Must We Subsidize Genetic Flaws?
When parents create a child who will have medical costs because of genetic flaws, they should bear the costs, as they willingly took on the risk.
May 1, 2008
Fred Foldvary, Ph.D.
Economist

Nature sometimes plays tricks on us, and a baby is born with genetic flaws. That person can require huge medical expenses the rest of his life. Who should pay the cost?

The parents should bear the cost at least until the child becomes an adult. To avoid ruining their finances, they should be able to obtain insurance against their children being born with genetic flaws. The insurance would be more costly for parents who have known genetic conditions that could be passed on to their children, but parents would make a knowing choice about whether to incur these costs.

It could well be questioned why the person with genetic problems should bear the medical cost when he is an adult. It was not his choice to be born. It can also be questioned why society should bear the cost, since if this generalizes, then each person would be obligated to pay the cost incurred by others because of bad luck. No, logically the cost should be on the parents, and it should be covered by insurance.

When parents decide to have a child, they know they are obligating themselves to pay many costs. The voluntarily take on themselves the cost of housing, feeding, and providing medical care for their offspring. If they create a child who will have medical costs because of genetic flaws, they as the creators should bear the costs, as they willingly took on the risk.

Policy should enforce this parental responsibility by requiring them to obtain genetic medical insurance before the child is born. This insurance would cover all medical costs, minus small co-payments, caused by genetic problems the child is born with. If the parents cannot afford the cost at that time, then it would be a lifetime liability not voidable by bankruptcy.

Governments often fail to do what is logical and efficient, so the U.S. federal government instead is now forcing the public to pay for genetic medical costs via higher insurance payments for everybody. In May 2008, the Genetic Information Nondiscrimination Act was enacted. It prohibits insurance firms from charging higher fees based on DNA tests showing that the insured customers are genetically predisposed to a disease.

People should not lose their medical insurance when genetic tests show they are at risk for illnesses. It is not their fault if they will have greater medical costs. Logically, they should be insured against genetic problems before they are born. That’s what insurance is for — to avoid having to bear large costs because of circumstances beyond one’s control.

There are now many tests one can take to discover genetic problems. But folks are afraid to take the tests when the results lead to higher medical insurance costs, or no insurance at all. The public benefits from this knowledge, and before-birth genetic insurance would join together personal and public benefits.

Severe genetic problems are rare, so the cost of before-birth genetic medical insurance would be small for most families, as the risk would be spread among the whole population. But for those parents with known genetic problems, the cost could be high, but why should they not bear the cost? By creating children likely to have large costs, they are imposing future social costs, and ethically those who create costs should bear them. If those parents don’t have to pay those costs, it creates what insurers call “moral hazard,” the imposition of greater social costs because people can make others pay the costs.

The medical impact of DNA testing will be a major 21st-century issue. DNA testing is becoming ever more widespread, so we should put genetic insurance on the table for discussion.

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Fred Foldvary, Ph.D.
Economist

FRED E. FOLDVARY, Ph.D., is an economist and has been writing weekly editorials for Progress.org since 1997. Foldvary's commentaries are well respected for their currency, sound logic, wit, and consistent devotion to human freedom. He received his B.A. in economics from the University of California at Berkeley, and his M.A. and Ph.D. in economics from George Mason University. He has taught economics at Virginia Tech, John F. Kennedy University, Santa Clara University, and currently teaches at San Jose State University.

Foldvary is the author of The Soul of LibertyPublic Goods and Private Communities, and Dictionary of Free Market Economics. He edited and contributed to Beyond Neoclassical Economics and, with Dan Klein, The Half-Life of Policy Rationales. Foldvary's areas of research include public finance, governance, ethical philosophy, and land economics.

Foldvary is notably known for going on record in the American Journal of Economics and Sociology in 1997 to predict the exact timing of the 2008 economic depression—eleven years before the event occurred. He was able to do so due to his extensive knowledge of the real-estate cycle.