Premium differentiation in the basic health care insurance: an ethical discussion on 'fining' unhealthy lifestyles

Abstract

Summary

An increasing number of people think that people should be held responsible for their own health, for example by means of making unhealthily living people pay a higher health insurance premium. This thesis is written as a plea against the vision behind such an opinion. In this thesis, I distinguish different types of responsibility and explain to what type of responsibility premium differentiation on the basis of lifestyle makes an appeal. I assess whether the conditions for holding people responsible in that way rightfully, are met in case of unhealthy behaviour and reach the conclusion that this will not be the case most of the time. A closer look at premium differentiation reveals that there are more ethical objections to this idea, for instance that it will be morally loaded and will compromise the ideal that all people are given the opportunity to live life according to their own convictions and values, one of the most important ideals our democracy is based on. Furthermore, I assess whether preserving solidarity, doing justice, containing costs and improving people’s health are sound reasons to aim for measures holding people responsible for their own health, such as premium differentiation. The final conclusion is that there are no good reasons to propose premium differentiation, only reasons against it. It is unfair, unfeasible, arbitrary, morally loaded, unjust, ineffective and it can – from a moral point of view – have undesirable effects on the way society treats its sick and needy.