Genes 2 Brains 2 Mind 2 Me

There is no doubt that -omics and digital-bio is improving healthcare, IF, you’re NOT one of the 50 million uninsured human beings in America who lack health insurance. As a fan of all things free-and-open, bioinformatic and health2.0, I was glad to read Timothy Stoltzfus Jost ‘s new book, Health Care at Risk: A Critique of the Consumer-Driven Movement. A review of the historical and economic foundations of the so-called ‘consumer-driven healthcare’ movement which is well underway (supported by leading candidates from both parties), Jost unpacks inefficiencies inherent to both private insurance systems (adverse selection – ‘sick people need NOT apply’) and to public systems (moral hazard and demand inducement – ‘hey dude, pass the twinkies and cigarettes, – no worries, I’ll just rely on my free healthcare’). The main arguments, from Jost, that stuck with me, are that the consumer-directed system, as it stands today, is one that is skewed to address the moral hazard conundrum, and this is not likely to resolve much of the current economic crisis since healthcare spending is distributed very asymmetrically (a tiny fraction of very sick people account for most of spending). Indeed, Jost suggests the current consumer-directed healthcare movement (pass off the first $5,000 spending to the consumer) is likely to make matters worse before they get better. While sobering, the book may prompt a redoubling of the focus of the many free-and-open bioinformatic and health2.0 efforts working to enhance care and access for all.

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I much enjoyed the recent article, “Do Not Ask or Do Not Answer” in the August 25th Economist. As genetic data begins to trickle into the hands of consumers, the debate on genetic privacy grows more intense. On the one hand, the article notes that the SRY gene has long been used to price insurance (its the gene that determines the male vs. female pathway during embryonic development – sorry males) and that a look at one’s parents and siblings gives a fairly decent sense of one’s genetic liabilities. On the other hand, the article notes a study showing that folks who find they carry a potent Alzheimer’s risk gene are more likely to purchase extra health insurance – thus out-gaming the insurance industry to their discontent. Both hands having acknowledged the disconnect, the article turns to the search for new financial strategies for the future when consumers possess detailed knowledge of their own genomes (speaking of which, take a moment to browse Jim Watson’s genome). Some of the solutions noted were a form of compulsory universal coverage where neither side can outgame the other, HSA’s where out-of-pocket expenses are paid from individual tax free investment account and other new business models such as provided by RedBrick Health where benefits are maximized by optimizing participants behavior. The science is moving fast. Will the health insurance markets keep up?

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If I may shill for the corporate medical industrial complex for a moment … I much enjoyed the video interviews found at the Corporate Research Group. Regina Herzlinger predicts universal coverage, but not a single-payer system – rather a system where consumers have choices. How to decide which plan to chose ???

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