Bad behaviour is going without insurance when it can be obtained for some reasonable percentage of income. Yes, Bill Gates and Warren Buffett actually don't require health insurance. Some bad accident happens, like happens to somebody, somewhere everyday,  Warren or Bill can write a check for that $500,000 medical bill. Most all invincibles don't have that luxury. They are going to rely on bankruptcy, provider write offs and provider write downs. It happens every day. Providers then up rates to responsible people to make up for the write downs and write offs. How high can a medical bill go? In Premera's rate filing they show an expense for carrying reinsurance for claims over $2,000,000. The PPACA encouraged responsibility through a tax penalty for going uncovered, which at least in some little way compensates us for the uninsured using the rest of us as their "insurance". This bill dumps the penalty for being irresponsible. The existing law already allows for a 300% age tax.