Reviews issues in the ethics of access to health insurance based on health problems due to genetic inheritance.

Creating a single national health insurance pool is not likely to destabilize the economy by supplanting the private health insurance industry. This industry insures a relatively small percentage of the population and holds very little of the risk such insurance implies. In effect, insurance companies function as middlemen, bundling risk packages to distribute to other, larger companies and so serve a limited purpose. Were insurers to handle claims for a national pool as they do for the (...) Medicare program, any destabilization to the economy more broadly would be further minimized. (shrink)

This book presents startling evidence that state monopolies can produce better outcomes than the free market. It provides an empirical comparison of the property insurance market in five European countries: Britain, Spain, France, Switzerland, and Germany. The market and cost structures of insurers in each country are described, and particular features of each market and the outcomes for customers examined. The regulatory frameworks vary widely from country to country and so do the market outcomes, (...) both in terms of premium level and in terms of available insurance cover.In view of the increase in major floods and other forms of natural damage over the last decades, the non-availability of insurance cover in many competitive insurance systems is likely to become a major political issue. This book shows that state monopoly is an adequate policy response. Competitive insurance systems are shown to provide incomplete cover at a substantially higher cost. In mixed systems, where the private sector can obtain reinsurance from the state the state tends to end up paying most of the costs while the private insurance companies keep most of the premium income.The book will be of interest to academic economists interested in privatization, regulation, the theory of the firm, and insurance; Policy-makers concerned with regulation and privatization; Insurance companies, regulators, and analysts. (shrink)

In the mid-1990s, several state legislatures enacted a "second generation" of small group health insurance reforms that required guaranteed issue of all products and prohibited the use of health as a rating factor. We use data from two large employer surveys to compare the behavior of small business in nine states that adopted these reforms between 1993 and 1997 to the behavior of small business in 11 states and the District of Columbia, where neither of these small group health (...) insurance market reforms existed prior to 1997 (N = 8,465 in 1993; N = 12,219 in 1997). Our analyses focus on several outcomes: health insurance offer and enrollment rates in any employer plan, and in an HMO plan; turnover in offer decisions; and premiums, variability in premiums, and the rate of change in premiums. Overall, we find no effect of small group reform on any of the outcomes; the sign of the effect is not consistent across reform states, the estimates rarely attain statistical significance, and they show no consistent pattern across the outcomes within each state. Therefore, predictions of the harm these regulations might cause to the market have not come to pass. On the other hand, proponents' hopes for a solution to low coverage rates among small businesses have not materialized either. (shrink)

Not since the civil rights era has enacted national legislation been fought so fiercely as the Patient Protection and Affordable Care Act. Political, ideological, and social forces have mobilized to undermine the ACA at numerous fronts, including the Supreme Court, Congress, state governments, and the court of public opinion. The ACA has survived a constitutional challenge, a presidential re‐election, numerous repeal votes in the House, and avowedly obstreperous state regulators. But it has not yet run the full gauntlet of lethal (...) strategies. The latest line of attack is a collection of orchestrated lawsuits seeking to keep the federal exchange from paying any premium tax subsidies.What if the challengers eventually prevail? What would happen then? (shrink)

The research on technologies and methodologies for (accurate, real-time, spontaneous, three-dimensional…) facial expression recognition is ongoing and has been fostered in the past decades by advances in classification algorithms like deep learning, which makes them part of the Artificial Intelligence literature. Still, despite its upcoming application to contexts such as human–computer interaction, product and service design, and marketing, only a few literature studies have investigated the willingness of end users to share their facial data with the purpose of detecting emotions. (...) This study investigates the level of awareness and interest of 373 potential consumers towards this technology in the car insurance sector, particularly in the contract drafting phase, with a focus on differentiating the respondents between generation Y and Z. Results show that younger people, individuals with higher levels of education, and social network users feel more confident about this innovative technology and are more likely to share their expressive facial data. (shrink)

