Employees who decline genetic testing could face penalties under proposed bill • Hacker News Board

Re: Employees who decline genetic testing could face penalties under proposed bill

#111

Post by nisa » Sun, Mar 12, 2017, 1:55 PM UTC

Exofunctor wrote: post #49

While I think health insurance shouldn't be attached to employers, I don't really have an objection to insurance companies using genetic testing. This is certainly an unpopular opinion here, but as someone who believes that medical care is a service, not a right: I think it's unfair to force people to subsidize the healthcare of other people, regardless of the mechanism used. When you have car insurance, the insuranc…

> If you had to pay an extra $200/mo to your insurance company because you were morbidly obese, one would expect that this would encourage a lot of people to start eating better.

That homo economicus myth is still going strong? Mental issues and addiction don't exist?

> Let the market do the heavy lifting!

What if the market decides it's not worth the risk and costs to cover the unhealthy? What do we do with the disabled that need more medical supervision?

> This is exactly the sort of thing that the market excels at.

...in some idealised simplified textbook version of reality with simple linear algebra.

Re: Employees who decline genetic testing could face penalties under proposed bill

#112

Post by chimeracoder » Sun, Mar 12, 2017, 2:23 PM UTC

icebraining wrote: post #107

pdkl95 wrote: post #99

Earlier quoted context omitted.

> a lot of people I know--in the IT industry, obviously--flatly refuse to recognize that a union could be a good thing Usually this includes knee-jerk arguments against dues, mandated wages/salary, and other aspects of existing/older unions. It seems like many people implicit assume that a union must involve a list a of traditional practices. A union can be what you want it to be. If you don't want it to cover someth…

It seems like many people implicit assume that a union must involve a list a of traditional practices. It's not an assumption that it must, it's a recognition that very likely, it will. Organizations aren't created in a vacuum, they require bringing in others, and if you're starting an union, you'll attract people who are already predisposed to all the ideas of what makes up a union, and you'll attract offers of help…

> It's not an assumption that it must, it's a recognition that very likely, it will.

To add to everything you just said, the NLRA sets very rigid rules regarding how unions can form and how employees and employers can interact with them. So you can't just charter it however you want and assume all the problems are solved - the NLRA imposes a number of requirements and protections for the union (not the members, but the union itself as a corporate structure) which way be at odds with the employees.

As a result, once a union forms, it's very difficult (practically) for its members to deunionize, even if a majority of the membership opposes the union representing them.

So people are very hesitant to go down a road which is essentially seen as a one-way street, except as a last resort.

Re: Employees who decline genetic testing could face penalties under proposed bill

#113

Post by maxerickson » Sun, Mar 12, 2017, 2:38 PM UTC

james1071 wrote: post #90

programmarchy wrote: post #20

Earlier quoted context omitted.

The history behind our current nonsensical scheme started with FDR capping wages during the great depression, which spurred companies to offer "perks" like healthcare to recruit talent. An example of one market intervention leading to another, and another, ad nauseam. Totally agree that insurance should be decoupled from corporations. The way the "market" is regulated hampers people from working independently or star…

There are many things that started 70 years ago which have long since gone. So, there must be forces which sustain the US model, where the employer pays for medical insurance. Also, I fail to see how employers offering medical insurance should make insurance for an individual any more expensive. So, while I appreciate the sentiment that something is clearly wrong, the two things that you mentioned are not the cause.

A big one is that there is a tax deduction for employer provided health insurance. So offering a decent health plan is more compensation than just handing over the cost of the plan (which would be taxed).

As far as how employer coverage can drive up individual costs, there are a couple of factors. One is that people with good health plans often don't pay attention to how much they cost, and often don't have much of a deductible, so they just use the medical system without paying too much attention to costs. That at least has the potential to drive medical prices up.

The other is that people in the group insurance market tend to be somewhat healthier than the individual market. So the pool for individual insurance is more expensive to insure. Setting aside discussions about whether it is fair or not, it does result in higher costs for the individual market.

Re: Employees who decline genetic testing could face penalties under proposed bill

#114

Post by lmz » Sun, Mar 12, 2017, 2:44 PM UTC

chongli wrote: post #93

M_Grey wrote: post #75

Earlier quoted context omitted.

...And then, after slaughtering those people and years of insularity, nationalism, and populism... what's going to be left, but for those insular nations to fight over remaining resources? I can't see a nuclear nation shrugging and saying, "Well I guess we're conquered! Here are the keys..."

Using a nuke to fight off a tide of refugees is like bringing a grenade to a fist fight. Do you think the people who are already here are going to tolerate the wholesale slaughter of their family members who are trying to rejoin them? What about all of their friends? No. If we don't find some way to rescue everybody we will be torn apart by civil war.

Sounds like a good argument to not let even one of them in.

Re: Employees who decline genetic testing could face penalties under proposed bill

#115

Post by ohstopitu » Sun, Mar 12, 2017, 2:47 PM UTC

icebraining wrote: post #110

Exofunctor wrote: post #49

While I think health insurance shouldn't be attached to employers, I don't really have an objection to insurance companies using genetic testing. This is certainly an unpopular opinion here, but as someone who believes that medical care is a service, not a right: I think it's unfair to force people to subsidize the healthcare of other people, regardless of the mechanism used. When you have car insurance, the insuranc…

A lot of health risks, including at least the top 6 causes of death worldwide (heart disease, stroke, lung infections, COPD, respiratory cancers, diabetes) can be substantially mitigated by personal choices such as diet and exercise That's true, but genetics is literally the opposite: it's the one thing you definitively can't choose to change. So your argument doesn't work in the case being discussed. If you had to p…

Because spending $200/m hits you more than just the thought of future illness.

