So strong is the American aversion to "socialized medicine" that neither major candidate in this year´s presidential election has dared question the fundamental role of the private sector in underwriting the U.S. health care system. Indeed, most health care reform proposals on the table involve attempts to make private health care insurance more widely available through the use of various subsidies and other incentives. Yet the collision of two well-established trends in medicine and law may soon make the private sector´s role in spreading the risk of health care costs unworkable, and government provision of universal health care coverage increasingly difficult to avoid.

The first of these trends is the rapid advancement of genetic testing and other means of determining proclivity to disease. Ten years ago there were fewer than a dozen genetic tests available, mostly for relatively rare inherited disorders such as retinoblastoma, a cancer of the eye, and cystic fibrosis. Today, tests have come on line for approximately 400 genetic disorders, including common diseases such as Alzheimer´s and cancer, and many more are in the offing. For example, one supplier of genetic tests, Myriad Genetics, a biotech company in Utah, markets a test for a gene that governs which drug is most likely to help a patient with high blood pressure. Within a year, the company hopes to launch tests for genes that contribute to melanoma, an inherited form of colon cancer, and perhaps 20 percent of heart attacks. Within three years, the company hopes to offer tests that predict the risk of asthma, insulin-dependent diabetes, obesity, and osteoporosis. ed medicine.

To continue reading, please click Download PDF, above.