As someone who spent the majority of his career within the insurance industry, I must admit I find this question somewhat troubling. My background in insurance was that of a claims specialist, claims manager, benefit administrator and then I moved into sales of life, group, accident and health insurance, I went out of the salaried positions and became a New York State insurance broker and a New York State Insurance consultant. I was also licensed in several other states. Before I answered your question I wanted to provide you with my brief biography, simply so you are aware I know the insurance business inside out...both on a corporate and sales level.
Comparing automobiles, real estate and the like to health insurance premiums is the equivalent of apples to oranges. Actuaries, employed by insurance companies put to use their mathematical abilities in determining premium costs. There are a myriad of factors they use, but by and large, to spread the risk, an actuary uses the "law of large numbers." Of course, some medical plans are "experience rated," which simply means that the higher their claims payouts are, then the premiums in the following year will be adjusted accordingly. Again, let me stress this is still based on the law of large numbers.
Insurance companies are not in business to care for their policyholders well being. No...they are in business to make a profit. No one has a crystal ball and whenever a new medical report comes out hailing the benefits of eating one type of food, without fail, a few years later that food group is found to be bad for you. I have known many people in their teens, thirties and fifties who didn't smoke or drink and yet dropped dead walking into school, jogging, or on a treadmill.
"Accountability" is an open ended word, left to many varying interruptions. Accordingly, I do not believe premiums on health insurance should be different for different types of people, based on current opinions regarding what is healthy and what is not because as sure as the sun rises and sets, those opinions will change.