Looks to me that in USA there is no incentive for healthy lifestyle at all: if you can pay (for the insurance), the healthcare provider does anything regardless your condition or costs. In government-funded health care the idea is to maximize results in the whole population. For example the surgery of fat person is so risky and expensive that it is not worth it, you can save 10 normal persons while the fatty tries to lose some weight. People know that and that is why you rarely see those Texas-style lumbering mounds of flesh in Stockholm.