La participation accrue des personnes handicapées au marché du travail reste une priorité politique pour les gouvernements européens. Cette étude visait donc à examiner les facteurs favorisant l’intégration sur le marché du travail des demandeurs de prestations d’assurance-invalidité (PAI) et des personnes ayant droit à des mesures d’intégration et d’occupation en Suisse. Un ensemble de données inédit a été créé via la mise en relation de l’Enquête suisse sur la population active 2018 avec les données des registres administratifs (2000-2017). La (...) régression logistique multiple a été utilisée pour analyser les associations entre l’activité économique et les caractéristiques démographiques, socioéconomiques, de santé et régionales chez les demandeurs de PAI en âge de travailler (N=9,309) et les personnes ayant droit à des mesures d’intégration et d’occupation (N=5,753). Il en ressort que le fait d’être un homme, jeune, de vivre avec un partenaire ayant un emploi, d’avoir fait des études secondaires supérieures ou tertiaires, d’avoir réalisé l’entretien dans la langue de la région linguistique, de ne pas déclarer de limitations d’activité liées à la santé à long terme ou de morbidité chronique, est associé à une probabilité plus élevée d’activité économique. Les demandeurs résidant dans la région lémanique et au Tessin étaient moins susceptibles d’être économiquement actifs que leurs homologues vivant dans l’Espace Mittelland. Plus important encore, les résultats impliquent que l’éducation au-delà du niveau secondaire inférieur ainsi que la maîtrise de la langue sont essentielles pour l’activité économique des demandeurs de RAI et de ceux qui ont droit à des mesures d’intégration et d’occupation. (shrink)

While the existing literature finds that corporate social responsibility (CSR) can provide insurance-like protection in negative events, it remains unclear how CSR buffers firms from market penalties for negative events. To address this concern, we conduct event studies and regressions using data from the environmental violations by Chinese publicly traded companies and their interlocked companies from 2009 to 2021. Our results show that the market reacts negatively to environmental violations. The market penalty diffuses through director networks (...) and leads to the collective punishment of interlocked firms. CSR has an insurance-like effect that buffers market penalties and collective punishment for environmental violations. Long-term CSR has a stronger insurance-like effect than short-term CSR. Additionally, the insurance-like effect of CSR still exists during repeated environmental violation events. This paper contributes to the literature on the insurance-like effect of CSR and provides a reference for corporate CSR practice and investors' CSR decisions. (shrink)

This article discusses the disability insurance industry in order to provide context regarding the potential impact of genetic testing on disability insurance. It describes disability income insurance, exploring both the protection it offers and its main contract provisions. It goes on to describe the private insurance market and the differences between group and individual insurance, and concludes with implications of genetic testing with respect to the private disability insurance market. The individual disability (...) income insurance market is theoretically of great interest as a matter of public policy since there is potential for unfair discrimination through genetic testing although this remains very unlikely as a matter of practice, however.It is more likely that a person will become disabled than die before age 65. The loss of income during a disability can be quite devastating. In contrast to the high risk and high impact of disability are the realities of the disability market. (shrink)

Applying an evolutionary framework, we investigate how a reputation mechanism and a buyer insurance (as used on Internet market platforms such as eBay) interact to promote trustworthiness and trust in markets with moral hazard problems. Our analysis suggests that the costs involved in giving reliable feedback determine the gains from trade that can be obtained in equilibrium. Buyer insurance, on the other hand, can affect the trading dynamics and equilibrium selection. We find that, under reasonable conditions, buyer (...) insurance crowds out trust, and trustworthiness. (shrink)

Catastrophe insurance differs from regular insurance in that individual claims are correlated and insurers have to pay more clients at once, which creates a liquidity strain. In this paper, I show two related findings: first, that when customers know their claims are correlated, this correlation can cause positive-sloping demand at low prices, and second, that because of this, a catastrophe insurance market can fail. Market failure is a stable equilibrium, which provides a better understanding of (...) the frequent failures in catastrophe insurance markets. (shrink)

This article brings together two different conceptions of culture—a shared meaning system on one hand and a repertoire of strategies on the other—to understand the emergence of a market. Based on ethnographic data, it examines how a Chinese life insurance market is emerging in the presence of incompatible shared values and ideas acting as cultural barriers, and how these cultural barriers shape the formation of the market. The findings reveal a burgeoning Chinese life insurance (...) class='Hi'>market despite local cultural logics incompatible with the profit-oriented institutional logic of life insurance. This Chinese market, however, has developed along a different trajectory from what might be expected. It first emerged as a money management, rather than a risk management, market. I argue that the very cultural barriers that compose the local resistance to a new economic practice also necessitate the mobilization of the cultural tool-kit to circumvent this resistance. These dual processes, shared ideas composing the resistance and the cultural tool-kit circumventing the resistance, shape the trajectory and characteristics of an emergent market. I propose a theoretical model specifying the mechanisms through which the two forms of culture interplay to influence the development of the life insurance. I apply this model to extend Zelizer’s (1979) insights and discuss how culture matters in forging a new market in the global diffusion of capitalism. (shrink)

