Physicians, Business, Professional and Information Technology Communities

 Networking to Restore Accountability in HealthCare & Medical Practice

 Tuesday, June 8, 2004

 The perfect Father's Day gift is enrolling Dad in MedicalTuesday

 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.

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In This Issue:
1. The Digital Age is Upon Us - The Unsung Benefits of a Database Nation
2. Continuing Medical Education (CME) of Physicians
3. Quality of Care is Only a Catch Phrase for Those Who Want to Control HealthCare
4. This Week’s Review of Corporate Socialized Medicine - Manage Care
5. Medical Gluttony Not Only Causes Excessive Costs, but Medical Tragedy
6. Medical Myths - Dr Phil's Weight-Loss Counsel
7. Overheard in the Medical Staff Lounge - Doctor, Don’t Worry About the Cost
8. The MedicalTuesday Recommendations for Restoring Accountability in HealthCare & Government

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1. The Digital Age is Upon Us - Kiss Privacy Goodbye - And Good Riddance, Too?
This month's issue of Reason, the Magazine of Free Minds and Free Markets, arrived with my name emblazoned on the cover along with an aerial view of my office and hospital. On the inside cover was the above caption with a semi-personal letter from Nick Gillespie, the editor, along with a street map to my office and hospital. The photograph on the back cover looked disturbingly like the bulldozer that had recently excavated the gas tanks at the service station across the street. To think that Reason, in collaboration with Entremedia, Xeikon, AirPhoto USA, and Cal Poly computers, can access their database on the basis of my office address label and pull all that data together and present it on three separate pages of a journal that reaches 40,000 individuals, indicates a total loss of privacy. Gillespie states that a publication can be assembled for an audience of one - you. Articles, news, commentary, ads and catalogs can be targeted so you get only the information and offers in which you're clearly interested.

Living in a database nation raises innumerable privacy concerns. We lost our privacy beginning with our first computer purchase. The internet was able to take our slow mail address and link it to our internet activity. Gillespie thinks we may have kissed privacy goodbye and calls it a good riddance. But he thinks it also makes life easier and more prosperous. Google and Yahoo! can record every search you've ever made and link it to whatever computer you used at the time. Spammers are able to take any word in this newsletter and send me promotional or related product info, which totaled more than 800 email this weekend. But it’s easier to remove 800 email than go through 80 surface mail promotions that also arrive each day. The key is NOT to pass any laws to get the government involved. My spammator is much more efficient than any bureaucratic non-solution. My spammator removed an additional 1200 known spam. Hundreds of privacy-related bills have been proposed in the US Congress and state legislatures. A Harris poll indicated that 69 percent of those surveyed agreed that "consumers have lost all control over how personal information is collected and used by companies." That view was summed up with cynical certitude by Sun Microsystems CEO, Scott McNealy. "You have zero privacy anyway," he said a few years ago. "Get over it."

What McNealy didn't mention, and polls and politicians don't recognize, is the unsung or invisible benefits that have accompanied the databasification of American society. It's easy to complain about a subjective loss of privacy. It's more difficult to appreciate how information swapping accelerates economic activity. Like many other aspects of modern society, benefits are dispersed, amounting to a penny saved here or a dollar discounted there. But those sums add up quickly, as the Google financial statement prior to its planned IPO pointed out, adds up to billions. To read this cover story in the June issue of Reason by Declan McCullagh go to www.Reason.com, hit current issue, page 26, or go directly to http://www.reason.com/0406/fe.dm.database.shtml.

Markets function more efficiently when it costs little to identify and deliver the right product to the right consumer at the right time. Data collection and information sharing emerged not through chance but because they bring lower prices and more choices to consumers. This will also bring greater choices in health care, increase efficiency and lower prices. The Health Savings Accounts (HSAs) are beginning to allow this to happen. As Medicare, Health Maintenance Organizations (HMOs) and other bureaucratic and regressive forms of health care delivery give way to digital efficiency, we will be able to design a health plan geared to our individual needs at a price we can afford. It can't come too soon. If the government gets more involved, it will only delay the solutions.

