The trap I've heard described is that people are living longer thanks to "hardcore" medicine like heart bypass and other things which prolong but do not always

The trap I've heard described is that people are living longer thanks to "hardcore" medicine like heart bypass and other things which prolong but do not always improve the quality of life, along with greater general food security, yada yada. However, they are not living as long as they necessarily could in a theoretically perfect environment AND they are not living to greater ages with the same general level of health they could with better behavior. The last bit is what creates the actuarial and cost problems--people living longer but needing more attention and intervention throughout their life. So, and I think you agree here, the optimum situation would be to improve general lifestyle habits and have people live older, more productive lives on average without generating excess costs relative to what we see today. If that's possible, it's a good goal. And since it can be improved incrementally in both directions (quality up, cost down) without a 100% see-saw effect, it seems like an attainable goal.