After an automobile accident, the insurance company will, with help from the police and sometimes courts, make a decision as to fault.
If you are not at fault, your car may be destroyed but your rates will not increase. If, however, you are at fault, then your rates will rise - often very significantly - or your policy may be cancelled. Rates will also increase if you are the recipient of too many citations for speeding or more serious moving violations.
The reason is simple, logical and fair: if you cause accidents or get caught driving like a maniac, it is highly likely that you will cost the insurance company much more money than does the average driver. So it is only reasonable that your rates should rise.
Health insurance companies, however, care not at all about fault and, under pressure from politicians and interest groups, not much about lifestyle choices. They charge modest additional premiums to smokers but barely consider other lifestyle choices - unsafe sex, lack of exercise, alcohol and drug abuse, excessive consumption of sugar, fats, red meat etc. etc. - that are known to cause massive increases in the risk of contracting diseases that are seriously expensive to treat.
If on the other hand, a person was a passenger, wearing a seat belt, in the innocent car, who suffered extensive injuries - including two amputations - he or she will always have a preexisting condition. As an individual purchaser, if coverage is not declined, that person will be charged outrageous premiums. In contrast with the automobile insurance model, fault is assumed where none exists. Individual underwriting is not unreasonable, but it should take fault into account.
So why do medical insurance companies wonder why they are so disliked?
Reform is urgently needed and it is supported by the electorate. The medical establishment, however, with the insurance companies to the fore, appears to be lining up to oppose it.
Follow the money is a good rule of thumb when evaluating the public statements of any interest group likely to be affected by legislation. Since it is the medical establishment - mostly the insurance and major pharmaceutical companies - that is scattering cash in the general direction of the Congress, there is a serious risk that reform, even if it happens, will be so watered down that it will amount to little.