We have quoted a number of the Reason editors over the years. Jacob Sullum who spoke to the Association of American Physicians and Surgeons (AAPS) wrote For Your Own Good, reviewed at  http://healthcarecom.net/bkrev_ForYourOwnGood.htm.

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2. Continuing Medical Education (CME) of Physicians
Last week, I attended the International Scientific Assembly of the American Thoracic Society, where 15,000 of my pulmonary colleagues from 60 countries were congregated in Orlando to learn the latest developments in Pulmonary Medicine, Thoracic Surgery, Pulmonary Pediatrics, Pulmonary Pathology, Respiratory Nursing and Respiratory Therapy. This is how physicians, nurses, and allied health specialists obtain continuing medical education (CMEs) credits to document that they are remaining up-to-date with the latest advances in medicine. Physicians and others have done this for over a century, long before it was demanded by government bureaucracies. It just became more formalized to prevent prosecution from the Medical Licensing Boards. By attending one of many concurrent sessions every available hour, one could obtain up to 52 hours credit over the five days. However, there were more than 300 hours of tape recorded sessions for credit, plus nearly another hundred hours of informal gatherings covering various aspects of medical practice. I saw one pulmonary fellow who had ordered 85 tapes. Because there were so many good lectures beyond those he could attend, he had to purchase 85 tapes on topics he felt were vitally important to his practice. It is unfortunate that politicians, as well as many well known foundations that the public feels are providing innovations in health care, actually feel that medicine is in a sad state of affairs, making many errors. They are unable to appreciate this tremendous thirst by our profession for the highest level of care. They are unable to conceive of any physician spending $10 a tape for an additional 85 learning sessions to provide the highest quality of health care with the least possible errors imaginable. Those additional 85 hours of education occur after the 60 hour physician work week. I once asked a bureaucrat if he obtained additional information about his field through tape listening. He said, “Only if my employer pays for the hours.” We need to get this message out to the people in this great land of ours before the subterfuge of those who claim an interest in health care, but have an ulterior motive to gain control of the health care establishment, subvert any true interest in improving health care. This poisons our citizens to the reality of high quality care. Be sure to forward this message to as many of your friends and associates as possible.

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3. Quality of Care is Only a Catch Phrase of Those Who Want to Control HealthCare
It was interesting to talk with colleagues from many countries last week. Most of them were participating in some form of government medicine that controls how they practice pulmonary medicine. Many of them admitted they had to make medical decisions based on bureaucratic directives that may or may not have been in the interest of their patients and hence not of the highest quality. Yet in the United States, quality of care has become a catch phrase of those that want to take over the health care system. These international meetings point out the shortsightedness of those that criticize American Health Care. The quality may have decreased over the past two decades, but it is because government and other bureaucratic directives have interfered with the free choice in medicine. The best assurance of maintaining or improving the high quality of American medicine is to free medicine from the clutches, not only of government and HMOs and other bureaucrats, but also from such socialistic organizations or foundations as the Robert Wood Johnson Foundation, the Institute of Medicine, Physicians for Single-Payer Medicine, Physicians without Borders, even from our own physician unions and professional organizations, and others highly critical of American medicine. This morning Sutter Hospital in Sacramento had a full page ad in the San Francisco Chronicle supporting socialized medicine.

