Obviously it would be very difficult to get the public to accept health insurance premiums using age or gender as a rating variable, but why not lifestyle choices such as smoking or obesity? It's not right that someone who smokes and who is 100 pounds overweight pays the same premium that I do.
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I'll take this more from a group plan perspective. They CAN actually charge more for certain lifestyle choices, such as smoking. Some companies have actually fired employees who didn't quit smoking, as this is something employers may discriminate by when considering employment. My company charges an extra $25/mo if you or your spouse is a smoker. It is harder to vary rates by overweight or fitness level (even if it is for the fat, lazy slob who eats 3 big macs for lunch every day). Because of ERISA (which governs group benefit plans), companies can not discriminate on the basis of pre-existing conditions. Someone may have a hereditary condition or medical condition that makes them overweight or unable to exercise as much (hypothyroid or a bad heart). Because of this, it's extremely difficult to come up with criteria to separate out the people who just don't take care of themselves from the ones who may have some medical reason. If it makes you feel any better, they will die sooner, meaning that their pension and retiree medical benefits are likely worth less (if the company still has these).
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