Punishing the lemon: the ethics of actuarial fairness

The Patient Protection and Affordable Care Act rejects the notion that actuarial fairness is a normative ideal. The author discusses the ethics of actuarial fairness and attempts to draw a distinction between actuarial fairness and moral fairness. The ethics of wellness programs are discussed with both actuarial fairness and moral fairness in mind. The potential tension between physicians and patients in the zealous pursuit of healthy goals is described. Finally, the logical end point of actuarial fairness with the widespread availability of genetic information is highlighted.