“Making smokers pay accordingly for the actual cost of their health care is pragmatic. I also think it’s fair to have people who are overweight pay for the actual costs of their health care.”
How do you do that?
If a smoker has bronchitis health care is not paid for but if someone has bronchitis and doesn’t smoke it’s covered?
Same with diabetes and people who are overweight.
How can the cause of the illness be proven?
.
Regular checkups. If someone is a smoker then they'd be asked to quit, provided assistance to quit, and expected to do so within a certain time. After that their premiums would increase according to actuarial tables.
Likewise with obese people (whose obesity is not a symptom of a diagnosed disease) they'd be given options and if they were making progress toward an acceptable weight range then they'd not see any increase in rates. Otherwise, they would.
What I propose is letting free market forces be allowed to do their thing with regards to healthcare premiums. People who deliberately cause their own problems should have to pay their own way and insurance companies should be free to charge them accordingly.