Someone being obese doesn't impact my health directly. Second hand smoke impacts the kids/family of smokers. Second hand smoke impacts everyone walking past the front of an office building.

I don't actually know the math behind it but I would imagine that just smoking outside eliminates almost all the second hand smoke risk. The air outside is really really big, and the smoke is pretty small. Surely most of it misses you, even if you can smell it.

Sure it does. Hospital is more busy than it needs to be and service therefore is diminished or you pay more for the same.