Peter Huber’s Cherry Garcia and the End of Socialized Medicine in the Fall issue of City Journal is a must read. He makes the case that the war on germs has been largely won and pharmacology has moved on to the problem of tuning human chemistry—fighting what Huber calls “glut and gene” diseases. That transformation, he says, will expose more than ever before differences in individual risk and undermine health insurance as we know it.
… what will insurers do with the pill that leaves the kick in a pack of Marlboros but magically neutralizes the poison? Will
Aetnaand the surgeon general both celebrate this miracle drug, congratulate Pfizer for racking up $40 billion in new sales in just one year, gracefully accept their respective shares of the bill, and watch calmly as smoking rates ramp back up? Will Congress declare that every smoker needs this drug, every smoker must get it, and Pfizer’s price gouging must end at once? Or will some heartless bookkeeper in Hartford or Washington dare to suggest that enough is enough, smoking is foolish, and the smoker can jolly well pay for the pill himself—or, failing that, for his own cancer, emphysema, and heart disease?
Lipitor for the Marlboro Man will take a while, but molecular medicine already raises questions like these every day, and they will keep piling up until they can no longer be concealed in the fine print of insurance policies or federal regulations. Common as they still are, insurance systems that pool health risks indiscriminately are vestiges of the past. They can’t survive what lies ahead.