Physicians, Business, Professional and Information Technology

 Networking to Restore Accountability in HealthCare & Medical Practice

 Tuesday, September 9, 2003

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In This Issue:
1. Pro & Con Arguments for Single-Payer Health Care
2. Comparison of Health Care with Public Schools
3. Our Monthly Review of the Twenty Myths of National Health Insurance
4. Medical Gluttony or Excessive HealthCare Costs Cannot be Managed by Carriers or Government
5. The MedicalTuesday.Network for Restoring Accountability in HealthCare for Patients, Society & Government

Pro and Con Arguments on National Heath Care
Thanks to Merrill Matthews, Jr., PhD, for bringing to our attention the Council for Affordable HealthCare Insurance (CAHI), www.cahi.org, a huge repository of important health care information and its companion site, FactCheckers (http://www.factcheckers.org), which gives the reality side of the single-payer or universal health care agenda. This week’s lead entry on the latter site is the article by Physicians for a National Health Program published by JAMA, the Journal of the American Medical Association. In an unprecedented show of physician support for National Health Insurance (NHI), 7782 U.S. physicians propose single-payer NHI in an article in the August 13 issue of JAMA. The doctors’ article critiques the health reform plans that have been offered by President Bush and the major Democratic presidential contenders. Dr. Quentin Young states, “Proposals that would retain the role of private insurers - such as calls for tax-credits, Medicaid/CHIP expansions, and pushing more seniors into private HMO’s - are prescriptions for failure. By perpetuating administrative waste, such proposals make universal coverage unaffordable.” FactCheckers give four responses to this article. The first is from CAHI responding to four of their statements:

Claim #1:  Canada’s System of Socialized Medicine Is Sufficiently Funded to Provide Care to All. Canada spends about 9 percent of its GDP on health care and provides coverage for all, while the U.S. spends 14 percent and has millions of people uninsured. Proponents of a Canadian model thus conclude that the federal government could cover every American for what the country is spending now -- or less.

That argument ignores the fact that there is no government-run health care system in the world that is adequately funded. And the reason is simple: health care must compete with education, welfare, defense and other valid claims on government funds. As a result, every government-run system rations care, with bureaucrats and elected officials deciding who gets what and when.

Claim #2: Canada Provides Universal Access to Care. Proponents of socialized medicine argue that the uninsured typically postpone seeing a doctor and end up in the emergency room, which costs the system a lot more than it would had they just gone to see a family doctor. If everyone has government-provided coverage, then you remove that costly inefficiency and people have access to care when they need it. Or do they?

Case Study: Waiting lines in Canada. Access to a waiting line is not the same (nor as good) as access to a doctor. On January 18, 2003, the Canadian Press carried the headline, “Send cancer patients to U.S., Alberta MDs urge.” The story begins, “Breast-cancer patients, whose wait to see a specialist has jumped up to eight weeks from less than four, should be sent out of province for treatment, the president of the Alberta Medical Association says.” In a story about a proposal to allow private day surgeries in Vancouver, British Columbia, to reduce waiting times, the Vancouver Province (June 11, 2003) reports, “But even when the (Richmond) hospital was at its most efficient, 40 percent of patients were waiting three months or more (for elective surgery).” As bad as that is, it’s better than England, where 57-year-old Peter Smith got his heart surgery a full five months after he first complained of chest pains to his general practitioner (London Observer, May 25, 2003).

Claim #3: The Quality of Care in Canada Is as Good as or Better than the U.S.
“Quality health care” means different things to different people. For individuals, quality health care usually means a good outcome, conveniently obtained at a reasonable price. But can you have quality health care if a patient can’t see a doctor?

Case Study: The quest for quality health care. The headline in the June 16, 2003, Vancouver Sun pretty much says it all: “Doctors Demand Patient Care Guarantees.” The  British Columbia Medical Association has released a paper calling for “the establishment of maximum wait times, or ‘care guarantees’ for various medical procedures,” according to the story. The report “proposes that patients not helped within the guaranteed time frame should be able to seek care out of province – in a public or private facility – at no cost to themselves.” In Canada it is against the law for a citizen to pay out of pocket for care that is provided by the government-run health care system. The only other countries that criminalize privately paying for health care are North Korea and Cuba.

