9.21.2009

Risk a Verse: Medical Genetics and the Economics of Ethics


In the eye of the storm,
medical genetics and the economics of ethics.
High on the list of dire reasons for healthcare reform.

From what we all hear,
there’s an abundance of fear,
That the government
might move to ration.
Since insurance companies already have, might be better places to exercise all of that passion.
Ill informed anxieties serving the wrong master,
leading to the collapse just that much faster.

DNA may not be information,
but good luck explaining that to the actuaries of this nation,
All it will take is some errant allele,
leading to one's coverage repeal,
And then bankruptcy court,
for the sick, will be the only resort.

No doubt science will find the genes,
long before any agent or wonk knows what it all means.
Autosomal dominance with high penetrance is far from the norm,
Good Docs know that mostly it’s a factor, among many on a risk assessment form.
Not some programmed and well defined fate,
dooming all to with whom one might relate.
The gap between translation and the ultimate outcome,
is a complexity that clinicians can't shun, but the payers will likely shy from.

The ultimate in preexisting conditions, used to favor the house at the earliest possible date,
Fear keeps those who would benefit from the data away, until it’s often far too late.
While true that knowledge is power,
the possibility of uninsurability, makes most of us cower.

Both nature and nurture, have their place in assigning the risk of disease.
But insurance companies have all those investors to please,
Remember what insurance companies do best,
Refusing care to those with some risky label, and collecting regular fees from all of the rest.
Owning the tallest buildings in almost any major city,
hard to imagine that they aren’t sitting real pretty.

The money changers missed the lessons of Gattica during its run,
environment, chance, and choices all add to the sum.
We humans do love to assign all our labels,
But real life doesn’t always conform neatly to some column, in one of our tables.
The ethics of profit may rob us of the real value of these markers,
regardless of what tripe spews forth from the mouths of the barkers.

T
he real value of that genetic test,
is in helping our fellows tailor their choices toward, what for them, may be what’s best.
Instead of hanging over us like Damocles’ knife,
an aid in enjoying the best possible life.
To have that we must move from a system obsessed with the fare,
to one committed to constant improvements in care.

Which really seems the better wager?
That government or payers could be made to see you as something more than an entry in a ledger.
Up to now, private payers have been free to define the rules of the game,
if we let that continue, we’ll only have ourselves to blame.
Tactics like random denials show what we should expect,
If once again they are successful, reform efforts to deflect.

Listen not to all the fear mongers and naysayers,
for as predictive science is added we'll be more subject to the whims of the payers.
Their interests not yours drives their every decision,
all genetics is to them is denial with greater precision.

The government is always a danger, imperfect and its support takes its toll,
But unlike insurance payers it can be made to have more than profit as its goal.
Begrudgingly government can be bent by our will, to protect the least among us, and those from any station,
As it must always be, for more than armaments, this defines what it takes to be a great and moral nation.

15 comments:

Pliny-the-in-Between said...

Yes that title may represent a new high, or low in my lifelong punquest...

Jared said...

Wow, I'm impressed. Very impressed.

Pliny-the-in-Between said...

Thanks. trying to blend your idea with Mac's preference for rhyme was a bit of a challenge. But a great diversion while riding the train home.

mac said...

You are the master !

Pliny-the-in-Between said...

Hey Mac - how do I get your site to let me leave a comment - or is that the plan!

GearHedEd said...

"...insurance companies have all those investors to please,
Remember what insurance companies do best,
Refusing care to those with some risky label, and collecting regular fees from all of the rest."

Why is it that the Government's soluyion to health care is predicated on a "bottom-up" strategy? By bottom-up, I mean that reform is being presented to us as a method of forcing all of us to participate in health care, either with our own doctors, or if we can't afford private company insurance, a "public option".

This seems backwards to me. I don't object to the public option on the grounds that it's been said to be an "unfair competitor" that will eventually drive the private companies out of the health care insurance business, nor because it will benefit the poor at the expense of tax dollars. I'm not sure I object to the public option at all.

Here's a top-down approach:

What I object to is that "reform", as Congress and the President call it isn't reforming the real CAUSES of the issue: the FOR-PROFIT nature of the insurance companies and the pharmaceuticals companies, along with a court system that allows unbelievably gross (huge)tort cases to go forward, expecting huge rewards for the so-called "victims". Why don't the legislators address THESE problems, and bring the costs down, instead of trying to force us to play by MORE rules of their choosing? It's because the rich folks want to stay rich ("rich folks" here includes Congress, and anyone who has a vested interest in maintaining insurance companies as profit engines).

Why has no one suggested a "top-down" approach? Because it takes money out of the rich folks' pocketses, preciousss.

mac said...

I've always just clicked on the comment thingie.

I have tried to research this problem, but I'm not having much luck. It seems OK when I do it???

Pliny-the-in-Between said...

GHE - There is a lot of solid work on the bottom up approach, where reform efforts are concentrating on improvements to the actual care delivery models and workflow instead of the payer problems. Unfortunately that isn't getting the press that the top down problems get (payer options, dtc.) If the delivery models are improved costs will be controlled. This is a fact that these studies are showing. Problem is that all these excellent models are highly disruptive and will require more responsibility from the individual.

The model I'm most familiar with is conservatively estimated to cut 3.5+ trillion dollars in 10 years if rolled out nationally. That's in efficiency and waste reductions. The actual delivery model would reduce overall costs by considerably more.

GearHedEd said...

I guess my question should have been

"If health insurance is so expensive, WHY is it so expensive? Is it because not everyone needing health insurance participates, or is it because the providers are more concerned with pleasing the stockholders than providing health insurance?

And if the latter, then how is forcing everyone to participate (including the so-called "public option" for those that can't afford the private insurance) rather than rewriting the rules for the PROVIDERS to get them out of the profit business going to change anything?

Pliny-the-in-Between said...

GHE

It's both actually. And the simply reforming the payment structure won't fix the problem or save the money. The delivery mechanism and expectations of healthcare needs to be changed or else it's a waste.

GearHedEd said...

I just have this nagging feeling that it's going to be a horrible mess if the government starts trying to control it, is all.

oneblood said...

Pliny, you are truly an optimist.

I don't agree with that outlook, but I respect it.

I thought you were on hiatus...

Pliny-the-in-Between said...

I am - but the opportunity to rhyme a ethics in genetics post was too much for me, and the train ride was boring...

Stacy S. said...

I just read that whole thing with "pirate speak" going through my head thanks to your "Talk like a pirate day" reminder on the front page.

Pliny-the-in-Between said...

Stacy you win the prize!