Russell Korobkin asks us to consider three women. "Amy carries the BRCA1 gene, which is associated with an elevated risk of breast cancer. Beth has an aunt and a sister who had breast cancer. Five years ago, Cindy had breast cancer, which is now in remission. What these three women have in common is a much higher risk than the average woman of one day developing breast cancer. Should a health insurer be allowed to charge them higher premiums, or deny them coverage altogether, as a result?" Last week, the Senate passed the Genetic Information Nondiscrimination Act. The House is expected to follow suit, and Bush is expected to sign the bill. GINA would protect both Amy and Beth from insurer discrimination, despite the fact that both know they have a much higher risk of developing breast cancer. Cindy, of course, can still be denied insurance. "But if Amy and Beth should not be charged insurance premiums that reflect their true risks of illness," asks Korobkin, "why is Cindy less entitled to protection? She's not any more at fault for the possibility that she will suffer a relapse than Amy and Beth are responsible for their risk profiles." If genetic profiling were more sophisticated, this would crush the insurance industry. We could all get tested, figure out our likely risk, and buy exactly that much insurance. The insurers would be at a huge information disadvantage, and their business model would crumble. As it is, genetic profiling is still very rudimentary, so it's just one more factor promising the eventual end of the current insurance model. But the case of Cindy shows why that end should be hastened: If we don't believe it's morally justifiable or societally desirable for insurers to discriminate based on predicted genetic risk, then why allow them to do it based on proven genetic risk? The answer, of course, is that change is hard. But that doesn't make the status quo just.
