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At that rate, it will take 82 years for 100 percent of the GNP to be eaten up by health care. In response to these prognostications, people tend to say, in effect, "What is the big deal? " It is true: it would take only 82 years. Even if we did end up spending 100 percent of our GNP on health care, what would be wrong with that? " COSTS OF HEALTH CARE This scenario sounds comical, but not everyone is laughing at it. One person who is not laughing is an employee benefits manager of a typical American corporation.

This person is 30 years old, works for General Motors, and just made a payroll entry crediting cash for $800 million in health care for people who do not work for General Motors. One can imagine him asking, "Where do I put the debit? If these people aren't working, it can't be payroll. " That $800 million is in fact what General Motors pays per year for retired General Motors workers and their families, and indeed there is no clear place to record the debit. About this PDF file: This new digital representation of the original work has been recomposed from XML files created from the original paper book, not from the original typesetting files.

Could it be an economic theory, because Medicaid reimbursement is likely to be one-third of commercial reimbursement? Or could it be a legal theory—do poor women sue for malpratice and poor obstetric outcomes less often than rich women? No one knows. REASONS FOR THE EFFECTIVENESS INITIATIVE Canadians spend a lot less than Americans as a percentage of GNP, and that raises the question, What do Americans get in health care that Canadians do not get? We know what Canada does not get; it does not have 30 million uninsured—or any uninsured—but what do they miss that we get?

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