As an insurer, you can afford to insure if the losses occur within the assumed probability distribution and loss magnitude parameters.
In the case of auto (or driving) insurance, it is known that driving aggressively will cause more collisions hence more losses. Therefore, any insurance company not taking this knowledge into account will have uncompetitive premiums compared to another insurance company that is. Insurance only doesn’t work in this case for people who choose to drive aggressively.
A more contentious point would be people living in poor areas having to pay more for insurance due to more property crime in poorer areas. It’s easy to say someone who drives recklessly chooses to and should suffer the consequences, but what about someone who happened to be born to poorer parents?
In the case of healthcare, there are a few known factors that make many chronic health events not random, such as bad diet, lack of excercise, and bad genes. A broken arm might be a sufficiently random event, but what should society do about the non random health losses? What if you were born to poor parents and never had much of a chance to make it so you had a job schedule that allowed you a routine to workout regularly? Or time to cook healthy foods? Or you don’t make enough money to live near grocery stores that sell nutritious foods?
But then at least 70% of Americans are fat. And I see them voluntarily buying large containers of sugar water multiple times a week. Why should I have to pay for their diabetes? Same for a smoker or an alcohol drinker?
It’s a nuanced topic that makes me wonder what freedom is and how much freedom can cost. Am I restricting freedom by not wanting to pay for others’ actions known to cause certain losses? Should people be restricted from certain actions if they can’t afford the losses, therefore restricting their freedom? Can they even be restricted, logistically?
