^^ Credit JDSK above.. Two excellent descriptions of why fantasises of systems based on blame won't work in practice.
Amongst the issues with a blame system is who do you attribute blame to and what would be the enforceable consequences? With regard to individuals it could all quickly get rather complex, unworkable and more costly than what we already have. To my mind we need to focus much harder on wider public health and promote informed personal responsibility for health. Unfortunately, whilst doubtless saving money overall, that will have costs and will have various vested interests ‘up in arms’.
To my mind those that promote unhealthy lifestyles are the ‘people’ who should be held to account for it is the consequences of their acts that result in much sickness. I look at past generations and see promoted over consumption of tobacco, alcohol and sugar as being major, primary even, causes of ill health and premature death. That’s not the whole picture as things like gambling and pornography are socially destructive too and that destruction has heath consequences.
Big Pharma is not without some responsibility, but I’ll leave it for others to comment on how. Ultimately they’re commercial enterprises and their real focus is not on improved health but rather on share holder value - and bonuses for the board.