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Comment by sib | Hacker News Reader

>> The whole point of insurance is to manage risk by spreading it across all consumers.

Yes, but this does not imply that customers with (potentially vastly) different risk profiles should pay the same rates.

The canonical example is that 18-year-old single males with previous speeding tickets pay more for auto insurance than married 40-year-old women with clean driving records.

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So does that mean the minute you have a cancer diagnosis, the insurance company gets to charge you $20k/month or drop you?

If the same argument is to be followed why does a person with potentially large medical bills not pay a disproportionately larger premiums than a healthy person?

In general, health insurance is not insurance but (frequently subsidized) prepaid medical coverage, exactly because it is not underwritten with respect to risk.

It's clearly the case that people who are overweight, smoke, or consume alcohol heavily should pay more for health insurance based on massively increased risk of loss.

Fortunately, other forms of insurance (e.g., homeowners, automobile) are not regulated in this uneconomical fashion.

As a practical matter medical underwriting didn't make decisions based on lifestyle, the decisions were made by way of broadly excluding pre-existing conditions. An an example, pre ACA my insurer (whimsically named "Golden Rule Insurance Co") made everything cardiovascular-related excluded from coverage due to very mild hypercholesterolemia.

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