Healthcare in the US is treated as a business not as a necessity. It is a complex and difficult business to reform and some things will probably never change including the influence of industry lobbyists and politics. The American culture of fast food is creating an obesity epidemic as well the smoking issue you eluded to which are all lifestyle issues. I have young children and I feel like I am from outer space if I ask for milk at a birthday party or fast food restaurant. My kids go to camps and they teach about nutrition and then feed them fried food and soda.
There also needs to be tort reform to reduce legal costs in the healthcare system. It is amazing how many healthcare lawyers there are in the US.

Seems as though all reasonableness has evaporated from DC on a whole range of issues, the two you both mentioned being two of the biggest. We need to find the right mixture of providing affordable access to everyone, adequate and comprehensible information on health and health care, as well as incentives (beyond the obvious) to help people take responsibility for their protecting their health and that of their loved ones. As it stands now, too many people can’t afford to take advantage of regular, quality (preventive) care while at the same time there are too many “free riders” who choose unhealthy lifestyles and expect the system to take care of them when they develop health problems.