title: Should people with unhealthy lifestyles pay higher health insurance premiums?
abstract: This commentary sets the article by Dubois on the ethical justification for charging higher insurance premiums for people with unhealthy lifestyles in the context of US health care reform. It reviews the relevance and strength of normative concerns identified by Dubois about the acceptability of such differentiated "means-tested" plans. It identifies key issues involving whether certain health behaviors matter ethically, and if so, the grounds that would justify an obligation for people to take action. The article frames the answer in terms of the need to achieve an ethically acceptable balance between the principle of equality and principle of merit and concludes with four ethical standards to focus the terms of the debate.
authors.affiliation: School of Public Health & Health Sciences, University of Massachusetts, Amherst, MA 01003, USA. Buchanan@schoolph.umass.edu
authors.forename: David R
authors.initials: DR
authors.lastname: Buchanan
mesh_terms: D003363:Cost Control / Q000941:ethics / Q000379:methods; D015438:Health Behavior; D017048:Health Care Costs; D018166:Health Care Reform / Q000191:economics / Q000941:ethics*; D020408:Health Insurance Portability and Accountability Act / Q000592:standards; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000941:ethics*; D011907:Rate Setting and Review / Q000941:ethics / Q000331:legislation & jurisprudence / Q000592:standards; D014481:United States