Genetic Technologies and the
Challenge to Equality
As it stands now, many future genetic technologies will be accessible only to those people who have insurance coverage or who can afford to purchase such technologies with private funds. This will deny access to persons who lack health insurance—currently estimated to be around forty million individuals—unless they have sufficient personal wealth. Even those persons who possessed health insurance might be unable to obtain access to expensive genetic technologies that were not part of the insurers' benefits packages, either because the technologies were experimental or because they were too costly. One particular set of genetic technologies—genetic enhancements—are likely to be excluded entirely from coverage and will only be available to those persons who can purchase them with private funds.
Some people, particularly some economists, will defend this method of allocating genetic services. Allocating resources on the basis of willingness to pay is consistent with the belief that, all other things being equal, the best way to identify and measure the strength of an individual's demand for goods and services is to rely on the individual's own choices. This enables the market to price goods and services efficiently and to avoid wasting production capacity by producing goods and services for which people are not willing to pay. Allocating resources on the basis of a person's willingness to pay arguably also maximizes the individual's decision-making autonomy. No one else— not the government or a private insurance plan—is in a position to interfere with the individual's wants.
These attractions account for the popularity of proposals to replace government health insurance programs with medical savings accounts. These would allow people to put earnings in interest-bearing accounts without paying taxes on them and to withdraw funds to purchase desired medical care. Money in the account that was not spent could be used for other purposes or become part of a person's estate upon death.