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4. This Week’s Review of Corporate Socialized Medicine - Otherwise Known as  Managed Care - An Albatross in the Digital Age - Part I
Managed Care Organizations (MCO), the umbrella under which Health Maintenance Organizations (HMO) operate, have taken health care out of the Free and Open Medical MarketPlace by taking control of physicians, their office and hospital practice, their prescribing of medications, and their ordering of laboratory tests, x-rays, consultations and most procedures. This was done under the illusion of saving and controlling costs. The MCO meetings of the 1980s presented data that there were more than 400 percent variations in costs from the most expensive to the cheapest physicians. There were similar data on hospitals. They (MCO) convinced the insurance carriers (HMO) that they could manage their insured by eliminating the alleged excessive charges of those physicians whose charges exceeded the mean. Their management charges to control physicians would be reasonable in light of the moneys saved. (Similar variations in care are also seen in Canada and other socialized countries.) This lasted for nearly two decades with increasing control of every aspect of physician and hospital practices. As the level of health care quality diminished with administrators telling doctors how to perform, quality issues have come to the fore. Quality of health care was never an issue when patients could choose the best physicians and the best hospitals. Under managed care, the best hospitals and the worst hospitals, just like the best physicians and the worst physicians, are paid identically. Hence, quality of health care deteriorated as managed care supported the physicians and hospitals that were most effective in reducing expenditures, regardless of how poor their care was. This was all short lived since despite all these coercive forces, health care costs are now again showing double digit increases.

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5. Medical Gluttony Not Only Causes Excessive Costs, but Medical Tragedy
Some years ago, a 45-year-old man came to me, in his wheelchair, for pulmonary evaluation and asked if I would also help him control his back pain. In his mid thirties, he had developed back pain with radiculopathy down his right leg. He found a university neurosurgeon to operate on his back which unfortunately did not relieve his back pain. But the neurosurgeon told him that the relief of the radiculopathy down his leg was the anticipated result and back surgery frequently does not relieve back pain. Thereafter, the patient found another neurosurgeon who agreed to operate after hearing there was still some radiation of the pain into the right leg. The patient continued to have severe back pain and had to go to another medical center to find another neurosurgeon who thought he could help him. After the fifth back operation, he became paralyzed from his waist down. He developed a neurogenic bladder and, after wearing a catheter that interfered with coitus, had a suprapubic catheter surgically inserted through his abdomen. Unfortunately his potency was not restored. When I saw him for the first time, he was able to micturate by pulling the plastic catheter from his drawers and turning the stopcock to empty his bladder. He was also addicted to narcotics. I declined to interface with his pain management deferring to his pain physician specialist. It is far too risky to get involved in pain management when the California Legislature forces the prosecution of doctors who don't relieve pain and the Feds arrest doctors who prescribe too many pain pills. This man's pain would not have been relieved with anything short of anesthesia. He also asked me to find a sixth neurosurgeon to "cure his back" pain. I told him he already had at least four too many back operations. Since he admitted that his current back pain was far worse than it was prior to any surgery, he probably had five too many back operations. Wouldn't it have been preferable to have his pre-surgery back pain, not have paralysis of both legs, not live in a wheelchair, have a functioning bladder without a catheter, and a working phallus?

I totaled his health care expenses for one year which exceeded $100,000. This included several hospitalizations for chest pain and body paralysis (none of which showed evidence of new disease and resolved spontaneously without treatment), the cost of durable medical equipment and physicians fees. As usual, the cheapest item in his health care costs was the doctors’ fees which were less than $2,000 for the year. Doctors continue to be the best bargain in health care when they're in charge and can control utilization.

When he was totally paralyzed, I made an emergency home visit and diagnosed a hysterical paralysis. I reassured his wife that all vital signs were stable and he would awake as if nothing happened. She called a few hours later and said that everything was back to "normal." I probably could have kept his health care costs under $5,000 a year if it were not for the many nurses and allied health people who were unable to accept my phone reassurances and kept sending him to the hospital. An emergency room physician obviously always has to admit a paralyzed person or one with crushing chest pain. I would then discharge him a few days later when all was back to normal, with no evidence of either a stroke or heart attack. It always took "days" in the hospital rather than "hours" at home, if I would have been able to control treatment there.

