# Adaher Supports French UHC, What Country Do you Want To Emulate? **URL:** \ **Category:** Great Debates\ **Created:** [August 22, 2012, 3:47pm UTC](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278 "2012-08-22T15:47:19Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![ralph124c](https://avatars.discourse-cdn.com/v4/letter/r/8797f3/32.png) [@ralph124c](https://boards.straightdope.com/u/ralph124c)\ **Post date:** [August 23, 2012, 1:53pm UTC](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278/21 "2012-08-23T13:53:34Z")
One question that always comes up in UHC:how should the system work with diseases/conditions that are essentially self-inflicted? I am talking about things like: -morbid obesity -sexually transmitted diseases -adult onset diabetes -lung cancer (due to smoking) -opiate addiction The issue of diabetes is important-due to rising rates of obesity, diabetes cases are increasing dramatically. In other words, if a condition is preventable (with proper counseling and care), what do you spend resources on? Suppose it was found that marijuana use could prevent opiate addiction-wold it not be better to legalize marijuana to reduce the terrible costs of opiate addiction? Similarly obesity: by treating obesity in its early stages, you could avoid adult onset diabetes-early treatment would be much better that maintaining someone on insulin. So my question: which system is best at prevention? ---
**Author:** ![justrob](https://avatars.discourse-cdn.com/v4/letter/j/a9adbd/32.png) [@justrob](https://boards.straightdope.com/u/justrob)\ **Post date:** [August 23, 2012, 2:25pm UTC](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278/22 "2012-08-23T14:25:24Z")
> [@ralph124c](#): > > …diseases/conditions that are essentially self-inflicted? … > -sexually transmitted diseases STD’s are self-inflicted? I think you are catching them wrong. \<-Not meant to impy you have any STD’s. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [August 23, 2012, 2:26pm UTC](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278/23 "2012-08-23T14:26:59Z")
> [@ralph124c](#): > > One question that always comes up in UHC:how should the system work with diseases/conditions that are essentially self-inflicted? > I am talking about things like: > -morbid obesity > -sexually transmitted diseases > -adult onset diabetes > -lung cancer (due to smoking) > -opiate addiction > The issue of diabetes is important-due to rising rates of obesity, diabetes cases are increasing dramatically. In other words, if a condition is preventable (with proper counseling and care), what do you spend resources on? Suppose it was found that marijuana use could prevent opiate addiction-wold it not be better to legalize marijuana to reduce the terrible costs of opiate addiction? Similarly obesity: by treating obesity in its early stages, you could avoid adult onset diabetes-early treatment would be much better that maintaining someone on insulin. > So my question: which system is best at prevention? That’s not a question that always comes up. In fact, I can’t remember it ever coming up. It’s a disease, you treat it. Certainly prevention is better than cure, if that’s what you’re asking. ---
**Author:** ![Kearsen](https://avatars.discourse-cdn.com/v4/letter/k/82dd89/32.png) [@Kearsen](https://boards.straightdope.com/u/Kearsen)\ **Post date:** [August 23, 2012, 2:39pm UTC](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278/24 "2012-08-23T14:39:19Z")
> [@Really\_Not\_All\_That\_Bright](#): > > That’s not a question that always comes up. In fact, I can’t remember it ever coming up. It’s a disease, you treat it. Certainly prevention is better than cure, if that’s what you’re asking. Which is why there is always more and more push to classify something as a “disease” Since when is morbid obesity a disease? An opiate addiction? There has got to be a line for which, when people cross, they are held responsible. And yes, he was asking which system was better at prevention. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [August 23, 2012, 2:39pm UTC](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278/25 "2012-08-23T14:39:37Z")
> [@ralph124c](#): > > One question that always comes up in UHC:how should the system work with diseases/conditions that are essentially self-inflicted? > I am talking about things like: > -morbid obesity > -sexually transmitted diseases > -adult onset diabetes > -lung cancer (due to smoking) > -opiate addiction Diabetes isn’t preventable in any simple manner; as for lung cancer, even those types which have been linked to tobacco aren’t exclusive to smokers. In other words, your notions of what’s “self-inflicted” need reviewing. In any case, the only instance where I’ve heard anybody proposing that someone’s self-inflicted wounds not be treated is tourists practicing balconing\* and other similar idiocies; proposals are along the lines of “ship them home, in pieces if that’s how the ambulance picks them up”. - jumping from balcony to balcony, or jumping down from a balcony and hoping the other morons down at street level will grab them rather than move away ---
