Buy a Warranty For Your Unborn Child

Genetic testing is getting cheaper every day. Not using the results of genetic tests in setting insurance premiums is a shame, because it means those of us with good genes have to pay more than we otherwise would. It also means that there need to be laws and enforcement mechanisms to prevent insurance companies from gaining or using genetic test information, which imposes costs that don't need to be there.

It occurred to me a while ago that parents (or even a future parent with no prospective mate) could buy genetic defect insurance for their future children. Such insurance would pay all or part of the costs imposed by any genetic defects their children turned out to have, including the increase in medical insurance premiums brought on by the defect.

I had initially only been thinking of genetic defects that directly caused problems, like Downs Syndrome or MS or whatever. However, while I was searching on Google to see if someone had thought of it before me, I came across this article by Randall Parker objecting to Alex Tabarrok's call for genetic insurance.

Parker's objection is that as the costs of genetic testing falls people will get tested earlier and earlier, or that people could have secret tests before purchasing genetic insurance, thus causing an adverse selection problem. He goes on to claim that "There is not going to be a period of universal ignorance about each person's test results during which genetic insurance could be purchased."

It turns out that there must always, in the absense of time travel, be a period of time during with such ignorance exists. In the absolute worst case, that is the time preceding conception. If nothing else, parents could buy insurance for their children to cover any increase in medical premiums due to their genes. If the premium is too high, parents could (and probably should) decide instead to adopt. Future parents who are worried about being denied the opportunity to procreate with whomever they choose could decide to buy the insurance before they even find a prospective mate.

Some people might argue that people shouldn't have to pay for what their parents did or failed to do before they were even born, but this is a specious argument: we already pay (or benefit) from what our parents did from before we were born to well into our adulthood. People with poor parents are likely to be poor no matter what. Who are we to deny someone with poor parents the opportunity to pay lower health insurance premiums if they happen to have good genes?

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I guess one problem seems to

I guess one problem seems to be that an unborn child's genes are random variables, they are combinations of genes from the parents. The insurance companies could use parents' genetic info to predict childrens' genes. Then the problem arises again.

Oops, that should say "not

Oops, that should say "not random".

It seems to me that if

It seems to me that if parents could predict with some certainty that their child was going to have higher medical insurance premiums, then the child really has nobody to blame except its parents, which is the whole point of this exercise. My goal in life is to eliminate every possible opening for someone to blame "society" for their problems.

Trent: That's a feature, not

Trent:
That's a feature, not a bug. One of the great things about insurance is that it discourages people from acting in irresponsibly risky ways by requiring them to pay the expected costs up front. If a couple is so likely to produce a child with a costly genetic defect that they can't afford the insurance, isn't it better for all concerned that they adopt?

And insurance still doesn't account for all of the expected costs, in that it excludes the pain and suffering of the child. A genetic defect which costs a lot to treat is also likely to have a negative impact on the child's quality of life.

Anyway, don't we have the technology to make a bunch of embryos and then pick one that isn't broken?

One of the greatest fears of

One of the greatest fears of the insurance industry -

Are we to accept that insurers will (in effect) be the bringers of eugenics in our society? "Sorry, we can not insure you because your grandmother and both grandfathers died of heart failure and you have all five defective genes..."

Next step - "Please test this fetus for genetic defects so we can abort it if it is not insurable (i.e. 'perfect')".

What a sad world it will become...

To rephrase your question,

To rephrase your question, probligo, am I supposed to accept the costs of someone's choice to produce a defective child? I have no problem with someone's being able to make that choice. What I have a problem with is their ability to force me to pay for their choice.

I have no problem with

I have no problem with someone’s being able to make [the] choice [to produce a defective child].

I'm not sure I agree with that. Suppose a woman knows that if she gets pregnant her child will be born without arms or legs, or mentally retarded. And she does it anyway, intentionally. I have trouble seeing that as anything other than a crime against her future child. Of course, real-world cases are rarely so extreme---the outcome is usually uncertain---but there are still cases in which I would say that it would be criminally irresponsible to have a child.

That's not to say that I think that the state should be making decisions about who can and cannot have children. But I definitely do have a problem with people choosing to produce defective children, regardless of who pays for treatment.

That’s not to say that I

That’s not to say that I think that the state should be making decisions about who can and cannot have children. But I definitely do have a problem with people choosing to produce defective children, regardless of who pays for treatment.

Agreed that it's immoral behavior, but if I read you correctly you think it's non-coercive and hence consistent with libertarianism. Would that be a fair assessment of it?

No, I do think that someone

No, I do think that someone who does such a thing should be considered a criminal, and I don't in principle have any objection to making it a crime. The parents are essentially condemning a child to a life of disability and/or poor health. I just think that since it's a fairly small problem (in terms of frequency), and hard to prevent without giving the state undue power, it's probably better not to get the state involved.