This paper analyzes the legal issues associated with the leading and much-debated proposals that aim to revitalize state regulatory competition and allow individuals to purchase insurance across state lines. These proposals seek to reverse decades-old principles of state preeminence in the regulation of individual health insurance and instead create “jurisdictional competition” in the individual market by allowing an insurer to choose the state under whose law it wishes to be regulated, subject to certain consumer protections. Advocates say (...) this type of jurisdictional competition would reform perceived problems in the individual market and lower the costs of individual health insurance by imposing the regulatory authority of only the insurer’s selected “home” state. (shrink)

Prior studies have extensively explored factors that drive misselling behavior in life insurance markets, but considered little the influences of attributes of clients (particularly vulnerable clients) on unethical sales. Our study that is based on the neoclassical theory of the firm aims to investigate the relationships between attributes of life insurance clients and unethical selling behavior of salespeople. Applying logit and probit models to a sample of 35,075 observations from a Chinese life insurance company, our study finds (...) that salespeople are more likely to perform unethical selling to ill-educated clients. Further, when salespeople’s sex and education are considered, the result shows that male or poorly-educated salespeople are more likely to make unethical selling. These findings enrich the literature of misselling of life insurance and offer some practical implications for both insurers and regulators to manage life insurance markets and control misselling behaviors. (shrink)

After reviewing some of the insurance-related obstacles to access to health care, some ethical criteria for evaluating proposals aimed at reforming the health insurance marketplace to achieve universal access are developed. The additional reforms needed to eliminate many of the deficiencies in the current health insurance marketplace are discussed. It is suggested that without such substantial reforms some of the other goals such as expanded consumer choice and overall societal health care cost savings may not be effectively (...) promoted. (shrink)

Public insurance is commonly assimilated with redistributive tools mobilized by the welfare state in the pursuit of an egalitarian ideal. This view contains some truth, since the result of insurance, at a given moment, is the redistribution of resources from the lucky to unlucky. However, Joseph Heath considers that the principle of efficiency provides a better normative explanation and justification of public insurance than the egalitarian account. According to this view, the fact that the state is involved (...) in the provision of specific insurance is explained and justified by the greater efficiency of the state, in comparison with markets, in addressing market failures such as moral hazard or adverse selection. Our argument is that while insurance, intrinsically and idealistically, may diverge from a redistributive scheme, it is nevertheless difficult to deny that insurance has nothing to do with equality. More precisely, we argue that insurance may be understood as an egalitarian tool if our understanding of equality is broadened to include relational equality. Our paper aims to briefly recap the debates surrounding public insurance as a redistributive tool, advancing the idea that public insurance may be a relational egalitarian tool. It then presents a number of relational arguments in favor of the involvement of the state in the provision of specific forms of insurance, arguments that have been overlooked given the domination of luck egalitarian approaches in these debates. (shrink)

Actuarial underwriting, or discrimination based on an individual's health status, is a business feature of the voluntary private insurance market. The term “discrimination” in this paper is not intended to convey the concept of unfair treatment, but rather how the insurance industry differentiates among individuals in designing and administering health insurance and employee health benefit products. Discrimination can occur at the point of enrollment, coverage design, or decisions regarding scope of coverage. Several major federal laws aimed (...) at regulating insurance discrimination based on health status focus at the point of enrollment. However, because of multiple exceptions and loopholes, these laws offer relatively limited protections. This paper provides a brief overview of discrimination practices, the federal law, and federal reform options to manage discriminatory practices in the insurance and employee health benefit markets. (shrink)

National attention on issues of public health preparedness necessarily brings into sharp focus the question of how to assure adequate, community-wide health care financing for preventive, acute care, and long-term medical care responses to public health threats. In the U.S., public and private health insurance represents the principal means by which medical care is financed. Beyond the threshold challenge of the many persons without any, or a stable form of, coverage lie challenges related to the structure and characteristics of (...) health insurance itself, particularly the commercial industry and its newly emerging market of consumer-driven health plans. States vary significantly in how they approach the regulation of insurance and in their willingness to support various types of insurance markets. This variation is attributable to the size and robustness of the insurance market, the political environment, and regulatory tradition and custom. Reconciling health insurance markets with public health-related health care financing needs arising from public health threats should be viewed as a major dimension of national health reform. (shrink)

