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.

The 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.