The original post is a great premise and I agree with a lot of it in theory, but how the heck do you enforce it, like others have said where do you draw the line. Fat, smoke, drugs, alcohol, tanning beds, risky behavior (sports, hobbies) the list goes on. I have two neighbors that are at least 50 to 100 lbs overweight, neither are on any meds and hardly have to go to the doctor, yet I know 5 people in the neighborhood that have had lots of expensive surgery done because of risky sports, and others that are always getting some type of test because they think they have a problem. Heck, Ian had expensive surgery because he fell watersking, if he had not water skied that day our insurance company would have saved thousands. I also know several people that are normal weight, yet their blood pressure, cholesterol, and triglycerides are very high. They continue to eat bacon, ice cream, all sorts of fatty food and drink a bunch of Pepsi's each day all while taking prescriptons to control the problem. Since they are lucky and manage to stay at normal weight they get a pass while fat people would have to pay extra. Also while there are plenty of legit stories of why working people can't pay for health care there are many that opt out and spend their money on other things while some scrimp and give up things to pay for their families health insurance. I know both types and some of those without health insurance actually make more money. A lot of the ones that opt out of paying for their own insurance work in cash jobs like home improvement contractors, cleaning people, lawn care etc so. It's usually a double whammy because they usually make more than what if any is reported to the IRs. This is such a big problem that I would not know where to begin to make it fair.