The world of Extreme User Pays: It starts with higher premiums for fatties, and ends with higher school fees for stupid kids, and a beauty-parlour loading system for the ugly.

The world of Extreme User Pays: It starts with higher premiums for fatties, and ends with higher school fees for stupid kids, and a beauty-parlour loading system for the ugly. Photo: Jenny Evans

Of all the fears presently jostling for position in the federal budget mounting-yard (fear of expensive petrol, fear of a disappearing public service, fear of dispossessed street urchins roaming a Cormac McCarthy-style post-budget landscape pockmarked with dead hospitals and burned-out apartment towers and fighting each other with sharpened sticks), Fear Of A Fat Planet is not even in the top 10.

But a recommendation – from the National Commission of Audit – that would clear the way for health insurers to charge higher premiums to fat people is nonetheless a highly intriguing sign of things to come.

The argument goes that an obese person almost invariably is a bigger health risk than a non-obese person, and thus should declare their fatness when taking out a policy. Insurers already are allowed to ask about smoking; if a pack-a-day smoker is obliged to pony up higher premiums, then so should a bucket-a-day KFC patron, right?

Here we enter the new and exciting world of Extreme User Pays. At the heart of it is the view that people who draw disproportionately on services should be asked to contribute more. It starts with higher premiums for fatties, and ends with higher school fees for stupid kids, and a beauty-parlour loading system for the ugly.

There is a lot of interest in this concept in the airline industry, one courageous corporate member of which – Samoa Airlines – has already started charging higher fares for overweight passengers. In the US, several airlines employ a ''rule of tum'' to the effect that anyone requiring an extender seatbelt should actually purchase a second seat.

Of course, if we were serious about all this, it would make sense to institute a far more extreme scale of fares for air travel. A 50 per cent loading on snorers, for instance, or people who board early so as to cram the overhead lockers with their bajillion bags. A thousand-dollar spot fine for those lunatics who think it's reasonable to recline their seats on domestic flights.

But fare-hikes for fatties are just the slender end of the wedge in this age of too much information.

Health and life insurance used to be a national form of gambling; your hard-earned premiums, wagered against the great unknowns of life, like whether that nasty persistent cough really is nothing at all, or whether the dicky heart that killed your dad turns out to be a hereditary thing. It's a very particular form of wager, in which losing the bet – paying out all that money in premiums and never claiming anything back – actually means you won.

But in the age of megadata, the capacity for the dice to be loaded is unprecedentedly high.

Just think – in the old days, the gamble an insurance company took on you was a generalised bet, based on population-wide estimates of how likely an average person was to get cancer, fall off their bike or require a knee reconstruction.

Big data changes that. Now that you can lick a Paddle Pop stick and have some laboratory email you your entire genetic destiny, including a precise estimate of how likely you are to go mad and commit suicide by cop at age 46, it's not so much a gamble any more as an asymmetry of knowledge. How much should insurers be allowed to know, and for what should they be allowed to charge? The distinction proffered by insurers is that risky behaviour (like smoking or overeating) should be penalised, not genetic risk factors. 

Which brings us to the most intimate question of all: To what extent does a human being author his or her own ruin? Is fatness a fault? Obviously, there are often things you can do about fat. You could have something very strange done to your insides and then drink broccoli shakes, like the Treasurer. You could restrict yourself to a tisane of Chinese herbs, like Malcolm Turnbull. You could develop a sumptuously-detailed eating disorder, like Bob Carr.

But human detail is always messy, close-up. I can understand the complaints of the structurally-diddled – the fitness fanatics who subsidise the couch potatoes, the non-drivers who pay for roads, the childless couples who cough up for schools – but am always reminded of diners quibbling over who had the salad.

Life isn't fair. People get run over, bullied, overlooked, punched by random idiots, held up. They lose children to awful diseases. Their houses burn down in bushfires. They get cancer. None of it is fair, and even those of us who piously bemoan the fact that we subsidise the liabilities of others are only ever one bad holiday food-order away from a squillion-dollar Medevac drama; only one car accident away from an economy-sapping stint in intensive care.

Being part of a society is the best insurance there is.

Annabel Crabb is the host of ABC-TV's Kitchen Cabinet.