In this dawning era of genomic medicine, the concept of private health insurance, which is based on actuarially pooling risk within specified, fragmented groups, will become obsolete.

This is an interesting article, but I think its idealistic. In the United States we have a bunch of people who beleive that a massive cost sharing system that most (but not all) people are allowed to participate in coupled with a 10 year government vetting process for any new innovation is a "free market capitalist" solution to the problem of healthcare but any effort to extend the system to the small group who are currently shut out is "dirty communism." "Better that people die then we sacrifice our ideals about communism! Here's my $10 copay!"

Changes to the U.S. healthcare system will be driven by what suits the vested interests most. While I commend Bush for working to enable employees of small businesses to obtain health insurance the fact is that the Republican party has been calling health insurance for employees of small businesses "communist" for 10 years. Now that they are also calling small businesses the growth engine for the economy they were sitting on a rhetorical contradiction so big the democrats could have driven a truck through it. Of course they are doing something about it.

It is inevitable that genetic profiling will be used to cull people out of the healthcare system. Most people will not be culled out. Just the really expensive ones. Reasonable objections will be cast as "communist." Most people will not be affected. There will be talk of reducing the rising costs of health insurance but, of course, prices will not actually be reduced.

I think prices will continue to rise until the industry restructures. You'll go to walk in clinics and pay for it. Cost sharing will be limited to catastrophic diseases. Most people won't have access to state of the art treatments.

More people with treatable illnesses will die, but warbling about that is a bunch of liberal bullshit. Its possible that one might argue that as technology advances it no longer makes sense for everyone to have access to top notch care, and that the level of care that people receive will not regress. I have some sympathy for that perspective, but I don't beleive it. I think the level of care will regress. Anyone who gets an expensive and suitably rare condition will be shuffled out of the system by any means available because our society really does not care. The system will move from treating sick people via insurance to providing maintainance to people who aren't sick. There is simply a lot more money in it.

In this dawning era of genomic medicine, the concept of private health insurance, which is based on actuarially pooling risk within specified, fragmented groups, will become obsolete.

In this dawning era of genomic medicine, the concept of private health insurance, which is based on actuarially pooling risk within specified, fragmented groups, will become obsolete.

I thought this was very timely given our dinner conversation on Friday. While I don't think a single payer system is worthwhile (or will happen) in the US, I do believe that the author flirts heavily with what *is* a likely outcome: a realignment of stakeholders.

Consider that the NHIN/HIT initiatives in the US when at critical mass will allow a degree of transparency and incentive that has neverbefore been possible. It's not totally necessary to move the physician and the patient into a direct customer/provider fiduciary exchange if you can clearly see where the money is going and how service is provided by those dollars. I think that the system today is very broken and that the first inclination is to throw it out and start over with a very different architecture. But that's obviously next to impossible in today's world. What is very likely is that the system will reconfigure itself and become optimized in a way that has not been possible previously. Transparency and appropriately motivated incentives will make the system optimized.

That will eliminate a lot of the concern over genomics being used to deny and game the pool. Everyone will be able to procure healthcare just as everyone is able to procure other basic necessities. It'll just be that the richer you are, the better product you'll have access to.