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This is not single payer. It's insurance. As you say...risk spread around. Which means if you bring in more risk, you pay a bit more than someone who does not. That's the way it works. Or the way it used to work. Obamacare was NOT supposed to guarantee coverage for those with high claims at the same rate as someone who has no claims. But that's what they slipped in under the door. That's part of the reason that premiums (for the healthy people) sky rocketed. If you are sick, your premium went DOWN. Even though you will be using the insurance much more than others.
That's not right. It's not fair. And it shifts the costs of unhealthy lifestyles to those who don't use insurance that much, whether because of genetics or a healthy lifestyle. There are so many people who are obese (self-inflicted condition), which means they will get metabolic syndrome, if they don't have it already (diabetes, high blood pressure, stroke risk, etc.). All related to their obesity caused by their lifestyle. I, a healthy person, am footing the bill for their lifestyle, even though I live a healthy lifestyle myself. I walk every day, eat veggies & fruit, rarely eat pizza, etc., etc. Despite coming from a morbidly obese family, and tipping the scales at moderate obesity during puberty, I've escaped and have been a normal weight, healthy person all my adult life. It's not easy. My reward? I'm healthy. And I get to pay a higher premium so I can pay for an obese person's health care. Ironic.
Just try to get sick more often and do riskier things. :shrug: That will make it more fair for you.