We aren’t all Volvos

Healthcare debates are all the rage right now, but as a sci-fi writer I’m more interested in the arguments we might be having fifty, or a hundred years from now. Namely, that we aren’t all Volvos.

First, think about what insurance really is: collectivized risk. A major disaster (home flooded, car wrecked, heart attack) could put any of us in the poor house. It probably won’t happen to you… but what if it does? You need to protect yourself. How? By putting a little money into a fund with lots of other people and whoever draws the short straw gets to take some out.

Actuaries are the people who do the seemingly-impossible job of calculating how much each person needs to put in. They look at the likelihood of an accident and calculate the premiums and deductibles based on the cost of covering those accidents. (Premiums are just the dues you pay to belong to the collective and deductibles are the chunk of the accident that you’ll pay for yourself).

When you get car insurance, there’s two mitigating factors they look at to determine your risk. First, the built-in reliability of the thing they’re insuring. If you drive a car with a reputation for safety (like a Volvo) there’s less chance you’ll be severely injured in an accident, which means you pay less. Second, they look at the reliability of the user. That’s your driving record, your age, experience, etc…

With health insurance, they look at the same two things. You get a check-up and they look at family history to determine the state of the thing you’re insuring, and they inquire into the way you’re using that thing by looking at drinking/smoking/exercise habits. All well-and-good. Until we learn more about how bodies are built. And that we aren’t all Volvos.

In a hundred years, when DNA tests are standard and we know the likelihood we have for heart failure, or risk-taking, or addiction to drugs and alcohol, or propensity for violence, or various cancers… how is that going to change the game? In a world where users have more and more information and greater freedoms and control of their lives, what’s to stop people who score well on the DNA test to band together and collectivize their smaller risk with much smaller premiums? And if they aren’t allowed to do that, what will be the attitude of those with a solid chassis that find themselves paying the same rate as an unfortunate jalopy?

And what does it mean that we have no control over how that test turns out? We can choose to buy a safer car. We don’t have the same control over our DNA. Even the argument that diet and exercise can help overcome some of our propensities for bad health rings hollow. Finding out that one person can smoke and eat donuts and live to be 100 while others have to eat like rabbits and run five miles a day for the same result… well you can see how the unfairness is just moved, not erased.

Does this sound like fanciful conjecture? It shouldn’t. These debates are inevitable. As will arguments over whose fault it is when we compare parental DNA to the child’s. You think in-laws have a bad rep now? Just wait until behavioral and health problems can be accurately blamed on a spouse’s parent. We are just a generation away from these arguments, people. It’s enough to make me hope I don’t live that long.

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