Frameshift

She moved her attache case up onto the lab bench and opened it. “Well, then you’ll need a comprehensive package. We offer what we call our Gold Plan, which provides for one hundred percent of all your emergency hospital bills, including ambulance transfers, and anything else you might need, such as wheelchairs or crutches. Plus, it also covers all your routine medical needs, such as annual physical checkups, prescriptions, and so on.” She handed him a gold-embossed trifold brochure.

Pierre took it and browsed through it. Huntington’s patients usually ended their lives with a protracted hospital stay. If it turned out he had the disease, he’d certainly want a private room for that, and — ah, good.

This package also covered at-home nursing services and even experimental drug treatments. “Looks good,” said Pierre. “How much are the premiums?”

“They’re on a sliding scale.” She pulled a yellow-and-black binder out of her attache case. “May I ask how old you are?”

“Thirty-two.”

“Do you smoke?”

“No.”

“And you don’t currently have any medical condition, like diabetes, AIDS, or a heart murmur?”

“Right.”

“Are your parents still alive?”

“My mother is.”

“What did your father die of?”

“Umm, you mean my biological father, right?”

Tiffany blinked. “Yes.”

Henry Spade had passed away four years ago; Pierre had gone to Toronto for the funeral. “Complications from Huntington’s disease.”

Tiffany closed the binder. “Oh.” She looked at Pierre for a moment.

“That makes things rather complex. Do you have Huntington’s?”

“I have no idea.”

“You have no symptoms?”

“None.”

“Huntington’s is carried on a dominant gene, right? So you’ve got a fifty-fifty chance of having inherited the gene.”

“That’s right.”

“But you haven’t taken the genetic test for it?”

“No.”

She sighed. “This is very awkward, Pierre. I don’t make the decisions about who gets covered and who doesn’t, but I can tell you what’s going to happen if we put your application in now: you’ll be rejected on the basis of family history.”

“Really? I guess I should have kept my mouth shut.”

“That wouldn’t have done you any good in the long run; if you ever submitted a claim related to your Huntington’s, we’d investigate. If we found that you’d been aware of your family history at the time you applied for insurance, we would disallow the claim. No, you did the right thing telling me, but…”

“But what?”

“Well, as I said, this is awkward.” She opened the binder again, going to one of the tabbed sections at the back. “I don’t usually show this chart to clients, but… well, it explains it pretty clearly. As you can see, we have three basic levels of premiums in each age/sex group. Internally, we refer to them as the H, M, and L levels — for high, medium, and low. If you had a family history that showed a predisposition to, oh, say, to having a heart attack in your forties, something like that, we’d still issue you a policy, but at the H premium level — the highest level. If, on the other hand, you had a favorable family history, we’d offer you the M level. Now, M is still pretty high—”

“I’ll say!” said Pierre, looking at the figure in the column labeled “Males, 30 to 34.”

“Right, it is. But that’s because we’re not allowed to require genetic testing of applicants. Because of that, we have to assume that you might indeed have a serious genetic disorder. Now, what I’m supposed to do after showing you that premium level is say, ‘Well, you know, I can’t ask you to have a genetic test, but if you choose to, and the results are favorable, then I’d be able to offer you this premium here’ — the L premium.”

“That’s only half as much as the M premium.”

“Exactly. It’s an incentive to have the test, see? We don’t make you take a genetic test, but if you decide to do so voluntarily, you can save a lot of money.”

“That hardly seems fair.”

Tiffany shrugged. “Lots of insurance companies do it this way now.”

“But you’re saying I can’t get any health insurance because of my family history?”

“Right. Huntington’s is just too costly, and your risk level, at fifty percent, is too high, to consider covering you at all. But if you take a test that proves you don’t have the gene—”

“But I don’t want to take the test.”

“Well, this gets even more complicated.” She sighed, trying to think of how best to explain it. “Last month, Governor Wilson signed a Senate bill into law. It comes into effect on January first — ten weeks from now. The new law says California health insurers will no longer be able to use genetic testing to discriminate against people who carry the gene for a disease but have no symptoms of it. In other words, we will no longer be able to consider merely having the gene for Huntington’s or ALS or any other late-onset illnesses to be a preexisting condition in otherwise healthy people.”

“Well, it isn’t a preexisting condition.”