Protection from this comes from laws that ban DNA-based policies, not by being secretive about sequencing. If it is allowed, insurers will have no need to obtain DNA sequences in devious ways, they will just ask and refuse cover or charge more when clients refuse to get sampled.
“Passed in 2008, a federal law called the Genetic Information Nondiscrimination Act (GINA) made it illegal for health insurance providers in the United States to use genetic information in decisions about a person's health insurance eligibility or coverage.”
Also prevents employment discrimination based on genetics.
Oh sweet summer child. The astute business person will construct a score that happens to correlate with these known genetic defects and then sell it to insurance anyway with the plausible cover correlated source.
Perhaps health insurance companies can't do this, but I know for absolute certain no one is looking closely enough at every little company's hiring decisions to find out if someone is doing this.
You resolve part of them, but immediately generate others. Hybrid systems are the way to go.
In Spain, for example, we have a private system but it is extremely inefficient in some areas (and very good in others). Of course, you can have private insurance, but you still have to pay your social security. Curiously, the only ones who can decide which system they want are the public servants...
You avoid the problem with medical debt, to be precise.
You cannot really avoid the fundamental constraints - anywhere in the world, there are only so many doctors and so much money available for treatments. IDK if USA has a shortage of doctors, but plenty of European countries do. A country like Romania just cannot give its doctors big enough wages to stop them from seeking employment elsewhere, where they will get five to ten times as much (UK, Germany, Switzerland). As a result, local hospitals are seriously understaffed.
Where I live, having personal connections to good doctors gives you an advantage - you will be examined and treated faster. Then there is outright nepotism.
The outgroups are different than in America, but there are always people for whom the system sucks.
That's a pretty poor way of pigeonholing the problem. Looking at the US healthcare system, it's obvious that many doctors' and nurses' talents are wasted doing bureaucratic paperwork. Simultaneously, if there is a genuine lack of healthcare providers, there is no price signal that would encourage more to enter the market.
What you say may be somewhat true in the context of transmuting the US's "private" bureaucracy into bona fide "government". But it's certainly not a "fundamental constraint" that's impossible to solve. Rather it's a failure of organization, whether critiqued in terms of bottom-up market failure or top-down governance failure.
> Looking at the US healthcare system, it's obvious that many doctors' and nurses' talents are wasted doing bureaucratic paperwork.
This is incorrect. Most of the paperwork is done by administrative staff. Paying for that giant staff + the actual medical professionals is why things are so expensive.
Hospitals are not stupid, they won’t waste their most valuable resource (healthcare time) on bureaucratic paperwork.
An oncology department I'm familiar with has an entire "nurse navigator" whose whole job is to submit "prior approval" requests to "insurance" companies justifying why patients need a specific treatment, plus the nurses employed by the "insurance" companies reading those requests. I believe it's similar for any moderately expensive specialty. A common career path is care nurse -> burnout -> administration. Most of the administration is made up of people who could be providing healthcare.
And no, hospitals' most valuable resource are their billing computers. I think when it comes to providing actual healthcare hospitals are very stupid. You cannot partition any knowledge worker's attention into 10 minute blocks and expect them to achieve anything useful, yet that is what their entire system is designed around. The hospital doesn't have unilateral say of course (an "insurance" company won't pay one doctor the "price" of two if they spend twice as long with a patient), but they're still content optimizing within that status quo outcome - completely scatterbrained care.
And it's not like individual doctors are well rested or happy when you talk to them. The system clearly takes their toll on them (eg disappearing for 5 minutes to go retrieve test results that didn't show up before your appointment). In fact I'd say the vast majority of human talent in the medical system ends up completely wasted.
Capitalism, nepotism, public, private, insurance, nationalised healthcare ... the GP is saying that these are methods of dividing up available care, not methods for creating more available care.
X is the amount of medical care available
Y is the amount of medical care wanted
If Y < X there is no problem with any of the systems. And, obviously, a certain amount of inefficiency doesn't affect patient care. Plus, perhaps relevant today: when shit hits the fan we can scale up available care quickly.
If X > Y it doesn't matter which system you choose, someone will go without. You can change who goes without but you cannot fix the system by changing the method of dividing care.
Can things be somewhat improved with better organisation? Sure. Probably. But let's not overestimate it either. Let's take a dream scenario: optimal organisation can make 20% more care available. How much more care is wanted? I think we can safely say the US population wants 200% or more than the current system provides. Whilst nobody's opposed to improving organisations, it cannot fix the problem.
Fixing the problem is something you can only do by doubling the medical training available. That'll be a lot of extra dollars, none of which go anywhere near patient care for at least 10 years, so I would expect a lot of strong opposition from a lot of sides. But it's the only way to fix things.
Looking at spending per capita it's clear that American problems aren't caused by lack of money in the system.
They are caused by high barriers of entry, which in turn are caused by entrenched elites gatekeeping jobs through absurdly high tuition fees, expecting everybody to take lots of student debt and a very litigation-friendly environment. These costs are then passed on to the general population through a byzantine system of health insurance that leaves a lot of people uninsured.
> Let's take a dream scenario: optimal organisation can make 20% more care available.
In 2020 UK spent 3278 GBP (~4400 USD) per capita on healthcare [1]. USA: 12,530 USD. That's about 3 times less or a difference of 200% [2].
In UK life expectancy is 81.2 years. In USA it is 78.79 years.
3 times more spent to get a worse outcome doesn't seem like "20% difference" to me. Of course there are other factors, but are they enough to overcome 3x difference? I don't think so.
You cannot compare healthcare systems on X doctors per Y patients basis, because the outcomes aren't linear. It's orders of magnitude more expansive to treat many health problems if you go to the doctor 2 years too late. And the outcomes are worse despite the higher costs. Guess what happens when people have to pay a lot for each visit - often they go too late.
There should be a directors cut where the mission fails because of Vincent's hidden heart condition.
Gattaca shows eugenics has been so vilified that the audience will root for a character who selfishly commits fraud, risking lives and scientific progress for his own vanity.
The really scary fact is that there would be no need for a police state and segregation. The genetically enhanced would just completely dominate an open and fair competition.
Gattaca shows a society in which eugenics, in hopes of creating a shortcut for people who have supposedly the better genes, devolved into a society where someone who did not have genetic augmentation could outcompete a whole bunch of genetically augmented people.
In the movie, either the genetic augmentation didn't work (as well) as expected, or their advantage caused the augmented people to become lazy because they got covered in undeserved status no matter how little or much they worked, as everything depended on which genes they have been "bred" for. Then someone with supposedly bad genes could run circles around them just by working hard.
Maybe some mixture, e.g. in order to protect those kids who fail at the task they have been "bred" for from considering themselves failed humans, gattaca's society adopted this model where they shower all kids in status who have the right genes. Maybe it's not the kids who are being protected but the companies selling the augmentations.
100% Agree. Gattaca actually showed A SPACE PROGRAM running similar to the real space programs. I don't know about now but the first astronauts needed certain genes or they weren't allowed in. AFAIK that used to be true for fighter pilots. Want to be one you needed perfect eye sight. Bad genes = selected out.
I'm pretty sure the effect was temporary and he had to do it a second time. It's very important to note that this research is still very new and he was lucky that his genetic code was prime for that test. (I'm not against bio hackers btw. I think they provide a very good service though obviously more risky. No problems when that risk is on yourself but just trying to say "don't try this at home").