Physicians, Business, Professional and Information Technology Communities

 Networking to Restore Accountability in HealthCare & Medical Practice

 Tuesday, July 13, 2004

 Government is not the solution to our problems, government is the problem.
- Ronald Reagan

MedicalTuesday refers to the meetings that were traditionally held on Tuesday evenings where physicians met with their colleagues and the interested business and professional communities to discuss the medical and health care issues of the day. As major changes occurred in health care delivery during the past several decades, the need for physicians to meet with the business and professional communities became even more important. However, proponents of third-party or single-payer health care felt these meetings were counter productive and they essentially disappeared. Rationing, a common component of government medicine throughout the world, was introduced into the United States with Health Maintenance Organizations (HMOs), under the illusion that this was free enterprise. Instead, the consumers (patients) lost all control of their personal and private health-care decision making, the reverse of what was needed to control health care costs and improve quality of care.

We welcome you to the reestablishment of these MedicalTuesday interchanges, now occurring on the world wide web and your own desktop. If this newsletter has been forwarded to you or you have not been on our email list, please go to www.MedicalTuesday.net and subscribe to continue to receive these free messages on alternate MedicalTuesdays. At this site you can also subscribe to the companion quarterly newsletter, HealthPlanUSA, designed to make HealthCare more affordable for all Americans. Please forward this message to your friends and your professional and business associates. If you do not wish to receive these messages, we have made it easier for you to unsubscribe simply by clicking the Remove Me link below.

In This Issue:
1. Medical Care Paid For in Cash - and Cheaper
2. Hospitals' Billing Policies for the Uninsured Targeted
3. High Deductible Plans are Cost Effective
4. This Week’s Feedback on Government Medicine - Letter to Editor on HIPAA
5. Medical Gluttony Reversed by Health Savings Account
6. Medical Myths - Weight-Loss Counsel
7. Overheard in the Medical Staff Lounge - The Goliath Casket Company
8. The MedicalTuesday Recommendations for Restoring Accountability in HealthCare & Government

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1. More Medical Care Is Being Paid For in Cash - and It's Cheaper
Alexandra Marks reports in The Christian Science Monitor that more doctors are opting out of the insurance system by billing patients directly and passing on the paperwork savings.

The founders of SimpleCare believe it's "the future of health care." Its goal: to restore the "soul" of America's medical practice. This loose network of doctors and patients believe they can do it by opting out of the expensive, complex and bureaucratic world of insurance and managed care. Instead, they're trading in simple dollars and, they argue, common sense.

Unlike the Park Avenue cash-only doctors who cater to the rich, these providers serve moderate- and low-income people - those without insurance or with a high-deductible plan. The goal is to give the same quality of care but with a discount by passing along the paperwork savings.

That's made visiting a doctor's office possible for thousands of people who otherwise couldn't afford it - people like Aleata Leete, a semi-retired nurse on a fixed income. And it's given more than 1,500 doctors a new sense of freedom in their practice as they lower the cost of services. Some analysts believe that if the trend continues, allowing many of the 43 million uninsured Americans access to affordable health care, the overall cost of health care could come down. It's been a boon for many patients, like Ms. Leete who's been diagnosed with diabetes and heart trouble. Her insurance doesn't cover doctors' visits. A regular office visit where she lives costs as much as $120. But because she's a SimpleCare member, Dr. Hamilton charges her only $30 for a short visit. Since she's been seeing Hamilton, her diabetes has been brought under control.

The idea of SimpleCare is catching on fast across the country. Since it was founded in Renton, WA, six years ago, more than 22,000 people have joined. The way it works is fairly simple. Although, like everything else in America's Rube Goldberg-style health care system, it takes some extra explaining. Right now, it's illegal for doctors to charge people without a health plan less than people with Medicare or Medicaid. That's to avoid fraud. Many insurance companies write similar limitations into their contracts. That's left many physicians frustrated, particularly those in rural areas with lots of uninsured people.

SimpleCare gets around that federal law because, while it's not health insurance, it is a health plan, and thus members are free to negotiate their own prices. Doctors who sign up agree to pass on the administrative savings to member patients, who agree to pay at the time of the visit.

There are some estimates that the number of doctors opting out of health insurance continues to increase into the thousands. We invited those that are doing so to let us know so that we can support this economic trend of providing health care to millions who can't afford insurance as it is now being written.

