As a species, we have always been obsessed with our own health and forestalling our own demise. Medicine is the manifestation of that obsession and for many, medical genetics is the perceived solution to conquering sickness, and even death.

But while genetics may be the great white hope of science and medicine—not to mention big business—our quest for a healthcare utopia is rapidly leading us to a social purgatory, because the moral, legal, ethical, political and economic ramifications of the genetics revolution are only beginning to manifest.

The complex issues surrounding genetics go beyond the obvious impact on healthcare methodology, demanding examination of many factors. But beyond the obvious direct impact on healthcare, genetics will also change the economics of medicine. As developments in the use of genetic technology increasingly impact the practice of medicine, healthcare providers and public and private systems will be challenged to find resources to meet the needs of the population.

As more information from the Human Genome Project is refined and applied to new standards of care, virtually every area of medicine will be affected. New diagnostics and new therapies could potentially be applied to every individual in the population – even to those not yet conceived. Yet to actually provide these services, delivery systems and reimbursement policies will need to change radically. Direct and indirect costs will stretch private and public resources, and the new medicine may well become the key factor instigating a compete revamping of the current managed care system.

The true challenge of the new medical genetics may well be determining how to pay for it. How much money will be needed to provide genetic tests, therapies, education and counseling for every single member of the population?

Patient demand and commercial gain will be the driving forces behind the new medical genetics. In a perfect world, all medical services would be available on demand to all members of the population. But existing and near-future reimbursement protocols do not support widespread provision of genetic services. Last year in the United States, more than one billion dollars was paid by third party and individual consumers to cover existing medical services, including the limited genetic services available. In perhaps 10 years, what will the cost be of new medical services based on the potential genetic testing and treatment of the entire population?

Of course, widespread application of genetics in everyday medicine is still in the future, and current healthcare coverage is based on patient outcomes and relative benefit. Today’s outcomes model supports the extension of life, some preemptive (wellness) care, and general coverage for accepted standards of care, most of which include only the minimum genetics services associated with prenatal and some cancer diagnostics.

To date, relatively few outcomes analyses of the cost of clinical genetics have been developed or published. For most of the more recent genetic tests and treatments, there has not yet been enough time or usage to apply the standard algorithm of research, practice and policy development which are normally used to change standards of care.

Despite this reality, it is unquestioned that genetics will alter all standards of care rapidly. The costs for much of current genetic testing are covered by Federal and State-supported programs. But as additional genetic services become available, and as the population increases and ages, public health budgets will be further stressed by rapidly expanding Medicare and Medicaid populations in need of both short and long term care.

There are no easy answers to any of the logistical or fiscal (not to mention the social, ethical and political) issues surrounding provision of genetic services. But the inescapable reality of advancing medical genetics options requires launching full-scale efforts to resolve as many questions as possible before the potential for genetic medicine is fully realized. Several states have been reviewing the question, with initial plans for educating the public and delivering some genetics services in place in Arizona, Hawaii, Ohio, Texas and Washington. Colorado is in the process of assessing current and projected need and developing programs to educate its population regarding the present and future options in genetics. The final plan will need to provide public health strategies for the education and support of genetics services providers, primary care providers, managed care and consumers in meeting the challenges of providing genetics services in a rapidly changing medical environment. These strategies must be appropriate for the long-term, taking into account a system that will continue to evolve, and the costs and needs of the required support systems that will sustain optimum services for the public.