As time went on, it became apparent that my availability after hours and on weekends in an attempt to control health care costs  was not appreciated by the hospitals, home care agencies, or other health care people who make a living by excessive bureaucratic control and manipulation of the system. As I witnessed maneuvers to allow this man to continue excessive utilization including unnecessary hospitalizations and before being confronted by powerful health care forces that could put my medical license in jeopardy,  I asked him to obtain the services of another physician. I'm sure his manipulations and health care maneuvers  probably continued at the rate $1 million dollars per decade. His wife continued to be employed with excellent full-coverage insurance. There is no full-coverage insurance or even one with a 20 percent deductible and full coverage after $10,000 that would have made a dent in these excessive health care costs. There has to be a copayment without an upper limit to stem this tide. Even the current HSAs with major medical insurance coverage must have a copayment without an upper limit to stem this kind of utilization. Consumer-directed health care with a percentage copayment without a limit would have dropped this man's health care costs from $1 million to probably less than $100,000 per decade of life.

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6. Medical Myths - Dr Phil's Weight-Loss Counsel
Recently, this section seems to be preoccupied with diet books. This is because obesity and overweight is a national and increasingly international epidemic making diet books very popular and financially lucrative. However, many don't pass the test of being nutritionally sound or accurate. In monitoring the Health and Nutrition Newsletter from Tufts University Medical School, another diet book, Dr. Phil McGraw’s Ultimate Weight Solution is on the New York Times best seller's list. Tufts feels this is less about an actual diet and more about how to find the psychological wherewithal to stick to a diet, part tough love, and part Texas good ol’ boy. http://www.healthletter.tufts.edu.

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7. Overheard in the Medical Staff Lounge - Doctor, Don’t Worry About the Cost!
Dr Albert, a surgeon, mentioned at lunch that a patient came in for a revision of a scar on his neck. Since cosmetic surgery is not covered by insurance, the patient stated that the "cost was no object" and he would like to proceed. Dr Albert decided to check with the patient's previous plastic surgeon and found that he had not paid for the surgery to remove the initial cyst. Obviously if one doesn't plan to pay the bill, then cost is of no concern. Rather like government or bureaucratic medicine.

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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 only 15 percent of patients fully understand what their doctors tell them. Read the Health Policy Digest at http://www.ncpa.org/newdpd/dpdarticle.php?article_id=129&PHPSESSID=e39a0a6e1124a6fe1ba752cf2830d08a. Then sit back and try to think about how many patients understand what Medicare or their HMOs tell them. In my practice, the percentage is less than 15 percent.

• 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. Dr. Tyler Cowen, General Director of the Mercatus Center at George Mason University, welcomed Dr. Anthony Woodlief as the new President. His bio is at http://www.mercatus.org/people.php/1521.html?menuid=1. He replaces current President Dr. Paul Edwards, who will assume a new role of Distinguished Research Scholar with the Social Change Project at the Mercatus Center. Susan Dudley, Director of the Regulatory Studies Program, testified on May 20, 2004, before the House Subcommittee on Regulatory Reform, on “Reforming Regulation to Keep America’s Small Business Competitive” To read the entire testimony, go to http://www.mercatus.org/article.php/709.html.

• 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. Galen Institute Briefing notes two trends that are prompting physicians to re-think the way they practice medicine: 1) The growing burden of regulations and the administrative hassles of third-party payment have left physicians frustrated and dissatisfied; 2) The growing number of self-pay patients has made physicians realize they can serve patients independent of third-party payments. To read her most recent newsletters go to http://www.galen.org/hpm_archives.asp.

• 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 on Tuesdays 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 the current issue, Greg discusses “Business Community Embraces HSAs.”  Read the entire newsletter at http://www.galen.org/ccbdocs.asp?docID=636.

• The Heartland Institute, http://www.heartland.org, publishes the Health Care News, Conrad Meier, Managing Editor. We have on occasion referred to this Free-Market Think-Tank as an excellent source of non-intrusive medical services to our sick and infirmed. This month’s lead article is written Jay Lehr, Ph.D., giving his personal experience with Canadian Medicare: “Claims That Canada's Single-Payer Health System Is More Efficient or More Compassionate than Ours Are Just Plain Untrue.” To read this report go to http://www.heartland.org/Article.cfm?artId=15034.

