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January 13, 1993

Risk-Related Health Insurance

JAMA. 1993;269(2):213. doi:10.1001/jama.1993.03500020047018

To the Editor.  —Physicians are well aware that poor health behavior is a major cause of illness in our society, and many benefits would accrue if patients would assume greater responsibility for their own health.1 It is therefore disappointing that in his otherwise comprehensive examination,2 Dr Light breezily dismisses the potential connection of risk-rated life insurance with self-induced illness in a single sentence claiming that "little evidence exists that such [risk-rated] rates are effective and that such risk rating leads to a tangle of problems about where to draw lines and how to monitor them." But the relationship of self-destructive conduct to insurance is central, not collateral, as he unfortunately implies by this summary treatment of the topic. He suggests that this is material for another article, but given the broad ramifications of his sweeping statement, he could at least have given us a few explanatory paragraphs.While