Finding The Proper Place for Genetics in Insurance

Posted by ELSI Contributor on October 28, 2009

This commentary in the Genomics Law Report’s ongoing series What ELSI is New? is contributed by Mark Henderson, Science Editor for The Times and author of 50 Genetics Ideas You Really Need to Know.

It is a mark of the quality of the science fiction movie Gattaca that, 12 years after its release, so many ethical issues surrounding genetics are still seen through its prism. In Andrew Niccol’s dystopian vision, DNA divides society into “valids” and “invalids”, some of whom are decidedly more equal than others.

Concerns about such genetic discrimination are relevant to many ELSI discussions, but rarely more so than when the subject is insurance. The great fear is that genetic data could create an uninsurable underclass, denied mortgages and life and health cover because of genomic flaws beyond their control.

The consensus that this would be wrong is so strong that the Genetic Information Non-Discrimination Act (GINA) passed the US Congress with barely a murmur of opposition. A UK moratorium on the use of genetic tests by insurers has also recently been renewed. But it is far from clear that the issues that genomics raises for fair insurance are either new or especially problematic.

Insurers have used genetic information for as long as there has been insurance. Until GINA they were quite entitled to ask about family health history — a proxy for genetics, and in the UK they still are. And it is not controversial to charge higher premiums to drivers with Y chromosomes. Neither is genetic injustice confined to consumers. An individual who discovers she has a raised risk of a degenerative disease like Alzheimer’s has an incentive to buy long-term care insurance, at a premium that is fair to neither the provider nor its other customers.

Insurers may also be less interested in genetic discrimination than is often imagined. Gil Baldwin, managing director of Aviva Health, has told me he would be happy in principle to give discounts to customers who have themselves sequenced, even if they do not share the results. His logic is that they will be better motivated to change their lifestyles to lower both their risks and his.

Market mechanisms like this, indeed, should be capable of meeting many of the insurance challenges of the genomic age. Nobody, after all, has a perfect genome, and insurers are businesses that need customers. We all have above-average inherited risks of some disorder or other, and companies that set the genetic bar too high will soon go bust.

I’m not saying that the insurance industry requires no regulation in its use of genetics. There may well be a need, for instance, for a safety net for people who carry rare mutations and risk profiles. The knee-jerk argument that DNA has no legitimate place in insurance, however, is not as compelling as it may seem.