Things like obesity, smoking, and alcoholism all kill you before you can get too old. Healthy citizens end up using far more of the far more expensive end-of-life care, to the point where it outweighs the extra healthcare the unhealthy citizens use in their youth.
[0] https://www.ofdt.fr/sites/ofdt/files/2023-08/field_media_doc...
It has to do with culture and wealth. Europe is getting fatter and richer.
This is like thinking medieval peasants or sub-saharan Africa are skinnier because of their robust paternalistic governments