To review Marks' article, go to http://www.csmonitor.com/2004/0407/p02s01-usec.html.

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2. Hospitals' Billing Policies for the Uninsured Targeted
Doctors would normally pass any cost savings to their patients except that it's illegal for doctors to charge people without a health plan less than people with Medicare or Medicaid. Hospitals, however, have no problem with charging those without a health plan more than the insurance reimbursement rate. Aurelio Rojas of the Sacramento Bee reports that the ailment that sent Rodney Bellows to Sutter Memorial Hospital in Sacramento last year eventually passed. But the shock lingers from the $8,751 bill for the three-hour visit to the emergency room for kidney stones. "I expected a bill for maybe a couple thousand dollars, (even) $25 cotton balls, but wow!" the uninsured security guard said. After Bellows and the hospital could not work out a payment schedule, his bill was turned over to a collection agency, which has threatened to put a lien on his condominium.

As the ranks of the uninsured mount, so do billing disagreements between hospitals and patients. California hospitals provided $5 billion in uncompensated care in 2003 and are shouldering an unfair burden for the 6.3 million people without insurance, said Jan Emerson, a spokeswoman for the California Healthcare Association, an industry group.

But witnesses told a congressional hearing last week that hospitals charge uninsured patients far higher fees than they do health plans, which are able to negotiate discounts because they represent millions of members. During the hearing, hospitals were accused of using aggressive collection tactics that often drive patients into bankruptcy. The 26 hospitals operated by Sutter Health, including Sutter Memorial in Sacramento, were among 20 hospital systems subpoenaed last year by the House Energy and Commerce oversight subcommittee to provide detailed financial information about their billing and collection practices.

In the California Legislature, two measures - Senate Bill 379 by Senator Deborah Ortiz, D-Sacramento, and Assembly Bill 232 by Assemblywoman Wilma Chan, D-Alameda - would increase consumer protections for "uninsured and overcharged" hospital patients. SB 379 would prohibit hospital bills from being sent to collection agencies for 150 days and AB 232 for 180 days after treatment. Hospitals would be prohibited from placing liens on a patient's home and other aggressive collection practices. Families with income under 400 percent of the federal poverty level (about $62,000 for a family of three) could not be charged more than Medi-Cal, Medicare or workers' compensation rates.

Bellows' bills from Sutter Memorial are still unresolved. But he said he has told the collection agency he can't afford the full amount. Bellows, 37, said he supports himself and the daughter for whom he shares responsibility on a monthly salary of about $1,200 he earns providing security for concert events. He fears the unpaid bills may cost him his three-bedroom condo in Sacramento.

Nancy Turner, a spokeswoman for Sutter Memorial, declined to comment on Bellows' case, citing patient confidentiality."

What isn't noted by either the hospital or California Healthcare Association spokespersons is of what does this uncompensated care consists? Many hospital administrators have freely admitted that they routinely charge the uninsured 400 percent of what Medicare pays. When you jack up the prices and then quote it as a loss, no wonder no one believes the hard luck stories of the hospitals.

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3. High Deductible Plans are Cost Effective
Jane Orient, MD, reports in the AAPS News (www.aapsonline.org) that a professional lady in Montana canceled her traditional health insurance and bought a $20,000-deductible policy for $1108 per year. Instead of paying $500 to $700 per month for insurance, she has placed the $500 per month in a savings account. Although the rising premiums forced her to increase the deductible to $40,000, after five years she has saved $30,000. When insurance executives told her that very few families can afford this level of risk, she asked how can they afford $500 to $700 per month? If she would have had a major medical expense, she would have taken out a loan for the deductible. In two more years she will have more than $40,000 in health insurance premiums that she has saved in her savings account. She feels this is even better than the Health Savings Accounts because she doesn't want to be limited to government conditions on how these dollars may be used.

A doctor in Michigan writes that a $10,000-or- higher deductible plan provides much greater savings than the plans approved for MSAs and HSAs. He uses an HRA for himself and his employees to pay for the premiums and routine care. He deposits $1,000 per month (after taxes) into a conservative investment account. For the same amount he was spending per year on Blue Cross PPO for his staff that he canceled in 2001, he has accumulated $27,000 in two years.

Employees generally do not understand that they are wasting part of their employment benefits in getting first-dollar coverage.

