"Frameshift" - читать интересную книгу автора (Sawyer Robert J.)

Chapter 9

Pierre’s lab looked like just about every other lab he’d ever seen: a poster of the periodic table on one wall; a well-used copy of the Rubber Bible lying open on a desk; lots of glass labware set up on retort stands; a small centrifuge; a UNIX workstation with Post-it notes stuck to the bezel around the monitor; an emergency shower station, in case of chemical spills; a glass-enclosed work area under a fume hood. The walls were that sickly yellow-beige that seems so common in university environments. The lighting was fluorescent; the floor, tiled.

Pierre was working at one of the counters that lined all four walls of the room, staring at DNA autorads positioned over an illuminated panel built into the countertop. He was wearing a stained white lab coat, but it wasn’t buttoned up, so his Quebec Winter Carnival T-shirt was visible underneath. He’d never been more shocked than when an American student had mistaken the Bonhomme on the shirt for the giant Stay-Puft marshmallow man from Ghostbusters — something akin to confusing Uncle Sam with Colonel Sanders.

Burian Klimus appeared in the doorway, looking most put out.

Standing next to the old man was an attractive Asian-American woman with black hair that had been teased into a frizzy halo around her face.

“That’s him,” said Klimus.

“Mr. Tardivel,” said the woman. “I’m Tiffany Feng, from Condor Health Insurance.”

Pierre nodded at Klimus. “Thanks for bringing her up, sir,” he said. The ancient geneticist scowled, then shambled away.

Tiffany was in her late twenties. She was carrying a black attache case, and was dressed in a blue jacket and matching pants. Her white blouse was open more than one might expect at the top. Pierre was amused; he suspected Tiffany dressed differently when going to see a prospective male customer than she did when the customer was female.

“I’m sorry I’m late,” said Tiffany. “Traffic was murder coming across the bridge.” She handed him a yellow-and-black business card, then looked appreciatively around the lab. “You’re obviously a scientist.”

Pierre nodded. “I’m a molecular biologist, working on the Human Genome Project.”

“Really?” said Tiffany. “What a fascinating area!”

“You know about it?”

“Sure. We’ve had some great lectures on it at work.” She smiled.

“Anyway, I understand you’re interested in talking about insurance options.”

Pierre motioned for Tiffany to take a seat. “That’s right,” he said. “I’m from Canada, so I’ve never bought health insurance before. For a little while longer I’ll still meet the Quebec residency test, but—”

Tiffany shook her head. “I’ve helped several Canadians over the years.

Your provincial health plans cover you only to the dollar value that the same services would cost in Canada, where prices for medical services are set by the government. Here, there are no price controls. You’ll find that most procedures are more expensive, and your Quebec plan won’t cover the extra. Plus, the provincial plans provide for medical treatments, but not such things as private hospital rooms.” She paused. “Do you have any insurance under the faculty-association plan?”

Pierre shook his head. “I’m not faculty. I’m just a visiting researcher.”

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.”

“Politely, Mr. Tardivel, that’s a matter of interpretation. The new California law is the first of its kind in the nation; in every other state, having bad genes does amount to a preexisting condition, even if you’re asymptomatic. Even those few states that do have anti-genetic-discrimination laws — Florida, Ohio, Iowa, a couple of others — even they make exceptions for insurance companies, allowing them to use actuarial or claims experience in deciding whom to insure and what premiums to charge.”

Pierre frowned. “But what you’re saying is, because we’re in California, if I wait until January first, you won’t be able to reject me on the basis of my family history?”

“No, we’ll still be able to do that — that’s valid information that you’re a high-risk candidate, and we’re not obligated to give policies to high-risk people.”

“Then what’s the difference?”

“The difference is that genetic information supersedes family-history information. Do you see? If we have concrete genetic info, it takes precedence over anything we might infer from the medical histories of your parents or siblings. If you take the genetic test, then, under the new state law, we have to give you a policy regardless of its results related to Huntington’s disease. Even if the test proves that you do have the Huntington’s gene, we still have to insure you as long as you apply before you have any symptoms; we can’t reject you or charge you a higher premium based on actual genetic information.”

“Wait a minute — that’s crazy. If I don’t take the test, you’ve got a fifty-fifty shot that I’ll end up making a lot of claims due to my Huntington’s, and so you reject me because of my family history. But if I do take the test, and even if it’s a hundred percent definite that I will get Huntington’s and therefore make a lot of claims, you will insure me?”

“That’s right, or at least it will be, after January first, because of the new law.”

“But I don’t want to take the Huntington’s test.”

“Really? I’d have thought you’d like to know.”

“No. No, I don’t. Hardly any Huntington’s at-risks have taken the test.

Most of us don’t want to know for sure.”

Tiffany shrugged a little. “Well, if you want to be insured, it’s your only option. Look, why don’t you fill out the forms today, but date them January — well, January second: the first business day in the new year. I’ll call you up then, and you can let me know what you want to do. If you’ve already taken the test by that point, or are prepared to take it, I’ll put the policy application in; if not, I’ll just tear it up.”

It was obvious that Tiffany simply didn’t want to risk losing a sale, but, dammit, this had already taken far too much time; Pierre certainly didn’t want to go through the same rigmarole again with somebody else. “I’d like to see some other plans before I make my decision,” he said.

“Of course.” She showed Pierre a variety of policies: the predictable Silver and Bronze Plans, with progressively fewer benefits; a hospital-only plan; a drug-only plan; and so on. But Tiffany pressed hard for the Gold Plan, and Pierre finally agreed, telling himself he would have made exactly the same decision even if her blouse had been done up all the way.

“You won’t regret your choice,” said Tiffany. “You’re not just buying health insurance — you’re buying peace of mind.” She got a form from her briefcase and handed it to Pierre. “If you could just fill this out — and don’t forget to date it January second.” She opened the left side of her jacket.

There was a pocket inside the jacket, with a row of identical retractable ballpoint pens clipped to it. She extracted one, closed her jacket, and handed the pen to Pierre.

He pressed down on the pen’s button with his thumb, extending the point, and filled out the forms. When he was done, he handed the form back to her, and absently went to put the pen in his own breast pocket.

Tiffany pointed at it. “My pen… ?” she said.

Pierre smiled sheepishly and handed it back to her. “Sorry.”

“So, I’ll call you at the beginning of the year,” she said. “But be careful between now and then — we wouldn’t want anything to happen to you before you’re insured.”

“I still don’t know if I’m going to take the test,” he said.

She nodded. “It’s up to you.”

Pierre thought, It hardly seems that way, but decided not to argue the point further.