Private Parties, Public Duties?

Abstract

What is the nature of insurance and how should it be distributed? Do private insurers have public duties in this respect, and if so: to what extent? This paper addresses these questions in the context of the debate on the use of genetic information by insurance companies in countries with a universal health care system. I will develop an argument based on Michael Walzer’s theory of justice. The attention to the cultural determinants of justice in his approach are particularly relevant in light of what I qualify as the “shifting role of insurance companies in the genetic era.” It should become clear that I do not argue that the role of insurance is necessarily changing as a result of the developments in genetics. Rather, genetic developments have to be placed in the context of systematic reductions in health care and welfare budgets in many states which claim to have a generous system in that respect. The increasing private involvement in health care and, in general, the essential role that several forms of insurance start to play as essential means to provide protection against misfortune, might offer sufficient grounds to argue that insurance companies are now playing a different role in society. Developments in genetic testing simply add another dimension to this societal change. I will argue that genetic developments could enable an increased individual differentiation on the basis of risk-status. As a result, issues of equitable access to health care and social services will be highlighted.