When somebody gets TB, regardless of their lifestyle, is it in your best interests that they get a full course of treatment in an isolation ward in hospital, or that they wander the streets coughing blood all over the place and incubate a new drug-resistant strain? Is it in your best interests that tap water is maintained by competing for-profit companies (see Victorian Britain and cholera), and is it better for you to pay 'insurance' to competing for-profit fire services?
> is it in your best interests that they get a full course of treatment in an isolation ward in hospital, or that they wander the streets coughing blood all over the place and incubate a new drug-resistant strain?
That's a false dichotomy. An example of a 3rd option is to put them in an isolation ward, and allow them to simply die if they can't pay for treatment.
When it comes to medical care, the question of how to allocate resources on quality of life improvements is never so simply and black and white.