Following up on the previous post, I should note that Morning's Minion of Vox Nova takes aim at John McCain's health-care proposals, and that on grounds virtually identical to those I cited in opposition to genetic screening as a condition of coverage:
As Ezra Klein notes, this is health insurance for people who don’t need health care. It relies on the idea that insurance should be based on actuarial principles, tying cost to individual risk. Therefore the private market (with products like health savings accounts) can be a very good deal to the young and the healthy, but does very little to those in most need of health care. It is a classic example of where the free market simply does not work, and can be highly unethical. Instead of actuarial insurance, we should strive for social insurance, which is basically risk pooling: the young and healthy subsidize the old and sick, secure in the knowledge that they will be taken care of in a similar situation.
There are, of course, complexities, and Zippy has reminded us, in the preceding thread, of the multivocality of the term "insurance":
Part of the reason genetic testing is controversial is because by providing greater information granularity it is detrimental to 'insurance' understood under one voice (that of providing low-cost health care to people who otherwise could not afford it) and yet beneficial to 'insurance' under other voices (that of providing on-average-more-expensive care but with protection from catastrophic loss, sometimes employing diagnostic/preventive measures).
The trouble with the majority of health-care reform proposals, as with the use of genetic testing as a screening mechanism (let's call it the medical gauntlet), is that, while both senses of 'insurance' are vital to a well-managed system, they end up downplaying or undermining the former sense as a profit-maximizing measure, and emphasizing the latter. And it is precisely the former sense in which health insurance and health provision are natural commons. The attempt to argue around this, to structure policies as though this were not so, and to extend the disciplines of the market into spheres not entirely suited for them, is where, I believe, this policy dispute meshes with a larger narrative.