What you're talking about is risk assignment. If you engage in risky behavior, who should pay the consequences? Life insurance takes into account risky behavior for their underwriting. If you skydive, you'll pay more. Same goes if you're a smoker, or have diabetes. You'll also have limited benefits for preexisting conditions for the first couple of years. Car insurance also takes into account your past driving records and where you live. Even workman's comp takes into consideration the type of work that is being done. I worked in the logging and lumber industry and, in some states, the insurance company got more than the worker. Insurance is one of the reason for so many subcontractors in the industry. Its all about risk assignment. But, for some reason, risky behavior isn't factored into healthcare. Single payer doesn't single out those risks and throws the consequences on society or a large pool of payers. The libertarian in me says that the consequences of bikers riding helmetless should be shouldered on those who partake in the activity. That can involve a large pool of like minded individuals, but doesn't have to be cast upon society as a whole. Too expensive? Find another hobby or wear a helmet.