Spanish legislation on insurance and reinsurance mediation stipulates that intermediary can only receive commissions and fees for the management of their policies and prohibits any other form of remuneration. However, it is possible that financial intermediaries who manage larger risks wait until the end of the legal deadline to settle with insurance companies. This common practice in the insurance market hides additional remuneration in defiance of the law. It also means that the risk is not covered (...) within the prescribed period and would, involve a commercial payment to the client, and, on the other hand, affect sustainable claims management. (shrink)

What level of government subsidy of higher education is justified, in what form, and for what reasons? We answer these questions by applying the hypothetical insurance approach, originally developed by Ronald Dworkin in his work on distributive justice. On this approach, when asking how to fund and deliver public services in a particular domain, we should seek to model what would be the outcome of a hypothetical insurance market: we stipulate that participants lack knowledge about their specific (...) resources and risks, and ask what insurance contracts they would take out to secure different types of benefit and protection in the domain in question. The great benefit of the hypothetical insurance approach is that it allows us to take apparently intractable questions about interpersonal distribution and transform them into questions about intrapersonal distributions: that is, questions about how an individual would choose to distribute risks and resources across the various lives that they might end up living, in light of their individual ambitions and preferences. Applying this approach to higher education, we argue that the UK model of higher education funding in which the costs of an individual's higher education are shared between general taxation and the individual herself, with the latter element to be paid retrospectively through an income-contingent state-backed loan, is vindicated as just. In particular, we argue that it is more just than alternatives such as a graduate tax, full funding through general taxation, and full privatisation. (shrink)

We examine the relationship between social insurance contributions and earnings management for publicly listed firms in China. Our empirical results show that the social insurance contributions burden significantly reduces the degree of earnings management by reducing the level of free cash flow. Additionally, the negative relation between social insurance contributions burden and earnings management is more pronounced when the internal and external social insurance pressures are high and when the firms are large non-state-owned enterprises. We also (...) discuss the heterogeneity among firms for different financing constraints, external financing environment, regional marketization, and internal and external corporate governance. Finally, we further find that under the dual collecting system, although the social security administration is a better collecting agency, the local tax bureau acting with full responsibility is more effective than the collecting system. (shrink)

Socialism is dead, though many of its academic proponents take no notice of its demise. With its death, private property in the means of production is not generally in dispute, and the action in political philosophy centers on the justification of the welfare state. The heart of the welfare state is social insurance programs, such as government managed and subsidized health insurance, retirement pensions, and unemployment insurance. The arguments about health insurance will arguably be among the (...) most ferocious, difficult, and important of the welfare-state debates: Ferocious, because proposals to alter government managed or subsidized health care strike at people's fears and concerns in a way matched by few other proposals. Difficult, because people can often not even conceive of a market alternative to the status quo in health insurance, and there is no real existing alternative to hold up as a model. Important, because if an intellectually solid case for market health insurance can be established, then supporters of the welfare state should be on the defensive, since social health insurance is an institution central to their vision of the just or good society. (shrink)

Microinsurance is the provision of insurance services to the poor, usually in developing countries. One of the key criteria of poverty is vulnerability even to minor events. In such cases, even micro coverage can make a major difference, yet still be funded by an affordable contribution by the insured. Like any kind of insurance, microinsurance can cover different risks to life, health, farming, property among other things. Our paper sketches how one could address and develop microinsurance business ethics. (...) First, we introduce microinsurance to the business ethics community and business ethics to the microinsurance community. Our draft of microinsurance ethics is then developed from two angles: as a holistic understanding of ideals and possible ethical conflicts in key stakeholder relationships and by distinguishing eight challenges when targeting the poor and when marketing microinsurance. As an open ending, the article suggests a three-stage action research design focusing on how microinsurance could (and should) internalize ethics, respecting rather than neglecting national- and local-cultural conditions. (shrink)