Claim #4: In Canada’s System, Everyone Is Treated the Same. The push for socialized medicine isn’t just about health care; it’s also a quest for social justice. Advocates don’t want the rich to get better care than the poor. But the rationing that always accompanies a government-run system means that some people will not get the care they need, and it is nearly always society’s marginal citizens – the poor, the very old and those with very high costs – who get substandard care, if they get care at all.

Just consider some of these headlines from England:  “Am I too old to be treated?” The Sunday Times,
April 17, 1994; “Kidney patients die as costly dialysis machines lie idle,” The Times, July 26, 1993;  “Too old to be cured of cancer,” The Times, August 16, 1993.

But there can be other perverse results from rationing. Greg Moulton of Guelph, Ontario, was in a three-month wait to get a CT scan “to learn the cause of his ‘excruciating’ headaches.” Since York Central Hospital’s radiology department was only open to the public at specified hours, the hospital decided to allow pet owners to bring in their animals in need of a CT scan after hours —
for $300 a scan. “For dogs, a scan can be arranged within 24 hours,” according to the Canadian Press (“Humans wait in pain, dogs don’t,” June 14, 1991).

Another Canadian was more resourceful. On December 18, 1999, the Washington Post reported that waiting lines for MRIs in Ontario had grown so long that one Ontario resident “booked himself into a private veterinary clinic that happened to have one of the machines, listing himself as ‘Fido.’” In a socialist effort to avoid a two-tiered system where wealthy people can get health care but the poor can’t, Canada has created a different kind of two-tiered system – where people can’t get care, but dogs can.

Conclusion.  These news articles (and many more not included) tell the story of a financially strapped health care system that threatens the health and lives of its citizens. The dates on the articles, ranging over a decade, tell the story that these are not simply past problems nor current problems, but systemic problems inherent to government-run health care.

Seniors in the U.S. Medicare program are already in a government-run system; and they are experiencing many of the same problems Canadians face every day. If we emulate Canada, America’s health choices will narrow,  and health innovations and breakthroughs will be suppressed. And while price controls and rationing mean we may spend a little less money, we will get a lot less care–just look at Canada. That is the story we are not being told. For the other responses, see http://www.factcheckers.org.

Are Public Health Care, Public Education, Public Golf Courses Free?
In a health forum, Linda Gorman, Director of the Health Care Center at the Independence Institute, www.i2i.org, commented on an article in the Oakland Tribune: Dr. Ursula Rolfe, described as "a retired physician who worked for years at Children's Hospital Oakland" and who has been waiting for a national health plan since she was a student at Stanford University Medical School in the early 1950s, uses the following as an argument: "This country has public schools, public libraries, even public golf courses," she said. "Why not public health care?"

Ms Gorman responds that apparently Dr Rolfe has been isolated in the Bay Area in a select political stratum for so long that she doesn't realize that the school-choice movement has become a real threat to the current organization of the political landscape--precisely because the public schools are an unmitigated disaster and huge numbers of people with children and grandchildren . . .  realize this. I find that claiming that national health advocates are trying to remake medicine in the image of public schools is a useful talking point. The school argument has traction. People know that lack of choice, union control, and stupid regulations have destroyed the public schools. They transfer that understanding to the health care debate. They also know that the wealthy get the good schools and that the schools for poor minorities are, to put it mildly, horrific. Then you ask how they think medical care will go if the same model is applied.

To which Vern S. Cherewatenko, MD, MEd, Chairman & CEO, SimpleCare, added, “The public golf courses around here are not FREE – you still gotta pay! There is a trend away from public education toward home schooling and private schooling… We already have public health care!”

To which we would add that the last time we played a round of golf on a public course, the green fee was more than patients had to pay for a medical evaluation. Why does the media continue to report such statements that have no basis in reality? Just because a doctor said so doesn’t make it factual. Don’t they owe the public some semblance of reliable reporting? Whatever happened to integrity?