Really? My analysis is that

Really? My analysis is that there can be no rights-violation since no person exists to have their rights-violated at the time of the supposed crime (conception). I'm not 100% confident in this however, since in some super futuristic world I think this argument might be used to support an indirect form of human slavery; say a bunch of evil scientists find the genes that make a person more submissive and inclined to blindly follow authority, and then make the army of obedient Pamela Anderson sex clones mentioned on the IP thread.

While we're on the subject

While we're on the subject of rights for things of questionable personhood, one thing I've always wondered is whether on Star Trek people still have libertarian rights when they are being sent through the transporter buffer. For example, say Captain Picard makes a contract with Chief O'Brien that the Chief always finishes the transporter cycle (since he is in charge of the transporter). But once O'Brien energizes the beam, Captain Picard has ceased to exist, hence he has no rights. What then compels the Chief to finish the transport cycle successfully, since a contract with someone who doesn't exist can't be valid?

Don't even get me started on that episode where they wanted to disassemble Data...

Stefan.- What about when you

Stefan.- What about when you are asleep. Since you are not really yourself does the same thing apply.

But seriously.
This concern about genetic testing is overblown. For most diseases there are few ironclad predictors of mortality. Genetic determinism for most persons is not an issue. Even if it were, most people carry at least recessive genes for numerous rare conditions and new mutations are occurring all the time. The amazing thing is that most well defined genetic diseases are really caused by one of numerous different but related mutations that modify protein function. In other words many different mutations could be responsible for the same genetic disease. So to test for one disease, the company would have to test for multiple mutations, maybe a hundred, and there are hundreds of rare genetic conditions. And for common conditions such as cancer, or Alzheimer ’s disease only a minority of persons who get the disease have a know genetic cause. The rest have an unknown cause. Suppose the insurance companies required genetic testing before issuing each insurance policy. They would be able to write hardly any policies since practically everyone is a mutant.
Anyway companies have many sneaky ways of reducing risk already. For example, when you apply for insurance you have to submit your whole medical record to their purview. Then you get examined by their tech and blood and urine is collected. You better not be using drugs or have HIV or you are out of luck. They can even tell if you smoke.
So forget about the science fiction. The real way they screw you with state mandates for various required care. So you don’t want chiropractic care. Too bad, you get it anyway thanks to the influence of the chiropractors in your state. They also have a no coverage list that is unfair. You take blood thinners or Prozac or you are a diabetic, forget applying. They won’t even rate you even if you are in otherwise perfect health.
The above applies to individual private insurance only. If you are employed and there is insurance in your company, they have to take you, sick or not. This is what finances most non- Medicare, non-Medicaid health insurance in this country and many people fall through the cracks.

Stefan.- What about when you

Stefan.- What about when you are asleep. Since you are not really yourself does the same thing apply.

No, I already thought of this objection. When you're asleep your awareness doesn't cease to exist, but merely enters a different level (we know this because brain waves can be observed in sleeping patients). However, as far as I know there are no detectable brainwaves when Captain Picard is in the transporter, because all his brain cells were disassembled and then reconfigured on the other end. It's as if Captain Picard were murdered, then magically brought back to life, so to speak. I think Nozick has a solution to the problem of who constitutes "the" Captain Picard, but so far as I know he didn't comment on the libertarian rights of someone whose molecular structure has been completely disassembled.

Man, the things you think about at night...

So, if a parent knows they

So, if a parent knows they will have a "retarded" child (i.e. of significantly lower IQ than the norm), then would that not make criminals of parents who choose to produce a "normal" child (in today's terms) in a world where eugenics or genetic engineering have made it the norm for children to have 200+ IQs?

You know, I seriously doubt

You know, I seriously doubt most people around today who have genetic defects are particularly angry at their parents about it or would prefer not to have been born. I think that anyone who tried to make a law against producing children with genetic defects would come up aganst very strong opposition from many sides. IMHO you'd be more likely to get a law against abortion even in the case of genetic defects, at least in the US. In the hypothetical still-existing USSR (or maybe future Russia) you'd probably get the opposite.

The genetic screening

The genetic screening technologies are a great example of a metaphor I once read. The reality is like a large hotel in which some rooms are lit while most are still dark. As science proceeds, it flips on the lights in more rooms. And each time it does this, it reveals people who had their hands in other people's pockets under the cover of darkness.

The issue of using genetic tests in determining the cost of insurance should be no problem to any libertarian. If everyone pays the same price for insurance regardless of their risk, it is not insurance but socialism.

Leftists, of course, will oppose any genetic testing or insurance scheme for this very reason. They will resist the insurance scheme and instead demand that the state fully pays all costs for defective children. The words "heartless" and "selfish" will be used a lot.

