Lifestyle choices and health care costs

I agree with B's concern about government getting too involved in our private lives, especially regarding what we eat and drink, and I think we should be careful to draw intelligent notches in that slope.  That said, I think the lifestyle and cost comparison presented is too unrealistic to be helpful in thinking about this (I understand B. was using hyperbole on purpose here).  The problem, really, is that most of the obese and otherwise unhealthy people in this country don't die at 40; rather, the many wonderful medicines, surgeries, and treatments that we have available to us are able to keep people like this alive, many well into their 60s, 70s, and 80s.  This places an enormous burden on our health care system, and especially on Medicare.  Perhaps the solution should focus less on punishing individuals and more on incentivizing institutions - rewarding doctors and hospitals, maybe even employers for better health outcomes (target weights/BMIs, etc.).