National HealthCare Systems in the English-speaking World. (No 17)
In his recent update of the “Twenty Myths about National Health Insurance,” John C Goodman, PhD, president of the National Center for Policy Analysis (www.ncpa.org), states that ordinary citizens lack an understanding of the defects of national health insurance and all too often have an idealized view of socialized medicine. For that reason, Goodman and his associates have chosen to present their information in the form of rebuttal to commonly held myths. See previous issues or the archives at www.MedicalTuesday.net for the summary of the first sixteen myths, or www.ncpa.org for the original 21 chapters of the book and the well-annotated references.

Myth Seventeen: Single-Payer Health Insurance Would Benefit Residents of Rural Areas

What we know about who gets care and who does not under non-price rationing schemes is very incomplete. However, geographical variations in health care and outcomes exist: Despite extensive reform efforts to combat geographic disparities in access to medical services, Canada, Britain, New Zealand and Australia all struggle with medically under-served areas.

Waiting times are longer in rural areas, principally because advanced medical equipment is in short supply. Expensive technology is often only available at major hospitals in large cities. In addition,  rural patients are at a considerable logistical disadvantage because care is given to patients who are available when an opening occurs in the surgery schedule. Urban patients live closer to medical facilities and benefit most from public provision. Their rural counterparts often have to travel hundreds of miles just to get treated. So, by using waiting as a rationing device, public systems indirectly discriminate against rural patients.

Rural Patients in Britain. Britain is one of the few countries that even publishes hospital waiting lists for the entire country by region. Yet in Britain, as in other countries with single-payer systems, rationing decisions are made by doctors and hospital personnel at the local level. There is no national procedure to guarantee that those in greater need move to the front of the waiting lines.

Those who established the British National Health Service (NHS) felt that the most important philosophical principle was equal access to health care. However, as noted above, inequalities across England persist and may even have grown worse since the NHS was founded in 1948. The British government tends to spend the most in metropolitan areas - especially the wealthier urban districts - where private sector alternatives are most abundant. For example, the NHS spends 20 percent of its annual budget on the greater London area, although only 15 percent of the population lives there and have access to the most private sector services. Nonetheless, there are persistent pleas to allocate even more resources to the London area. Overall, there are vast differences in the amount of resources allocated to different regions of the country:

• The North East Thames region (near London) has 27 percent more doctors and dentists per person, 15 percent more hospital beds and 12 percent more total health spending than the Trent region (in the more rural northern part of the country).
• There are 63 doctors per 100 beds at University College Hospital Trust in London, compared to 11 doctors per 100 beds at the hospital in Northern Devon, a rural area in southern England.
• At Chelsea and Westminster Healthcare Trust, located in one of London’s most prosperous districts, there are 64 doctors per 100 beds, compared to only 18 doctors per 100 beds at Pinderfields Hospital in rural West Yorkshire.

These differences in resources reinforce regional disparities in the levels of care that patients receive. To be sure, government reforms of the past two decades have brought some noticeable declines in the waiting list numbers. However, it is significant to note that some areas have seen greater improvement than others.
• Between March 1997 and 1999, the total number of patients waiting for medical treatment in the three London health authorities fell by between 23 and 31 percent.
• Over the same period, the total number of patients waiting for medical treatment in the three rural health authorities increased by between 12 and 19 percent.