Insurance markets have always relied on large amounts of data to assess risks and price their products. New data-driven technologies, including wearable health trackers, smartphone sensors, predictive modelling and Big Data analytics, are challenging these established practices. In tracking insurance clients’ behaviour, these innovations promise the reduction of insurance costs and more accurate pricing through the personalisation of premiums and products. Building on insights from the sociology of markets and Science and Technology Studies, this article investigates the (...) role of economic experimentation in the making of data-driven personalisation markets in insurance. We document a case study of a car insurance experiment, launched by a Belgian direct insurance company in 2016 to set up an experiment of tracking driving style behavioural data of over 5000 participants over a one-year period. Based on interviews and document analysis, we outline how this in vivo experiment was set-up, which interventions and manipulations were imposed to make the experiment successful, and how the study was evaluated by the actors. Using JL Austin’s distinction between happy and unhappy statements, we argue how the experiment, despite its failure not to provide the desired evidence, could be considered a ‘happy’ event. We conclude by highlighting the role of economic experiments ‘in the wild’ for the making of future markets of data-driven personalisation. (shrink)

. This paper presents the findings of two surveys conducted in April 2003 of Chartered Life Underwriters (CLUs) and Chartered Financial Consultants (ChFCs) who are members of the Society of Financial Service Professionals. The first survey of 3000 CLUs and ChFCs – the life insurance industry’s most highly regarded professionals – was aimed at identifying the key ethical issues faced by professionals working in the life insurance industry today. A comparison of these findings with those of earlier studies (...) conducted in 1990 and 1995 suggests that while the key ethical issues facing those working in the life insurance business today are essentially the same as those encountered during industry’s highly troubled ethical environment of the early 1990s, these issues are perceived as presenting somewhat less serious problems than in the past. The second survey of 3000 CLUs and ChFCs was aimed at determining the extent to which these professionals perceive the industry created Insurance Marketplace Standards Association (IMSA) as having contributed to any change in the ethical environment that has taken place. The findings suggest that IMSA has played an important role in influencing senior managers to more strongly encourage and support ethical market conduct, a critical step in improving the industry’s ethical environment. (shrink)

In the 1990s, large insurance companies failed in virtually every major market, prompting a fierce and ongoing debate about how to better protect policyholders. Drawing lessons from the failures of four insurance companies, When Insurers Go Bust dramatically advances this debate by arguing that the current approach to insurance regulation should be replaced with mechanisms that replicate the governance of non-financial firms.Rather than immediately addressing the minutiae of supervision, Guillaume Plantin and Jean-Charles Rochet first identify a (...) fundamental economic rationale for supervising the solvency of insurance companies: policyholders are the "bankers" of insurance companies. But because policyholders are too dispersed to effectively monitor insurers, it might be efficient to delegate monitoring to an institution--a prudential authority. Applying recent developments in corporate finance theory and the economic theory of organizations, the authors describe in practical terms how such authorities could be created and given the incentives to behave exactly like bankers behave toward borrowers, as "tough" claimholders. (shrink)

The debate on whether insurance companies should be allowed to use results of individuals’ genetic tests for underwriting purposes has been both lively and increasingly relevant over the past two decades. Yet there appears to be no widely agreed upon resolution regarding appropriate and effective regulation. There exists today a gamut of recommendations and actual practices addressing this phenomenon ranging from laissez-faire to voluntary industry moratoria to strict legal prohibition. One obvious reason for such a variance in views and (...) approaches is that there are competing bases for evaluating the outcomes of restricting insurers’ use of such information. For example, an outright ban on the use of genetic test results may seem the best method for protecting against unfair discrimination, while allowing their use may seem to be the best way to foster efficiency in the market for insurance. However, there is also a lack of understanding about how restricting the use of genetic information would play out in the market through the so-called phenomenon of adverse selection. Using economic analysis, we discuss how the type of adverse selection that occurs in insurance markets affects various arguments both in favour and against an outright ban on insurers’ use of genetic tests for pricing insurance. We review arguments based on moral principles . Practical concerns from the insurance industry based on actuarial principles and economic efficiency are also compared. Each perspective is shown to lead to a range of conflicting recommendations about how genetic information should be regulated and these conclusions depend critically on whether one conducts the analysis from the ex ante temporal perspective , from the interim temporal perspective , or from the ex post temporal perspective. (shrink)

This is a volatile time for health insurance policy. Medicare and Medicaid are in turmoil, as is the private health insurance market. Public and private health insurance costs constitute eighty percent of healthcare spending in the United States. Public health professionals depend on the insurance system to behave in ways that are responsive to public health in prevention and crisis management.Seventy-five percent of the American population, excluding the elderly, has coverage through the private health (...) class='Hi'>insurance system. Ninety percent of this group receives their insurance through employer-sponsored programs, and the remaining ten percent buy their own coverage. Approximately ten percent of the non-elderly population has insurance through a government program, and fifteen percent of the non-elderly population, almost forty-one million Americans, is uninsured. (shrink)