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4. This Week’s Feedback on Government Medicine - Letter to Editor on HIPAA
Hi Del:  HIPAA and a lot of doctrinal regulations are oriented to the urban American Experience. Here in the hamlet, it really is disruptive. Everyone knows who is in the doctor's office by the car or pickup parked outside for instance. We thought of providing horse blanket type covers to conform. The next thing is that the sign-in list in the waiting room disappeared, and we had to call people by their first name. All the patients know each other anyway here, and when you say Mary, half the women stand up.

Over at the provincial hospital on the  first day of enforcement, all the names disappeared on the location board, and the doctors and nurses could not find anyone, since the names were now cryptic initials. The key decoding document was in the hands of a clerk who would show anyone who asked for it unless she was in the bathroom.

We are trying to devise special glasses that blur out human form and print to use here, the special embedded crystalline dye would be photochromic so that only special inks will show. The staff will have universally keyed glasses so we can read the charts, but no one else can. That way, the charts can be placed in the usual fashion facing outward on the door.        Henry Go

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5. Medical Gluttony Reversed by Health Savings Account
Grace-Marie Turner recounts in her recent newsletter that a friend of hers going back to high school found that the premiums for her individual health insurance policy were soaring, and she was worried she might not be able to afford to keep her coverage. When Grace-Marie visited early this year, she told her friend about HSAs, and she immediately saw the savings potential. She started her search for HSA-compatible insurance in January (even educating some insurance agents about the new products). By March, her new policy was in place.

She sent Grace-Marie an e-mail saying that her knee had been hurting. "In the past," she said, "I would have gone to the doctor to get a scan to see what was wrong. But then I realized the money would come out of my account. So I went into the closet, got a set of crutches, and used them for a few days. My knee felt a lot better. I think I probably saved about $1,500."

If 100 million Americans saved $1500 each for just one temporary painful joint, that would save $150 billion! And if everyone used common sense in the other ten organ systems that have temporary problems, that would be about $1.5 trillion. That would reduce health care costs in this country to less than half the average car payment.

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6. Medical Myths - Weight-Loss Counsel
Recently, this section seems to be preoccupied with obesity and with diet books. This is because obesity and overweight is a national and increasingly international epidemic making diet books very popular and financially lucrative. One final word on this subject. Researchers at the University of Pennsylvania asked these very questions of a group of obese women beginning a weight-loss program:
   1.  What is your dream weight?
   2. What is the weight at which you’d be happy—not as ideal as dream weight but still something you’d be glad to achieve?
   3. What is the weight you’d find acceptable—not something you’d be terribly happy with but which you could live with if it were your current weight?
   4. What is the weight at which you’d feel disappointed—it’s less than you weigh now, but it would still leave you feeling very unsatisfied?
The answers can be found at http://www.healthletter.tufts.edu/issues/2004-07/weight.html. They may surprise you.

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7. Overheard in the Medical Staff Lounge - The Goliath Casket Company
Dr Edwards, a endoscopic gastric bypass surgeon, feels he's on a mission. He had been informed that the supply of large caskets was woefully inadequate. There is an increasing number of Americans that won't fit in the conventional six by two foot box. He stated that the Goliath Casket Company had just redesigned their factory and can make caskets of just about any size. Since their three-foot wide caskets weren't large enough for many Americans, they are now producing a four-foot wide casket and can make them even larger on special order. But be sure to order it before your loved one dies, since it will take several days longer to deliver the larger sizes. Dr Edwards feels it must be very embarrassing for the family to be unable to find a box big enough and suggested that we all refer our morbidly obese patients to him before they become ill so that they will have adequate time to lose one or two hundred pounds before they say goodbye.

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8. MedicalTuesday Recommends the Following Organizations for Their Efforts in Restoring Accountability in HealthCare, Government and Society:

• The National Center for Policy Analysis, John C Goodman, PhD, President, who, along with Devon Herrick, wrote Twenty Myths about Single-Payer Health Insurance which we reviewed in this newsletter the first twenty months, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log onto www.ncpa.org and register to receive one or more of these reports. This week, NCPA reports that The Food and Drug Administration (FDA) recently approved a French company’s proposal to market leeches as a medical device. W@#$O%^*W! Read this story at http://www.ncpa.org/newdpd/dpdarticle.php?article_id=253.

