The passage of the Affordable Care Act (“ACA” or “Obamacare”) in 2010 promises to bring about significant changes in the way that health care is provided and paid for in the United States of America (USA). Supporters of ACA point to a 2000 WHO study of worldwide health care systems in which the USA ranked 37th as justification for proposed changes, and many of them have expressed a preference for ultimately implementing a single-payer or single-provider system (such as currently exists in Canada or the United Kingdom). Detractors, who generally label the act Obamacare, have expressed concerns about whether the act can achieve its stated objectives, whether it represents a negative step instead of a positive one, and whether the ultimate goal of a single-payer or single-provider system is desirable one or even an achievable one. In the context of the ongoing debate over health care in the USA, this paper reviews the WHO study and subsequent comparative analyses of world health care systems to address the following questions:Does the USA really have the 37th best health care system in the world?Does either a “single-payer” health care system or a “single-provider” health care system offer prospects for significant improvement?What model or models for delivery of health care services represent “best practices” and how can and should they be emulated?

ABSTRACT

Dependence on foreign oil by the United States of America creates massive problems from the economic, environmental, and national security perspectives. In recognition of this reality, the USA embarked upon an energy independence plan in the mid-1970s, following the Arab oil embargo that accompanied the 1973 Yom Kippur War. Unfortunately, this effort has failed to the extent that the USA is more dependent upon foreign oil today than it was in 1976. At about the same time that the USA initiated its energy effort, a similar effort was also initiated in the South American nation of Brazil, which like the USA was alarmingly dependent upon foreign oil and had sustained substantial economic hardship as a result of the Arab embargo. Today, Brazil is substantially energy independent, and in fact exports oil to the USA. Obviously, Brazil implemented a more effective energy independence effort than did the USA. Lessons which the author believes may be learned from the Brazilian experience are that solving the problem requires that all possible solutions be pursued simultaneously with maximum vigor, that maximum use should be made of existing usable technology rather than waiting for laboratory-scale technologies to be perfected, and that solutions will be reached much faster if the private sector is actively engaged in a cooperative rather than adversarial manner. With these principles in mind, we review available alternatives and propose a comprehensive energy strategy that reduces the USAs dependence on foreign oil in the short run, and ultimately eliminates that dependence in the long run. We further enunciate reasons for believing that such an integrated strategy is far superior to any effort to address the problem by focusing solely upon conservation, or alternative fuels, or drill here, drill now, to the exclusion or minimization of the other approaches. We conclude with a proposed plan for implementing the all hands on deck approach to energy independence.

The total debt of the United States (US) federal government now exceeds annual Gross Domestic Product (GDP). This level has historically proved problematic in other countries. The primary driver of the debt is a federal budget deficit that now exceeds $1 trillion per year. Despite forecasts of dire consequences, the deficit and debt have not been controlled, as efforts to make meaningful reductionsincluding plans developed by the bipartisan Bowles-Simpson and Domenici-Rivlin groupshave so far fallen prey to infighting in the political process. This paper examines one approach to eliminate the annual deficit, balance the federal budget, and reduce the federal debt. This approach increases tax revenues with a flat income tax applied to a broader tax base plus a consumption tax. Health and welfare spending is reformed using the Boortz-Linder Prebate and the Bismarck social-insurance health care plan to provide a more comprehensive safety net. Defense spending is reduced by making greater use of reserve forces following the model of Sweden, Switzerland, and Israel, by reducing overseas deployments, and by reforming procurement. Many unnecessary or counterproductive activities are cancelled, transferred to the states, or privatized. Social security is placed on a sound footing for the future. These proposals are based in large part upon programs and procedures that have produced positive results in other countries. This approach is offered not as the only or best solution, but rather to indicate that solution is possible and to lead to further discussion.

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