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.