The Mercatus Center at George Mason University (www.mercatus.org) is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center’s Government Accountability Project. Join the Mercatus Center for Excellence in Government 2004: Leading When It Matters Most, July 27-29, 2004, at the new Washington DC Convention Center! This premier conference, created by government managers for government managers, brings together more than 1,000 federal thought-leaders focused on high-performance government. U.S. Comptroller David Walker joined Mercatus Scholars Maurice McTigue and Dr. Jerry Ellig in presenting the Government Accountability Project’s 5th Annual ranking of 24 federal agencies’ mandated Results Act (GPRA) disclosures, based on clarity and usefulness for policy makers and the public. Topping the chart were perennial leaders, the Departments of Labor, Transportation, and Veteran Affairs. Most in need of improvement were the Departments of Defense and Health & Human Services along with the USAID. To read or download the full report, see individual agency reports, and view Mercatus agency evaluations, see  http://www.mercatus.org/governmentaccountability/.

The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging onto their website at www.galen.org. A new study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels. The study shows that 70 percent of purchasers are over age 40, one-third make less than $50,000 a year, and 75 percent are families with children. Critics of Health Savings Account have charged that HSAs are only for the “healthy and wealthy” and argue that they should be rejected because they will destabilize health insurance for everyone else. But early findings about HSAs and other consumer-directed health plans show that the critics are wrong. To read her most recent newsletters go to http://www.galen.org/ccbdocs.asp?docID=660.

• Greg Scandlen, Director of the “Center for Consumer-Driven Health Care” at the Galen Institute, has a Weekly Health News Letter: Consumer Choice Matters. You may subscribe to this informative and well-outlined newsletter that is distributed every Tuesday by logging onto www.galen.org and clicking on Consumer Choice Matters. Archives are now located at http://www.galen.org/ccm_archives.asp  This is the flagship publication of Galen's new Center for Consumer-Driven Health Care and is written by its director, Greg Scandlen, an expert in Medical Savings Accounts (MSAs) which recently  became Health Savings Accounts (HSAs). In last month’s issue he discusses "Hospitals Resist Charging the Uninsured Reasonable Fees." "Business Week" reports on a dispute over hospital price transparency. The article by Lorraine Woellert discusses the efforts of Medical Savings Insurance (MSI) and KB Forbes of the Consejo de Latinos Unidos to make hospitals charge reasonable prices to self-pay patients. The article is very strange, however, calling Mr. Forbes a "Republican strategist" and Mr. Rooney "one of the most powerful voices on the Right," as if what hospitals charge patients is somehow a political issue. In fact, Consejo has been very effective in bringing attention to the plight of the uninsured, who are often charged three to four times what someone in a PPO is charged for the exact same service. Read the entire newsletter at  http://www.galen.org/ownins.asp?docID=652.

• The Heartland Institute, http://www.heartland.org, publishes the Health Care News, Conrad Meier, Managing Editor.  Thomas Sowell writes in Health Care News about "The Problem With Price Controls." If you ask most people about the cost of medical care, they may tell you how much they have to pay per visit to their doctor's office or the monthly bill for their prescription drugs. But these are not the costs of medical care. These are the prices paid. The difference between prices and costs is not just a fine distinction made by economists. Prices are what pay for costs - and if they do not pay enough to cover the costs, then centuries of history in countries around the world show that the supply is going to decline in quantity or quality, or both. In the case of medical care, the supply is a matter of life and death. The average medical student graduates with a debt of more than $100,000. The cost per doctor of running an office is more than $100 an hour. The average cost of developing a new pharmaceutical drug is $800 million. These are among the costs of medical care. When politicians talk about "bringing down the cost of medical care," they are not talking about reducing any of these costs by one cent. They are talking about forcing prices down through one scheme or another. All the existing efforts to control the rising expenses of medical care - whether by government, insurance companies, or health maintenance organizations - are about holding down the amount of money they have to pay out, not about reducing any of the real costs. For political purposes, what "bringing down the cost of medical care" means is some quick fix that will win votes at the next election, regardless of what the repercussions are thereafter. There are already 125,000 pages of Medicare regulations. "Universal health care" can only mean more. To see graphically how price controls and bureaucratic medicine cause patients to die, see Sowell's entire editorial at http://www.heartland.org/Article.cfm?artId=15031.