**Author:** ![Sunspace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/sunspace/32/1250_2.png) [@Sunspace](https://boards.straightdope.com/u/Sunspace)\ **Post date:** [August 23, 2012, 2:51pm UTC](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278/26 "2012-08-23T14:51:53Z")
And besides, even for diseases which are acts of will, it may be cheaper to simply treat them all than to erect a system to decide who is worthy of treatment. ---
**Author:** ![fumster](https://avatars.discourse-cdn.com/v4/letter/f/e9c0ed/32.png) [@fumster](https://boards.straightdope.com/u/fumster)\ **Post date:** [August 23, 2012, 4:04pm UTC](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278/27 "2012-08-23T16:04:01Z")
> [@ralph124c](#): > > One question that always comes up in UHC:how should the system work with diseases/conditions that are essentially self-inflicted? > I am talking about things like: > -morbid obesity > -sexually transmitted diseases > -adult onset diabetes > -lung cancer (due to smoking) > -opiate addiction I’d be tempted to include conservatives in the list of self-inflicted conditions. We have recently seen how it interferes with the ability to process medical knowledge such as rape pregnancy, and of course conservative opposition to sex education results in the US having a disproportional rate of teenage pregnancy. But alas, being a liberal, I have to include them in UHC as well ---
**Author:** ![polar\_bear](https://avatars.discourse-cdn.com/v4/letter/p/ec9cab/32.png) [@polar\_bear](https://boards.straightdope.com/u/polar_bear)\ **Post date:** [August 23, 2012, 4:31pm UTC](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278/28 "2012-08-23T16:31:27Z")
If you’re sick, you’re sick… a country with UHC isn’t going to let you die of lungcancer (or leave it untreated), because it was your choice to light up a cigarette. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [August 23, 2012, 4:35pm UTC](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278/29 "2012-08-23T16:35:01Z")
Reported fumster’s post. > [@Kearsen](#): > > There has got to be a line for which, when people cross, they are held responsible. Sure. Who said there shouldn’t be one? ---
**Author:** ![Marley23](https://avatars.discourse-cdn.com/v4/letter/m/45deac/32.png) [@Marley23](https://boards.straightdope.com/u/Marley23)\ **Post date:** [August 23, 2012, 4:38pm UTC](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278/30 "2012-08-23T16:38:54Z")
> [@fumster](#): > > I’d be tempted to include conservatives in the list of self-inflicted conditions. Knock it off. ---
**Author:** ![Simplicio](https://avatars.discourse-cdn.com/v4/letter/s/c37758/32.png) [@Simplicio](https://boards.straightdope.com/u/Simplicio)\ **Post date:** [August 23, 2012, 4:44pm UTC](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278/31 "2012-08-23T16:44:06Z")
> [@adaher](#): > > Actually, I support the Swiss. I just acknowledged that according to many international measurements, the French system is the best. > > I think the basic idea of the ACA is sound policy, I just don’t like a lot of the specifics. But I think that reform of Obamacare is a fine idea if they can’t repeal it and start over. Isn’t the Swiss system basically Obamacare? There’s an individual mandate, state regulated exchanges and subsidies based on ability to pay. ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [August 23, 2012, 5:23pm UTC](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278/32 "2012-08-23T17:23:09Z")
> [@Simplicio](#): > > Isn’t the Swiss system basically Obamacare? There’s an individual mandate, state regulated exchanges and subsidies based on ability to pay. I believe so. IIRC, when first proposed and put into effect, it was not terribly popular but a few years after implementation it had become very popular and no one wanted to repeal it. One big difference is that insurers are very tightly regulated compared to the US and are not allowed to profit from standard health insurance policies. ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [August 25, 2012, 1:57am UTC](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278/33 "2012-08-25T01:57:13Z")
Most health care economists feel the Bismark model health care system used by Germany/Switzerland/Nederlands would be the easiest to transition the US into. While slightly less effective than the Beveridge model used by the UK/Scandinavia or the NI model of Canada etc, it should still be a masive saving. > [@ralph124c](#): > > One question that always comes up in UHC:how should the system work with diseases/conditions that are essentially self-inflicted? I cannot remember that ever coming up. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [August 25, 2012, 3:10am UTC](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278/34 "2012-08-25T03:10:39Z")
