The public's general indifference to one of science's landmark achievements has persisted even as the science and technology involved have yielded some remarkable discoveries. Of course, people can perhaps be forgiven for not wanting to recognize that they don't have many more genes than round worms or fruit flies. In this dawning era of genomic medicine, the concept of private health insurance, which is based on actuarially pooling risk within specified, fragmented groups, will become obsolete. I thought this was very timely given our dinner conversation on Friday. While I don't think a single payer system is worthwhile (or will happen) in the US, I do believe that the author flirts heavily with what *is* a likely outcome: a realignment of stakeholders. Consider that the NHIN/HIT initiatives in the US when at critical mass will allow a degree of transparency and incentive that has neverbefore been possible. It's not totally necessary to move the physician and the patient into a direct customer/provider fiduciary exchange if you can clearly see where the money is going and how service is provided by those dollars. I think that the system today is very broken and that the first inclination is to throw it out and start over with a very different architecture. But that's obviously next to impossible in today's world. What is very likely is that the system will reconfigure itself and become optimized in a way that has not been possible previously. Transparency and appropriately motivated incentives will make the system optimized. That will eliminate a lot of the concern over genomics being used to deny and game the pool. Everyone will be able to procure healthcare just as everyone is able to procure other basic necessities. It'll just be that the richer you are, the better product you'll have access to. Decoding Health Insurance | 