• The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom’s Magazine, for over 50 years. Richard M Ebeling, PhD, is President, and Sheldon Richman is editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. An increasing issue: “Work and family experts see growing support for paid leave in the US. In the past several years, five states have passed laws requiring private-sector employers to let workers use their own sick leave to care for a family member who's ill.” This month, read another timeless FEE classic, "The Unseen Costs of Family Leave," by Robert A. Sirico, CSP, at http://www.fee.org/vnews.php?nid=2862

• The Council for Affordable Health Insurance, http://www.cahi.org/index.asp, founded by Greg Scandlen in 1991, where he served as CEO for five years, is an association of insurance companies, actuarial firms, legislative consultants, physicians and insurance agents. Their mission is to develop and promote free-market solutions to America's health-care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. “The belief that more medical care means better medical care is deeply entrenched . . .  Our study suggests that perhaps a third of medical spending is now devoted to services that don’t appear to improve health or the quality of care–and may even make things worse.” To see their latest efforts in making sure that all Americans have affordable health care, see  http://www.cahi.org/cahi_contents/newsroom/article.asp?id=218. During the “Cover the Uninsured Week,” they made an effort to get elected officials, the media and the public to focus on issues facing America’s uninsured with a series of five articles to highlight major problems. To read Solution #1: Fair Hospital Pricing, go to http://www.cahi.org/article.asp?id=222. This week read Solution #2 Eliminate Guaranteed Issue at http://www.cahi.org/article.asp?id=225. As an example of the problem, they have teamed with the American Legislative Exchange Council (ALEC) and produced a 44 page “Guide to Health Insurance Solutions and Glossary,” which can be found at  http://www.cahi.org/cahi_contents/resources/pdf/CAHI2004LegGuide.pdf.  Here is one illustration given of what community rating and guaranteed issue does to the cost of insurance increasing the uninsured problems.

 • In 1992, New York passed legislation applying both community rating and guaranteed issue to health insurance policies issued statewide. Before the law was passed, a 55-year-old healthy male paid about twice what a 25-year-old healthy male paid for a policy. After the law was implemented, the rates for the 25-year-old man jumped more than 60%. Faced with this kind of rate hike, younger people dropped out of the health insurance market. The death spiral started, and within a few years both the young and the old were paying more than the 55-year-old paid before the law was passed.
To eliminate the uninsured problem, the politicians should pass just one law - eliminate all mandates and all community ratings - and then get out of the way of the problem so the solutions can then occur.

• The Health Policy Fact Checkers is a great resource to check the facts for accuracy in reporting and can be accessed from the preceding CAHI site or at http://www.factcheckers.org/. This week click on “Follies” to  read the Daily Medical Follies: “Woeful Tales from the World of Nationalized Health Care.” http://www.factcheckers.org/showArticleSection.php?section=follies.

• The Independence Institute, www.i2i.org, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter at http://www.i2i.org/healthcarecenter.aspx.  Read her latest newsletter at http://www.i2i.org/hcpcjune2004.aspx which includes a section on PC Medicine and Euthanasia.  If you missed her excellent article on “Compulsory Evidence-Based Medicine: An Unproven Idea That Shouldn’t be Law,” go to http://www.i2i.org/articles/2004-F.pdf.

• Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Québécois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis. This month, read Martin Masse's editorial http://www.quebecoislibre.org/04/040615-2.htm. You can still read last month's editorial on “What The Rising Tide Against Statism in Quebec Means for Canadian Conservatives,” where in he points out that Quebec is still seen by the rest of the country as a very left-wing place. But if you look at polls, you find a few surprising results. For example, a majority of Quebecers favour a bigger role for the private sector in health care. In the rest of the country, where Medicare is the cornerstone of Canadian national-statist ideology, only a  minority do. Read the entire editorial at http://www.quebecoislibre.org/04/040515-2.htm.

• The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well-being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at http://www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section at http://www.fraserinstitute.ca/health/index.asp?snav=he. The Institute reports on the American Medical Savings Accounts and recommends them as Universal, Accessible, Portable and Comprehensive Health Care for Canadians. The literature in the United States indicates that MSAs or similar arrangements have the potential to reduce health expenditures up to 20 percent. One would predict an even larger decrease in health expenditures using Canadian data because Americans already face financial incentives with respect to their use of health care while Canadians do not for the most part. To read the report go to http://www.fraserinstitute.ca/shared/readmore.asp?sNav=pb&id=222. To read last week’s editorial, “Alberta Health Care is Mediocre at Best,” noting that Alberta’s taxpayers are tossing dollars into the wind when it comes to health care, go to http://www.fraserinstitute.ca/health/index.asp?snav=he. At the same page read the previous week’s editorial, “Tell Health Care Truth: Health Care is an Economic Activity Like Any Other,” noting that in the election, the public had neither the facts nor the evidence to accurately assess the system.