I don't support this bill, I do want this idea explored / discussed - as in, why should healthy people subsidize costs of insurance for the unhealthy? (as in, is not fair is it?)

Re: Employees who decline genetic testing could face penalties under proposed bill

#116

Post by DanBC » Sun, Mar 12, 2017, 2:54 PM UTC

Exofunctor wrote: post #49

While I think health insurance shouldn't be attached to employers, I don't really have an objection to insurance companies using genetic testing. This is certainly an unpopular opinion here, but as someone who believes that medical care is a service, not a right: I think it's unfair to force people to subsidize the healthcare of other people, regardless of the mechanism used. When you have car insurance, the insuranc…

Look at people who need an organ transplant.

Before transplant they have low quality of life. Their treatment is very expensive. They struggle to get an organ. They go through extensive support to help them realise that after the new organ they'll need to take meds for the rest of their life.

They have a very expensive operation that usually requires someone else to die and donate an organ.

After the surgery they need to take medication for the rest of their life.

This medication is the thing that prevents their new organ from being rejected; the thing that stops them going back to that expensive and painful life with a failed organ.

Currently the biggest caused of failure in transplanted organs is that people do not continue to take the meds.

This is the case in the UK where people don't pay for the surgery, and it's the case in the US where people pay considerable amounts for the surgery.

The money that people pay or the consequences for non-compliance don't seem to do much to change behaviour.

Re: Employees who decline genetic testing could face penalties under proposed bill

#117

Post by omginternets » Sun, Mar 12, 2017, 3:07 PM UTC

electricEmu wrote: post #50

wyager wrote: post #33

Earlier quoted context omitted.

> By essentially any metric, state provided (single-payer) healthcare is the best-known solution to the healthcare problem. Except things like, you know, quality of care or satisfaction. Single-payer healthcare beats the American implementation, which is not a high bar to clear. There's a reason medical tourism to Mexico and India is so prevalent. Totally deregulated private doctors seem to kick the ass of state heal…

If America completely deregulated the medical industry then where would you get that complex brain surgery? It doesn't sound like completely deregulated markets cater to that speciality. It sounds great until you need something that isn't routine.

Speaking from experience, it's easier to get non-routine procedures done in France than in the USA. This is because the provider is less concerned with profitability of the technique.

So no. It's especially great when you need something that isn't routine.

Re: Employees who decline genetic testing could face penalties under proposed bill

#118

Post by XorNot » Sun, Mar 12, 2017, 3:13 PM UTC

icebraining wrote: post #101

seanp2k2 wrote: post #88

Earlier quoted context omitted.

Yeah, I was just having a conversation with someone today about how it never works out in practice. There is no free market, and in anything approaching it, companies simply e.g. collude to keep prices high or make things unnecessarily complex. Look at cell phone plans and what "unlimited" means, for example. Not that the wireless ISP industry is unregulated (far from it), but why not just start your own and fix it?…

> why not just start your own and fix it? Because the State punishes you if you start emitting? It's called spectrum allocation. Just because you can technically start a company doesn't mean you have anything resembling a free market, and in fact the examples you gave (wireless and healthcare) are two of the most regulated industries. That doesn't mean the free market wouldn't be even worse than what we have now. It'…

Yes I'm sure no FCC would surely mean that wireless spectrum would remain usable.

Apparently the laws of physics are an invention of the state.

Re: Employees who decline genetic testing could face penalties under proposed bill

#119

Post by XorNot » Sun, Mar 12, 2017, 3:15 PM UTC

jedberg wrote: post #42

drawkbox wrote: post #12

We've got to separate healthcare from employers before this goes to far. Companies have no business in your health and we still tie health insurance to employment as a legacy error not a benefit. Many problems arise from healthcare provided from the job such as ageism, culling the sick, making it harder to change jobs or start companies, and losing healthcare as you change jobs, not to mention helping the fixed price…

Places I've worked have provide life, health, AD&D, pet, dental, vision, and lawyer insurance. So yeah, it's a lot more than health. But I still agree with you -- we need to figure out a way to separate insurance from a job. Although I don't like the idea of just precluding them from offering it. If a company wants to offer insurance we shouldn't stop them. We just need to make it so they have little advantage to do…

"figure out" - the rest of the first world has implemented this.

Pick a model, deploy, tweak for circumstance.

There's not a learning problem here.

Re: Employees who decline genetic testing could face penalties under proposed bill

#120

Post by dalbasal » Sun, Mar 12, 2017, 3:20 PM UTC

drawkbox wrote: post #12

We've got to separate healthcare from employers before this goes to far. Companies have no business in your health and we still tie health insurance to employment as a legacy error not a benefit. Many problems arise from healthcare provided from the job such as ageism, culling the sick, making it harder to change jobs or start companies, and losing healthcare as you change jobs, not to mention helping the fixed price…

Employer coupled insurance has certain pathologies. But, I think that insurance as a funding model has is a bigger problem.

"It's a terrible Hobson's choice between affordable health insurance and protecting one's genetic privacy."

Genetics is just another way of getting useful information for pricing insurance efficiently, guessing future medical expenses more accurately. To the extent that pricing becomes efficient it ceases to be insurance. This is basically the case for sick people. Their medical costs are known and high. Price efficiency puts more people in that boat. Known high costs expensive. Known low costs cheap. In an insurance based system, information is priced in.

Insurance is good for costs that are unlikely but high. In medicine, we're looking for a system that caters to all medical scenarios regardless of likelihood. Insurance only makes sense for some.