Perfectly reasonable for fatsos to pay higher health insurance premiums, no different than paying higher car insurance premiuns for higher risk people.
Smokers and drinkers will simply lie about their habits, so excise taxes on alcohol and tobacco should actually be used for alcohol and tobacco related costs. Probably needs to be doubled, then you could cover most social medicine costs. The savings on insurance premiums would be worth it. The problem is politicians never use tax money appropriately.
other steps: stop saving every damn fetal alcohol and crack preemie- tons of cash there, or simply stop thinking everyone deserves extreme medical care