… Genetic insurance cannot raise the total cost of health insurance because today's health insurance already covers the possibility of possessing a defective gene, but it does so implicitly, and given today's technology, inefficiently… Separating the genetic and nongenetic health insurance markets cannot raise the total price of health insurance because the same product is being sold… In fact, the total price of health insurance will fall under this proposal. Individuals who gain early knowledge of a genetic defect can seek earlier treatment, which is usually cheaper and more effective…