• The Heritage Foundation, http://www.heritage.org/, founded in 1973, is a research and educational institute whose mission is to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. The Center for Health Policy Studies supports and does extensive research on health care policy that is readily available at their site. Be sure to read yesterday’s editorial “Bitter Pills #12: Can You See The Big Picture in Medicare Spending?” at http://www.heritage.org/Research/HealthCare/bp12.cfm. Their addition of all unfunded Medicare promises add up to $42 trillion or $140,000 for every person in America. That means for a family of four, the debt is $560,000, the cost of a nice house (or two) in some parts of the country.

• The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we’ve seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at www.mises.org to obtain the foundation’s daily reports. To see what happens when we don't have the benefit of government, read Walter Block's economic essay “The State Was a Mistake” at http://www.mises.org/fullarticle.asp?control=1522&id=69. You may also log onto Lew’s premier free-market site at  www.lewrockwell.com to read some of his lectures to medical groups. To learn how state medicine subsidizes illness, see http://www.lewrockwell.com/rockwell/sickness.html; or to find out why anyone would want to be an MD today, see http://www.lewrockwell.com/klassen/klassen46.html.

• CATO. The Cato Institute (www.cato.org) was founded in 1977 by Edward H. Crane with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens’ ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio at  http://www.cato.org/people/cannon.html. To read his editorial on "Kerry Prescribes More Government-Run Health Care," see http://www.cato.org/dailys/03-30-04.html. To read about Medicare's grim outlook, see his article at http://www.cato.org/research/articles/cannon-040326.html. To read about the conflict federal workers have with the new Heath Savings Accounts, read Cannon's analysis at http://www.desertdispatch.com/cgi-bin/newspro/viewnews.cgi?newsid1080310702,29061. To review the policy of organ transplants, "Remedying the Organ Shortage: The Ethics of Market Incentives," go to http://www.cato.org/events/040513pf.html.

• The Ethan Allen Institute is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor. Please see http://www.ethanallen.org/index2.html and click on “links” to see the other 41 free-market organizations throughout the U.S. and Canada, which will then direct you to even more free-market sites. Of note, the Mackinac Center for Public Policy is featuring an address given by Lawrence W. Reed on "Why Limit Government?" recorded at http://www.mackinac.org/article.asp?ID=6657.

• Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of “educating for liberty.” It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. You may log onto www.hillsdale.edu to register for the annual week-long von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for its national rankings in the US News College rankings. Last year, changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Read President Arnn's comments at  http://www.hillsdale.edu/arnn/usnews.asp Also read his comments on Ronald Reagan, RIP, http://www.hillsdale.edu/newimprimis/default.htm. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read Philip F. Anschutz: Whatever Happened to the Family Film? at http://www.hillsdale.edu/newimprimis/2004/june/default.htm. The last ten years of Imprimis are archived at http://www.hillsdale.edu/imprimis/archives.htm.

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Stay Tuned to the MedicalTuesday.Network and Have Your Friends Do the Same
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Del Meyer

Del Meyer, MD, CEO & Founder
6620 Coyle Ave, Ste 122, Carmichael, CA 95608 USA

P. J. O'Rourke: When buying and selling are controlled by legislation, the first thing to be bought and sold are legislatures.

Mark Twain, (1866): There is no distinctly native American criminal class save Congress.

On This Date in History - July 13

The Northwest Ordinance Enacted in 1787. Being without a Constitution and an infant nation under a loose code known as the Articles of Confederation, the United States was able to formulate the law which has been basic to our geographical and national growth ever since. The Northwest Ordinance was enacted by Congress to outline how the Northwest Territory should be governed and how it would ultimately evolve into states that would be admitted to the Union and also established the requirement that US territories have freedom of worship and trial by jury.

Horace Greeley, 1865. On this date a famous editor named Horace Greeley wrote in The New York Tribune, "Washington is not a place to live in. The rents are high, the food is bad, the dust is disgusting and the morals are deplorable. Go West, young man, go West and grow up with the country. Spinard asks? "Have times changed?"