Perhaps it is time for a primer on 'insurance'.
The sole purpose of insurance is to spread financial risk across a pool of participants. At one extreme, you would treat everyone the exact same regardless of their choices. At the other extreme you create very fine grained risk buckets based on statistics.
For car insurance, we have chosen to bucket risk in a fairly fine grained manner, because we believe that safe driving is almost entirely a matter of choice. For health care, our primary 'risk bucketing' is connected to age. Without Medicare, 90% of the populace couldn't afford health care because health care for the 65+ crowd is staggeringly expensive.
As to fairness:
During ANY defined time frame under which you are insured, you are either below average or above average from a 'cost' perspective. If your costs are 'below' average you are subsidizing the folks with above average costs. If your costs are 'above' average you are being subsidized by the lower cost half of the pool.
Let's call the degree to which you are subsidizing or being subsidized an 'imbalance'.
There are objective factors which can be used to contour pricing in an attempt to PARTLY reduce the size of these imbalances. For health and life insurance these can be smoking and weight.
That said, if you FULLY address the imbalance, then you no longer have insurance, since the WHOLE concept of insurance is to spread risk across a pool. And if everyone is paying their true costs, there is no spreading.
We will ALL benefit from Medicare if we live to 65. And HALF of us will be in the above average cost group, meaning the subsidized group while on Medicare. The question becomes: Is that fair? And the answer is quite simple. If you believe we are here to take care of one another, then you will see this as fair.
If however, you are both healthy and of the belief that life is an 'every man for himself' proposition, than you will see it as unfair.
Because ACA isn't in a lot of our interests. Especially if you're a Liberty minded individual. I've stated repeatedly that ACA was damaging to me. It's been damaging to most single men my age. It is a horrible monstrosity.
What does it say about a person, if they think their only interest is money, JLD? If that's the only metric they measure by? Or the most important?
Now, the R's aren't going to just repeal it (sadly) they are going to replace it. Here's Rand Paul's Senate Bill
(which may or may not go anywhere) Full Text Here