No matter how optimistic and hopeful you might be by nature, it's difficult to approach the issue of health care in the United States without a sense of foreboding. And confusion. And frustration. And maybe a little anger. The issue of affordable, reasonable, pragmatic health care is the defining issue of our times. In the U. S. in 1969, we spent about 5.0% of GDP on healthcare; today that number is closer to 18.0%. We spend at least half again as much per capita on health care as any other developed country, yet our health outcomes lag significantly behind those countries that spend less.