The study is designed to provide an informal summary of what is known about consumer switching of health insurance plans and to contribute to knowledge about what motivates consumers who choose to switch health plans. Do consumers switch plans largely on the basis of critical reflection and assessment of information about the quality, and price? The literature suggests that switching is complicated, not always possible, and often overwhelming to consumers. Price does not always determine choice. Quality is very hard (...) for consumers to understand. Results from a random sample survey ( n = 2791) of the Alkmaar region of the Netherlands are reported here. They suggest that rather than embracing the opportunity to be active critical consumers, individuals are more likely to avoid this role by handing this activity off to a group purchasing organization. There is little evidence that consumers switch plans on the basis of critical reflection and assessment of information about quality and price. The new data reported here confirm the importance of a group purchasing organizations. In a free-market-health insurance system confidence in purchasing groups may be more important for health insurance choice than health informatics. This is not what policy makers expected and might result a less efficient health insurance market system. (shrink)

This paper examines several key aspects of the ethical environment facing the insurance industries of Poland, The Czech Republic and Hungary as they complete the transition from Communist insurance systems built upon state-owned monopolies to viable private domestic insurance markets, and then seek to harmonize their markets with the single insurance market of the European Union. Since many types of ethical problems encountered during the transition are unlikely to diminish significantly as a result of either (...) privatization or regulation of the insurance markets of these countries, measures are identified that should help to improve the ethical environments of these markets. (shrink)

This article examines some of the reasons why banks and insurance companies have been accused of discrimination, and shows that this is by and large a false accusation. Economic analysis demonstrates that racial discrimination is not a profit‐maximizing strategy. Actually, unwise public policies are actually precluding many consumers from the market.

In the insurance literature, it is often argued that private markets can provide insurance against ‘risks’ but not against ‘uncertainties’ in the sense of Knight ([1921]) or Keynes ([1921]). This claim is at odds with the standard economic model of risk exchange which, in assuming that decision-makers are always guided by point-valued subjective probabilities, predicts that all uncertainties can, in theory, be insured. Supporters of the standard model argue that the insuring of highly idiosyncratic risks by Lloyd's of (...) London proves that this is so even in practice. The purpose of this article is to show that Bruno de Finetti, famous as one of the three founding fathers of the subjective approach to probability assumed by the standard model, actually made a theoretical case for uncertainty within the subjectivist approach. We draw on empirical evidence from the practice of underwriters to show how this case may help explain the reluctance of insurers to cover highly uncertain contingencies. (shrink)

Current research on the human genome holds enormous long-term promise for improvements in health care, but it poses an immediate ethical challenge in the area of health insurance, by raising the question of whether insurers should be allowed to take genetic information about customers into account in the setting of premiums. It is widely held that such discrimination is immoral and ought to be illegal, and the prevalence of this view is understandable, given the widespread belief, which I endorse, (...) that every individual in a society as affluent as ours has a basic right to affordable health care. But prohibiting genetic discrimination in health insurance is not an effective way to protect this right. On the contrary, I argue that because of the nature of insurance as a product sold in a competitive market, such a prohibition is misguided, and its worthy aims must, instead, be pursued through reforms in our country’s system of publicly provided health care. (shrink)

I would like to begin by thanking all of the commentators for their insightful analyses of ‘Genetic information, insurance and a pluralistic approach to justice’; I learnt a great deal from them all. Naturally, I cannot do justice to all of their criticisms in this brief response; instead, I shall use their remarks to prompt some clarificatory points about my arguments in the hope that this will help readers to draw their own conclusions about the various points of disagreement. (...) My aim in the paper was modest; I aimed to argue that considerations of justice do not speak unequivocally against the use of Genetic Test Results (GTRs) in insurance, and that a pluralist approach may lend support to some limited uses. This represents a compromise position between outright prohibition, and using GTRs in an insurance market in accordance with purely commercial principles. Notably, this conclusion is compatible with the thought that there may be other very strong moral reasons in favour of prohibition. These include concerns about privacy, as well as the consequentialist and human rights considerations that Tiller and Delatycki rightly highlight.1 Of course, considerations of justice are not orthogonal to questions regarding the right against genetic discrimination, since such a right might plausibly be supported by appeal to broadly egalitarian considerations. Indeed, one important challenge for the rights-based argument for prohibition is to defend the strong degree of genetic exceptionalism it connotes. As I briefly suggested in the paper, broadly egalitarian arguments might be invoked in an attempt to justify at least some degree of genetic exceptionalism here. Notably though, in her commentary, Feiring expresses scepticism about the view of genetic exceptionalism that is implicit in my acceptance of the idea that the use of GTRs in insurance warrants its own specific guidance.2 Given the different …. (shrink)

