The amount of privilege in asking this question is just shocking. As if people can so easily choose where they live. Try telling miners and nomadic construction workers that.
Might as well abolish it and let everyone pay for their medical bills on their own. Which would be actually more fair than paying a "unhealthy food premium" - since you're only paying for actually getting sick, not for the prediction of whatever model the insurance company is using to predict your sickness.
I fear and loathe the future in which statistical models (of sickness, crime, etc.) determine the course of my life. I'd much rather be held responsible for my own actions and accept whatever randomness of the universe throws at me, than be a puppet of some huge statistical model created to maximize megacorporations' profits.
If all your neighbors play extreme sports or drive drunk all the time, would you like to pay the same premium as they do in the same insurance pool?
It’s an established practice for insurance companies to use statistics to charge a higher premium for some groups, eg young male drivers, even if many in such a group have a safe lifestyle. If they use a finer grained model, then it’s more fair to people who make a safer life choice.
The profits are largely orthogonal to whether they use a coarse or fine grained statistical model, but more about the level of competition in a given market. Over time, companies using a fairer model might win over the competition, all else being equal.
Yes, because choosing otherwise opens the door to discrimination based on many factors, many of which can be completely out of our control.
What if you're working a job with a non-insignificant risk of danger - should your premiums be higher? After all, you chose to work in that profession and to put the last 20 years of your life specializing in it. You should've just chosen differently...
What if you're living in a neighborhood with a high crime rate - should your premiums be higher? After all, you chose to inherit the house and live there and put the last 20 years of your life building a home and a social network there. You should've just chosen differently...
What if you're shortsighted which makes you more of a danger in traffic - should your premiums be higher? Maybe you didn't choose to be shortsighted, but you could change it with a laser surgery or whatever, and afterall, we're just following the model...
What if you're black - should your premiums be higher? Maybe you didn't choose to be black, but statistics shot that black people are significantly more at risk of being victims of violent crime. And after all, we're not being racist, we're just follow the model...
Et cetera.
If you allow insurance companies to discriminate, eventually, everyone who isn't following the "safe path" will be discriminated against. At that point, the insurance stops being merely an amortization of unpredictable cost, and becomes a tool to control the population.
Also, since it will all be managed by the same insurance vendor, then they can negotiate better prices in the market and make the system more efficient. Of course this will have to be highly regulated in order to make it fair. We could ensure this by having the major policies be managed by officials who are accountable to the public via a voucher system -- if the official makes bad decisions they get a 'no confidence voucher' and someone else who wants the job will get a shot at it.
This system would be far from perfect, but it would probably be better than paying corporations to run it when they are incentivized to provide only enough service to meet market and legal requirements and pocket the rest -- while showing shareholders consistent profit increases, which can't be tenable.
Yes, someone living in a high risk of car break-ins should pay more for auto insurance.
Yes, someone living in a low-lying area next to the beach in a place known for hurricanes should pay more for flood insurance than someone living in Colorado.
What we shouldn't do is charge people more for being of a certain race or gender.
I have no problem with people getting a discount on health insurance if they wear a continuous blood monitor and show that they only eat metabolically healthy foods that don't spike their insulin and glucose levels.
I have no problem with people getting a discount on health insurance if they wear a fitness tracker and show that they get their 30 minutes a day of exercise.
> Yes, someone living in a high risk of car break-ins should pay more for auto insurance.
> Yes, someone living in a low-lying area next to the beach in a place known for hurricanes should pay more for flood insurance than someone living in Colorado.
> What we shouldn't do is charge people more for being of a certain race or gender.
That's a very convenient way to contrast, but where do we draw the line?
For example, should people with genetic diseases pay more? If yes, then how is that different from discriminating race or gender (which are also part of genetics and may affect the risks)? And if not - then why not? Is the reasoning consistent with all the other scenarios you've listed?
Regardless, even if we did agree on a line in the sand, then insurance itself becomes just a class-based amortizer. Rich, fit, genetically lucky people in good neighbors collectively pay less, while the poor, unfit, genetically unlucky people in bad neighbors collectively pay more. Then you might as well not have insurance at all.
There was a time when being fit required having more money, but that is increasingly not the case. You don't need to shop at Whole Foods to eat well anymore (Aldi and Trader Joes and Grocery Outlet all carry healthy foods these days).
So being born in a particular place, having your history, your inheritance and most of your social connections in it, it's all just an arbitrary choice?
> occupation
Again, having an option to work in a certain career that brings you enough money to live and feed off your family, that's just an arbitrary choice, too?
What about STDs? They may make you more prone to illnesses. You may say "well, the person has voluntarily chosen to have unprotected sex", but then what about rape victims? Should insurance companies be informed of such private details of people's lives in order to weight out whether the condition is "chosen" or not? And who the hell decides what's "chosen" and what's not?
All I'm trying to say, it's not black and white. You can't just decide to count the "things you choose" and discard "things you don't choose" as most things don't fall cleanly in those two categories, location and occupation being just one of many examples of the gray area in that continuum. And once you go down the path of price discrimination based on anything, you're on a slippery slope towards thought police.
i'm scared of people that think like this. this all digital transactions enables such people to mandate these ideas - the road to hell with their good intentions.
* The person has a choice whether to consume fast food regularly. It’s their freedom, yes, but they should also accept the costs that come with their lifestyle choices. Similarly, if someone chooses to regularly drive at a daredevil speed, they should pay a higher premium.
* This is different than discrimination based on involuntary characteristics. If someone is born with genetic predisposition to get cancer, or happens to grow up in a city with high carcinogen level, it’s arguably a lot less fair to charge them extras.