How is it less effective? There seems to be no relation between type of UHC and mortality amenable to health care: [![](https://leisureguy.files.wordpress.com/2009/08/nolte_itl_chart2.gif) ](https://leisureguy.files.wordpress.com/2009/08/nolte_itl_chart2.gif) ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [August 25, 2012, 3:21am UTC](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278/35 "2012-08-25T03:21:00Z")
> [@adaher](#): > > How is it less effective? There seems to be no relation between type of UHC and mortality amenable to health care: > > [http://leisureguy.files.wordpress.com/2009/08/nolte\_itl\_chart2.gif](http://leisureguy.files.wordpress.com/2009/08/nolte_itl_chart2.gif) It is less effective in terms of cost/results. Bismarck type systems tend to cluster towards the top in costs. There seems to be no indication that this greater spending yields better results. (Of couurse, the gap from US spending, in % of GDP, down to the next highest Bismarck system is still big enough to swallow US military spending without trace. ) ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [August 25, 2012, 3:25am UTC](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278/36 "2012-08-25T03:25:33Z")
> [@Grim\_Render](#): > > (Of couurse, the gap from US spending, in % of GDP, down to the next highest Bismarck system is still big enough to swallow US military spending without trace. ) So, you are saying we could adopt a Bismark healthcare system AND more than double our military spending with no tax increases! 😃 ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [August 25, 2012, 3:29am UTC](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278/37 "2012-08-25T03:29:14Z")
> [@jasg](#): > > So, you are saying we could adopt a Bismark healthcare system AND more than double our military spending with no tax increases! 😃 Theoretically. In a perfect word, there’d be about 1-2 % of GDP left over in fact. Maybe half of todays military budget. Mind, the US is a sort of semi-Bismarck system aready, thats why getting to the setup of the others would be easier than setting up a NHS system or similar. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [August 25, 2012, 3:53am UTC](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278/38 "2012-08-25T03:53:27Z")
> [@Grim\_Render](#): > > It is less effective in terms of cost/results. Bismarck type systems tend to cluster towards the top in costs. There seems to be no indication that this greater spending yields better results. > > (Of couurse, the gap from US spending, in % of GDP, down to the next highest Bismarck system is still big enough to swallow US military spending without trace. ) There does seem to be a correlation between spending and results, as Britain’s system is the stingiest and does poorly compared to the other UHC systems on many metrics. And dead last for UHC systems on amenable mortality. I blamed the single payer system initially for the problem, but in the course of the debate i’ve changed my view. It could just be that they don’t spend enough and don’t pay their health care workers enough. ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [August 25, 2012, 3:59am UTC](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278/39 "2012-08-25T03:59:42Z")
> [@adaher](#): > > There does seem to be a correlation between spending and results, as Britain’s system is the stingiest and does poorly compared to the other UHC systems on many metrics. And dead last for UHC systems on amenable mortality. > > I blamed the single payer system initially for the problem, but in the course of the debate i’ve changed my view. It could just be that they don’t spend enough and don’t pay their health care workers enough. My point was that Bismarck type systems have higher costs without corresponding results. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [August 26, 2012, 11:52pm UTC](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278/40 "2012-08-26T23:52:20Z")
I don’t care that much, but I think a public hospital system with _no_ patient responsibility for funding would be part of a very highly efficient plan. I’m willing to consider a single-payer insurance plan in case it would be easier to adopt in the sense of making an administrative transition. [Previous page](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278.md?page=1) [Next page](https://boards.straightdope.com/t/adaher-supports-french-uhc-what-country-do-you-want-to-emulate/632278.md?page=3)