nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Tuesday, July 8, 2008

Healthcare reform plan comparisons

For those of you who are interested, the webpage below has a candidate comparison on healthcare reform. It’s a fairly good, neutral explanation of the elements of each candidate’s proposal. Having run a healthcare system for a population, I find it fascinating to see what policy makers think will work: some good ideas here, some bad.

I have an opinion on the relative merits, but I’m not giving it here, except to say that I look for a workable solution to all the major elements of a good system: quality, cost, access, coverage…in descending order of importance. Here’s why: (1) I don’t want crappy care at any price (quality), (2) if underlying cost increases are not controlled, access and coverage can’t be sustained, (3) if nobody’s there to see you (access), it doesn’t matter whether you’re covered, and (4) I believe everyone should have a coverage avenue, public or private.

One last thing. When the discussion turns to how we pay for all the things we want, I sometimes hear that we should cut defense spending. For the record, I’ve included a graph of defense spending since 1965. Back in 1950, it was about 30% of GDP. At the height of the Vietnam War it was 9.5%. It’s now 3.9%, and will be going to 3.5% in the out years. The interesting thing is how we’re going to deal with the “Acquisition Holiday” that occurred in the 90’s (a large part of the “Peace Dividend”). About $160B of the $200B budget deficit reduction came out of defense, mainly by cancelling future development and purchases.

Planes and tanks wear out, so get ready for some big bills to replace or repair them…and there’s little in the pipeline, which needs a 10-15 year lead time. Let’s hope we don’t go back to the late 70’s: when I entered active duty in 1980 we had blocks of wood we used as simulated surgical sets because we had no money to buy the real thing. Cheery thoughts.

Opinions are solely my own.

Doc D

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