rfenst wrote:My BCBS coverage already pays me $25 for getting an annual flu/pneumonia shot.
Technically that's still part of a contractual agreement between yourself and BCBS (a theoretically independent business). It's no different than a discount for going to the gym regularly which isn't technically any different than paying less if you're younger or more if you're older, or additional charges for smokers. The business is gambling on your health being better than what they're charging you (and anything you can do to improve/prove that makes them more secure in the gamble).
Things get a little weirder when it's a government entity... you've got a power imbalance, since they can make laws you're expected to obey. Currently, they are only requiring that you purchase insurance. They aren't collecting the money, a private insurance company is... but if they ever do get involved in the cash collection side, it will open up some very interesting opportunities for social engineering.