Reply #54: That's not entirely fair.

[Telly Savalas]

The guy is just saying that he doesn't like the idea of subsidizing unnecessary medical costs incurred by the bad lifestyle choices of others. The attitude expressed is "live and let live, but don't make me pay for your let living by footing me for the bill when your medical expenses are three times what they should be because you choose to smoke two packs a day, center your diet around high fructose corn syrup, and never exercise." To a certain degree, I sympathize with this attitude.

Nevertheless I still support single-payer universal health insurance. Despite the moral hazard, lower risk individuals still get more bang for their buck on several fronts:

1. Single-payer has drastically lower administrative costs, so the fact that you're subsidizing Homer Simpson is at least partially offset by the fact that a much higher percentage of the premium goes towards actual medical treatment versus useless paperwork and red tape.

2. You've covered your ass if you move into a worse risk class. That is, even people who make good health choices can still be struck with catastrophic medical problems. Once this happens, it can be a struggle to keep the low premiums that one once had. With single-payer this isn't an issue.

3. You're protected in the face of an unforseen financial crisis. In particular, if somebody gets restructured out of a job then under the current system they either lose their employer provided health insurance or can't afford the premiums if they're on an individual plan.

Not to mention a few other things:

Medically underwritten individual insurance and small group insurance is more expensive than large group insurance which can only be provided by a large employer. This stifles small business in as much as they can't provide as generous health benefits as a larger corporation.

Moreover, not all risk factors are consequences of lifestyle choices. For example, if you have asthma, you're going to pay more for medically underwritten health insurance even though it's in no way your fault that you have asthma.

On edit: And one more point. For folks that pay into large group insurance through their employer, the moral hazard the poster above is complaining about already exists.