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March 24/31, 1999

Marginal Medicine—Reply

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(12):1082-1083. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-12-jbk0324

In Reply: I would like Dr Houghton to recognize that the military already lives within a public policy budget. Congress decides how much to spend on defense and within that overall budget how much should be spent on the various branches of the armed forces, procurement retirement the Central Intelligence Agency. No Congress has ever been willing to give the military everything on its wish list, let alone everything beneficial.

Now that public policy funds approximately 50% of our health budget, it is necessary to apply the public policy reasoning to achieve health care reform. Congress should make an independent assessment of how our nation can maximize health care with available public funds, how much of the health budget should be spent on health care, and how to best organize and deliver that care purchased by public dollars. Congress should do more than blindly pay bills.

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