Even the concept of lifetime health insurance, which parents buy before a child is born, would be unworkable since insurance companies would know the inheritable conditions of the parents. The problems with genetic information, moreover, may flow into employment relationships. If employers remain the dominant sponsor of health insurance, there is great potential for genetic discrimination in hiring or other workforce decisions since an employer's health insurance costs will be affected by the health problems of its employees. In February, the unexpectedly rapid pace of the human genome project caused President Clinton to issue an order to all federal agencies prohibiting them from using genetic information in any decision to hire, promote, or dismiss workers. When these arguments are put together, they suggest that the rise in gene therapies will reopen the debate over government's proper role in health care.
Insurance is the most obvious example.
A universal government insurance program eliminates the need for the risk selection activities inherent in private insurance markets. Since everyone is in the risk pool, there is no competitive pressure to screen out people who are highly likely to have costly genetic conditions or diseases. A universal government insurance program also eliminates the reliance on employers as sponsors of health insurance and the incentive for employers to discriminate against workers likely to use expensive medical care. At the same time, this kind of government insurance program raises new problems. In particular, it requires a decision-making unit with the authority to determine that a therapy is cost effective and should be permitted.