In most other nations, insurance for medical care is called sickness insurance, and it covers sick people. In the United States, we have “health insurance,” and its major carriers — commercial insurers, large employers, and increasingly government programs — strive to avoid sick people and cover only the healthy. This perverse logic at the heart of the American health insurance system is the key to reform debates.Focusing on sick people versus healthy people might seem a strange (...) way to view the coverage issue. Most discussions of insurance categorize people into other groupings: the insured versus the uninsured; Caucasian whites versus other racial and ethnic groups; men versus women; poor and low-income people versus everybody else; children, adults, and the elderly; or citizens versus immigrants and undocumented aliens. More recently, health researchers have begun talking about “vulnerable populations,” using most of the same demographic groupings and adding other illness-inducing factors such as social isolation, stress, and impoverished neighborhoods. But as I will show, insurance plans now use premiums, cost-sharing, and other design features in ways that indirectly divide each of these groups into the sick and the healthy, to the detriment of the sick. By shifting the costs of illness onto people who use medical care — that is, sick people — market-oriented reforms of the last few decades have eroded insurance in the name of strengthening it. (shrink)

Over the past twenty-five years, thirty-seven states and the US Congress have passed mental health and substance use disorder (MH/SUD) parity laws to secure nondiscriminatory insurance coverage for MH/SUD services in the private health insurance market and through certain public insurance programs. However, in the intervening years, litigation has been brought by numerous parties alleging violations of insurance parity. We examine the critical issues underlying these legal challenges as a framework for understanding the areas in (...) which parity enforcement is lacking, as well as ongoing areas of ambiguity in the interpretation of these laws. We identified all private litigation involving federal and state parity laws and extracted themes from a final sample of thirty-seven lawsuits. The primary substantive topics at issue include the scope of services guaranteed by parity laws, coverage of certain habilitative therapies such as applied behavioral analysis for autism spectrum disorders, credentialing standards for MH/SUD providers, determinations regarding the medical necessity of MH/SUD services, and the application of nonquantitative treatment limitations under the 2008 federal parity law. Ongoing efforts to achieve nondiscriminatory insurance coverage for MH/SUDs should attend to the major issues subject to private legal action as important areas for facilitating and monitoring insurer compliance. (shrink)

The American health care system long has been distinctive in its embrace of market forces. For-profit private insurers play a major role in providing coverage, though they operate alongside public insurance programs that cover over one-third of the population. Historically, federal and state governments’ regulation of insurance markets was limited, leaving insurers to set premiums and coverage rules largely as they saw fit.Government’s role in controlling health care spending has been even more circumscribed. Purchasing power is fragmented, (...) with each insurer negotiating its own rates with physicians and hospitals. A formidable medical-industrial complex of for-profit providers, from hospitals to home-health care agencies, dialysis facilities, pharmaceutical companies and much more, has arisen to sell services. (shrink)

Critical analyses of international financial markets tend to explain changes over recent decades in terms of a resurgent liberalism. This paper employs a systems theoretical approach to argue that there has been a far more fundamental transformation in the operations of these financial markets than simply a shift towards more liberalized regimes of regulation. The use of risk as resource and the systematic randomness of these new operational trends have perverse implications not only for the integrity of political systems but (...) also for the neoliberal promoters and players inside the new complex system of global finance. (shrink)

Using a nationwide survey of randomly selected manufacturing firms in representative Chinese cities, we examine how firms’ compliance with social insurance policies is shaped by their historical imprinting, by their founding ownership structures, as well as by massive institutional changes. Our empirical results suggest that firms founded in the state socialist era and firms founded as Chinese state-owned enterprises (SOEs) were infused with socialist institutional logics of labor relations, and they tended to comply with social insurance policies even (...) in the present market socialist era. Chinese SOEs restructured into private and joint-ventured firms attenuated the lingering effect of organizational imprinting and provide social insurances for fewer workers. This research is among the first to probe the historical influence on labor protection in contemporary society. Through studying the stability and changes of socialist institutional logic of labor relations, our research leads to a better understanding of the situation of labor relations in contemporary China. (shrink)