As for whether refusing to use genetic screening should be a crime if a defective baby is born, note that parents already have to use the current reasonable medical technology to maintain and improve the health of their children. It was OK for a parent 200 years ago to take his kid to a dentist who used the dental technology available in that era. Doing the exact same thing today would be considered child abuse and be a serious crime. Similarly, it is OK to not use genetic screening when genetic screening doesn't exist, but when such technologies are widely available at a reasonable price, one doesn't get to plead ignorance for refusing to use them any more than, say, a driver who has run over a kid when the cars had a red traffic light gets to plead ignorance for not checking what colour the traffic light had.

OK, perhaps someone can

OK, perhaps someone can sort out these -

Our next door neighbour have a family of three boys. The elder two are healthy, normal in every (percievable) way. The third is massively retarded, with severe physical handicaps. The cause was (believed) due to lack of oxygen during birth. Totally uninsurable. Who pays? Who decides his fate?

I have a minor heart defect. Not detectable on DNA testing, but inherited from my mother (that 50/50 chance thing). Am I uninsurable for heart disease generally? Yes. "Pre-existing condition" they call it.

A woman aged 32 and her husband decide to have a child. Fetal DNA testing shows no problems but the child is born with Downe's Syndrome (should have shown up?). Who pays? Oh, statistically there are about 3 per 1000 DS babes born to women between 30 and 40.

No. Sorry. Everything that has been said here, no matter how careful, is ignoring or concealing one very important fact.

This is eugenics. It is the same as Hitler's dreams of the "master Aryan race".

What is the justification for it? Reading through all of this - plain unadulterated old-fashioned greed.

How many of you consider yourselves to be "good Christians"?

This is eugenics. It is the

This is eugenics. It is the same as Hitler’s dreams of the “master Aryan race".

I don't see in principle why genetic insurance, even if viable, would be equivalent to Nazism. Perhaps you could provide the link?

Our next door neighbour have

Our next door neighbour have a family of three boys. The elder two are healthy, normal in every (percievable) way. The third is massively retarded, with severe physical handicaps. The cause was (believed) due to lack of oxygen during birth. Totally uninsurable. Who pays? Who decides his fate?

Good argument for insuring against birth defects in general instead of just genetic abnormalities. I hadn't been thinking about that, but it makes a huge amount of sense. I guess what we're talking about is the general concept of prenatal or pre-conception insurance.

I have a minor heart defect. Not detectable on DNA testing, but inherited from my mother (that 50/50 chance thing). Am I uninsurable for heart disease generally? Yes. “Pre-existing condition” they call it.

Too bad prenatal/pre-conception insurance didn't exist when you were conceived. Might have saved you a lot of trouble. Also, I thought preexisting condition exclusions were generally for limited periods of time, say six months. It sounds like you're making an assumption here rather than speaking from experience.

A woman aged 32 and her husband decide to have a child. Fetal DNA testing shows no problems but the child is born with Downe’s Syndrome (should have shown up?). Who pays? Oh, statistically there are about 3 per 1000 DS babes born to women between 30 and 40.

This question seems to indicate a basic misunderstanding of the point of the article. If prenatal testing showed no problems, then the couple would pay a low premium if they chose to get birth defect insurance and the insurance company would be taking on the risk that the test was wrong. If, on the basis of the test, the couple decided not to get insurance, they would be no worse off than they are now.

Are you really proposing that *I* should have to pay for another couple's choice to have babies when they get older? If someone else is paying, why not have babies right up until menopause? Who cares if there's a greater chance of Down's Syndrome, because someone else gets to pay! In fact, while we're at it, let's have kids even though we're too poor to support them. That's what welfare and public school are for, right?

Probligo, I'm assuming your

Probligo, I'm assuming your use of the term "eugenics" is referring to the discussion around the criminalization of failure to use genetic testing. I'm generally opposed to any law requiring genetic testing. However, I'm also realistic about the utility of laws *against* the use of genetic testing by insurance companies. Like laws against rejecting unhealthy people, such laws will lead to higher premiums for everyone and more calls from people like yourself for socialized medicine because of the "failure" of the current "private" medical care system. Therefore, I've proposed a way for people to insure against negative outcomes from genetic testing by allowing them to get insurance before such an outcome can be known by them or by the insurance company.

You asked about Down's Syndrome. An incentive in the form of higher prenatal insurance for an older couple might cause them to choose to have children earlier rather than later in their childbearing years, leading to fewer abortions for Down's Syndrome fetuses. Or the fact that they can get insurance at all against the possibility of Down's Syndrome, even at an elevated premium, might cause them to carry a child to term that they might not otherwise. After all, the entire class of people who choose to take the risk of Down's Syndrome and choose to buy prenatal insurance will be sharing the cost.

Note that at no point have I proposed insuring against only those abnormalities that show up in a genetic test. Yes, some proposals have talked about paying out specifically based on the results, but such payouts would be specifically to offset the increased premium for medical insurance *based on the result of that same test*.