@Worstal - you're slightly off there.
One of the biggest factors on the health care clustertruck that is the USA is "political correctness".
Obesity is a "disability" thrust upon it's victims, right? Smoking is "self-inflicted". Yet, one of our former board members (health insurance company), as a doctor and an actuarial, tried repeatedly to point out that smokers should NOT be penalized. They maybe should be encouraged. They smoke, they get cancer or something equally bad and die. Money wise from the insurance company... a winner. Obese people tend to get diabetes and heart issues with drugs, surgeries, recoveries, more of the same over and over (even transplants) until they die... a money loser.
In the offices, the smokers were constantly badgered by... the fat ones. Yet they were worst insurance risk for health care. As a smoker, I'll take my cigs and stogies and face my doom. It's far better than heart surgeries, amputations starting at toes and nibbling upwards, kidney transplants, etc. until the end.