• The Foundation for Economic Education, www.fee.org, Richard M Ebeling, PhD, President, has been publishing The Freeman - Ideas On Liberty, Freedom’s Magazine, for over 50 years, with Sheldon Richman as 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. This month, read a classic, “The Government, the Market and the Poor,” about what happens to the poor if government becomes smaller, at http://www.fee.org/vnews.php?nid=891.

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.

• The Health Policy Fact Checkers can be accessed from the preceding CAHI site or at http://www.factcheckers.org/. This is a great resource to check the facts for accuracy in reporting. This week read the Facts on “Cost of Health Insurance” at http://www.factcheckers.org/showArticleSection.php?section=factInsurance&archive=

• 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/hcpcmay2004.aspx. 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/hcpcmay2004.aspxhttp://www.i2i.org/hcpcmay2004.aspx.

• 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 an address by Martin Masse 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 speech 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. 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’s Nadeem Esmail’s latest editorial, “How Good is Canadian Health Care? 2004 Report,” co-written with Dr. Michael Walker, the Executive Director, and Sabrina Yeudall, can be found at http://www.fraserinstitute.ca/shared/readmore.asp?sNav=pb&id=658.

• 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 conducts extensive research on health care policy that is readily available at their site. This month, Derek Hunter discusses “The Truth About the Medicare Drug Discount Card” at http://www.heritage.org/Research/HealthCare/bg1766.cfm.

• 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. They will be meeting in Pavilion Office Building in Montpelier, Friday June 25. One keynote speaker will be Greg Scandlen of the Galen Institute. 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 this week, 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. Supreme Court Justice Clarence Thomas spent his winter recess at Hillsdale teaching a special course on the Constitution. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, brush up on your middle east history from the author of Two Faces of Islam by Stephen Schwartz at http://www.hillsdale.edu/newimprimis/2004/May/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
The MedicalTuesday website has now been fully automated. Each individual on our mailing list is now able to be invited, register, or de-enroll as desired. If you were added in error or you are not interested in or sympathetic to a Private Personal Confidential Affordable HealthCare system, we have made it easier for you to unsubscribe simply by clicking the Remove Me link below. If you encounter difficulties, please send an email to Admin@MedicalTuesday.net, and your name will be removed. Please be sure that Remove, Your Name and your Email address appear in the subject line of the email or our spammator will not forward it to us. Please forward this message to as many of your friends and colleagues as possible. You may want to copy this message to your Template file so that it is available to be forwarded or reformatted as new at any time the occasion arises. Then, save the message to a folder in your Inbox labeled MedicalTuesday.

Del Meyer

Del Meyer, MD, CEO & Founder

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.

Ronald Reagan (Feb 11, 1911 to June 5, 2004) The government is like a baby's alimentary canal - with a happy appetite at one end and no responsibility at the other.

On This Date in History - June 8

Former President Dwight D Eisenhower on this date in 1964 delivered an address to the National Governors Conference. He said: "Our best protection against bigger government in Washington is better government in the states." Spinrad carried it a couple of steps farther. Our best protection against government is better governing of ourselves. Repressive measures adopted under the banner of law and order are too often prompted by the excesses of individual citizens and the failure of other citizens to stand together.

Frank Lloyd Wright was born on this date in 1869 in Richland Center, Wisconsin. Frank Lloyd Wright designed the Imperial Hotel in Tokyo, the Guggenheim Museum in New York, and striking, innovative homes all over the country. He was a pioneer at blending a house into its surroundings. He thought of architecture as a design for living, a way to approach our life on earth. Since we can't count on finding a Frank Lloyd Wright when we want him, we have to be our own architects as we build our lives. There is a lesson here for planning and building our own health care innovations.

Our Increasing Number of Quirky Holidays: Today is National Best Friends Day.