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actually you can shift basic definitions and you do it through a political process that changes the nature of the game of health insurance itself. in a better, more comprehensive bill, one that actually operated on the assumption that access to basic health care is a fundamental human right---maybe narrowed into a citizenship right (this is america after all & after 30 years of reactionary politics about the undocumented, maybe they're understood as less-than-human...but across the figleaf of not being citizens)--then the game would change. access would be guaranteed because a political decision had been made that this end was socially desirable.
like any game, insurance operates within rules that the industry itself did not make in their entirety.
as to the rather bland insistence that folk who "don't take care of themselves" should pay higher premiums---the fact is that there is a rather brutal and stark class system in the united states & that "taking care oneself" can and typically does end up being a projection based on a relatively narrow class position onto others who do not occupy that kind of class position. the notion is not neutral, in other words. that one can transpose it into cash money doesn't make the category any less problematic to the extent that it is a class-specific category.
one of the central points of health care reform, such as it is, is to reduce the consequences of this kind of class biais--something which once mapped out into the world institutionally becomes a mechanism of class warfare.
btw i disagree entirely with the op. i think it operates in an inverted world.
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a gramophone its corrugated trumpet silver handle
spinning dog. such faithfulness it hear
it make you sick.
-kamau brathwaite
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