In a true free-market insurance system, you are charged based on your risks of the insurance company paying out. If your home doesn’t have fire extinguishers or fire alarms, be prepared to pay more for fire insurance.

For health insurance, it would follow that if you are overweight and thus more likely to get diabetes and other such illnesses, you should pay more. However, by and large this isn’t the case. Most people are covered by group insurance where you can’t charge different amounts based on health-based criteria. Individual insurance applications do ask for height and weight info, but as I understand it, in a lot of states activists for the obese have made it such that you can’t charge more.

The ultimate problem with the US healthcare system is that you get all of the drawbacks of private insurance with few if any of the benefits of the free market.