THE LONG VIEW - HOW GENETIC DISCOVERIES WILL AID HEALTH-CARE REFORM

The lack of universal access to healthcare in the United States has be en a major concern to the population, healthcare professionals, and bi omedical ethicists as well as to many in the local, state, and nationa l governments. The United States is the only high-income country that does not have a ''safety net'' for healthcare for all. The figure gene rally quoted for the uninsured in the U.S. is 41 million persons. In c ontrast to this lack of access to care for almost a fifth of the U.S, population, the finest tertiary care that is possible is accessible to those who can afford it. The United States leads the world in its hea lth research, research advances, and the high quality of medical care available to those with means or insurance to pay for it. Among the ex traordinary advances in health research have been the accomplishments of the human genome program. It is anticipated that this program shoul d have the characterization of the hundred thousand human genes comple ted within a decade or two. With this extraordinary feat accomplished, there is hope that gene therapy will provide treatments for the numer ous chronic diseases that are responsible for the statistically signif icant share of morbidity and mortality as well as for the rave genetic disesases. John C. Fletcher, Ph.D., is one of the first biomedical et hicists to address the ethical issues related to genetic disorders, pr enatal diagnosis, and the potential for gene therapy. Dr. Fletcher nev er hesitates to confront thorny issues and is forthright in his apprai sal and recommendations. In this article, he is outspoken in stating t he dilemma of increasing costs of a technology such as genetic diagnos is and therapy in contrast to limited funding for health care for all the citizenry. The availability and application of the advances of the technical accomplishments of genetic diagnosis and therapy promise to be extremely costly. These costs are a paradigm of the costs of speci alized treatments and high technologies available to those Americans w ho can afford them while those who do not have adequate funds suffer w ithout adequate primary and preventive care.