There is the other unstable equilibrium if insurance is fully fair but non compulsory - it’s participation bias. What’s the benefit of getting insurance now when I can get it right before I go to the doctor (health) or on my deathbed (life)? Obviously at that point there’s no insurance - risk dilution - it’s a subsidy.

Which makes the only way to have fair insurance is to require everyone to have it and enforce very simple underwriting criteria. It will also require most folks to pay more than they could otherwise. Unfortunately the US has historically been bad at attempting to pass a law with that kind of effect, though the ACA got closer than most attempts before the recent changes.

In practice, monthly insurance premiums are around 110-130eur per month with a minimum deductible of 385eur. GP visits don't cost anything additional and only specialist care eats into the deductible.

Now, if you are talking about requiring everyone to use the same insurance for the same price (maybe a government insurance) then I would want to ban drinking and smoking. Because now their actions directly impact my by rasing my insurance cost.

You will not receive exactly what you pay. Some people will receive much more, and their payouts are subsidized by the others who receive much less. That is the nature of insurance.

What's the difference between your question and "How would you like it if you had to pay just as much flood insurance as someone down the street whose house actually gets flooded next year?" The only difference is that you can't reliably predict things with that level of accuracy.

Insurance companies and low-risk insurance buyers are both incentivized to predict individual risk profiles as accurately as possible, but this gradually drives the system towards uselessness.

Currently I want the insurance company to know what my expected value is properly so that I can get a rate that is appropriate for my needs. Of course I would prefer that they make a mistake and assume that my expected value is lower than reality, but if they make to many mistakes like that then either they will go out of business or raise their premiums.

Call me naive, but I also always thought that's kind of the point of it: spreading the risk, or solidarity to use a less fashionable term. People can be very sick through no fault of their own, and those who are healthier should look out for them. If you calculate that "fair share" according to exactly how sick people are, then what's the point, wouldn't that just be a needless middleman that gets paid upfront?

Cautious Prius owners probably wouldn’t be happy sharing equally in a risk pool with enthusiastic drivers of sports coupes. If insurance rates were standardized, there’d be a lot more sports cars out there, until the Prius constituency got them banned altogether. Charging different insurance rates gives all parties what they want at a cost that creates appropriate incentives.

You might be able to say something similar about health insurance and sedentary smokers vs. runners. If an extra hour of work is less economically valuable than a gym visit, the incentive structure should reflect that.

I agree that insurance rates should not be affected by luck. One of the reasons the preexisting condition part of the ACA is important.

If someone gets sick and thus becomes sedentary due to their illness now you’d be effectively discriminating against them due to their preexisting illness because they can’t go be a marathon runner.

So we better create a rule that somehow excludes ill people from being discrimated against like this. Oh and then we’ll force the sick person to go through a hellish process to prove it too. Etc.

Wrt health insurance we should just get off that train. It only leads to a worse and worse place.

2. Being healthy already has quality of life consequences. And the extra cost to insure those lifestyle choices are probably pretty low, and most of that cost is just shifting it from primary insurance to medicare. Because everyone dies of something, and a lot of times it's really expensive. Insurers care a lot about whether that happens at 64 or 66. But as a society it doesn't really matter, and the insured bears most of the impact.

I'm one of those people who gain weight easily due to always wanting to eat. I was morbidly obese at 19 despite coming from a household of healthy eating. I'm now 33 and have maintained a healthy weight for years but it isn't fun. For me to maintain a constant, healthy weight I need to be hungry. Despite 5+ years of maintenance, I am still hungry constantly.

Is insurance that large a cost factor? I would imagine the increased cost of the car and fuel costs would still be strong incentives against upgrading to sports cars.

You could say there's a spectrum, between stuff like healthcare and genetic diseases, and someone insuring their pinky finger not because they need it, but because they're vain and think it's an astonishingly pretty finger, and they're just that rich. But somewhere on that spectrum, there are also families that lose bread winners, and I don't see why solidarity wouldn't also apply there.

I bust my hump in the gym a few days every week because I want to age well - I make an effort to eat healthy food and now I gotta pay for an cookie addict who would rather slurp down medication than make lifestyle changes? Screw that.

I made my choices, I can live with them. Others make their choices, they get to live with their choices. If they get to take good stuff from me to support their bad choices, I expect some reciprocation.

That cookie addict will be paying for your medicare and social security for 30 years, while you pay for their medicare and social security for 5.

Everyone dies, and healthy people live a long time, and can die very die slowly and expensively. He'll pay for your full time assisted living while you die from Alzheimer's at 95, you'll pay for some critical care after his heart attack at 65.

Why can't we just pay for our own if we have the means and give those without means basic, cost-effective care for things that can't be solved with lifestyle changes?

And why do I have to be forced into this? Why can't I just chose my relations and affiliations for myself? Besides, bold of you to assume that social security will be there for me when I'm able to retire. That money is gone, I'm not going to see a dime of it - it's just an extra 15% tax on my first 110k.

This is called the Iron Triangle of healthcare.

Furthermore, you can have public insurance that charges co-pays, high-deductibles etc. Public Healthcare does not guarantee 'free healthcare', and if it did it would do so at cost of access (rationing) or quality (cost-effective care).

You can do that today with an HMO or a High-deductible plan if you wish.

There are many issues with healthcare in the us, but this is not a solution for them.

That Iron Triangle assumes that you have an efficient system. If you have a wasteful system (say, you pay twice as much per person as other places do without any advantage in quality or access) then you can reduce costs without hurting other things.

There are some benefits in government administration, but "efficiency" is not one of them.

Taken to its conclusion we should all be in risk pools of 1.