Medical Gluttony
In this section, we highlight excess health care costs as demanded by patients. Almost all patients have a wish or shopping list. These get larger as they attend gatherings of their peers and see illnesses that they think can be prevented with tests. Cost is never a consideration inasmuch as the patient is shielded from all knowledge of costs. In fact, some physicians have been reprimanded in the past for considering cost as an object. Something so important as health care should be available to all regardless of cost, or so the reasoning went. There are actually adults who are so naive that they believe this. They have no comprehension of the human appetite for greed. Most responsible physicians judiciously reduce requests for hospitalizations, consults, surgeries, x-ray, CT, MRI, and laboratory tests to only those that are medically warranted. This section has shown a consistent 100 percent to 10,000 percent increase in costs if we follow patients’ requests for hospitalizations, consults, surgeries, x-ray, CT, MRI, and laboratory tests that they desire based on their lack of understanding of their true health picture. Every day in my practice, I am able to reduce requests for costly unnecessary medical care by at least $2,000, possibly to $5,000 on some days. I’m sure this is an experience shared by the other 500,000 practicing physicians in the US. At the low end of the estimate of one billion dollars a day, that translates into a quarter trillion dollars in a 250-day work year that is stopped at the physician encounter. The physician encounter stops this without any rules, regulations or carrier requirements, but simply because of personal physician integrity. That doesn’t include the patients that bypass their personal physician encounter and go directly to an urgent care center (at twice the office rate) or hospital emergency room (at ten times the office rate). This is precisely the reason that all single-payer, universal health care or socialized medicine plans are doomed from the start and require intense bureaucratic restrictions. Should they become implemented, they will cause a bottle neck at the point of service and consequently increase waiting lists for care. In the absence of a medical evaluation prior to such a wait, this then causes unnecessary suffering and deaths. To see a listing of these “Woeful Tales from the World of Nationalized Health Care,” see http://www.factcheckers.org/showArticleSection.php?section=follies

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The MedicalTuesday Network 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 review in this newsletter monthly, 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. Be sure to study his series on how Health Insurance Mandates increase costs, where a single mandate that increases a premium by $700 can sometimes force well-insured individuals to drop their insurance, adding to the uninsured problems. Read the whole article at http://www.ncpa.org/edo/jg/2003/jg021103.html.

• The Mercatus Center at George Mason University is a strong advocate for accountability in government. Nobel Laureate Vernon L Smith, PhD, who has joined the Economics faculty, is currently visiting Alaska and performing a cyberspace study in economics. Please log on at www.mercatus.org to read the government accountability reports–their fourth annual Performance Report Scorecard by author Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former government minister in New Zealand, and now director of the Mercatus Center’s Government Accountability Project . . .  The well-known market economist Professor Walter Williams will be honored at a reception and dinner at George Mason University on Tuesday, September 23, for his many accomplishments from his nationally syndicated column, numerous books and articles.

• The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter to which you may subscribe by logging onto their website at www.galen.org. The politics of Medicare reform become more complex by the day but always are driven by deep and still-unresolved ideological fissures. The question that is always at the center of the debate over health care in this country is whether government or individuals should be in charge of managing resources and decisions. This week we bring you her response to the JAMA article above which she titles:
 To jolt the health policy debate out of the August doldrums, nearly 8,000 physicians announced that they are supporting a taxpayer-funded, single-payer health care system based on “an expanded and improved version of traditional Medicare.”
  In this FantasyLand plan, the federal government would pay for all physician and hospital care - without any co-payments or deductibles - and also would cover prescription drugs, medical equipment, long-term care, rehabilitation services and dental care. The authors claim that their plan, described in detail in the current Journal of the American Medical Association, would SAVE $200 billion a year.
  Where should we start? First, today's Medicare covers only about half the health care expenses of seniors, with 90% of beneficiaries obtaining supplementary coverage. The proposed universal version of Medicare would have to be very much “improved” - and much more expensive - to even match the average private health plans that the great majority of working Americans have today, plans that are much more comprehensive than current Medicare.
  The list could go on and on, but perhaps an article in The New York Times this week is the best way to show where this all-you-can-eat health care buffet would lead. It describes the experience of the residents of Wales in the United Kingdom seeking dental care from their government-run National Health Service.
  “…On a rainy Monday morning two weeks ago, 600 people turned up outside Brynteg Dental Surgery, a tiny white-stucco office, to secure one of the 300 advertised appointments to see a National Health Service dentist,” the Times reports. “Wales is so lacking in government-subsidized dental treatment that some people pitched tents overnight rather than miss a chance for a slot
  “Heather Davies, 25, the office manager who handed out numbers, deli style, on the morning of registration, said she was still getting nasty phone calls from some of the 300 people she had to turn away. “People hurled curses and rude gestures at her. One man threatened her, saying, 'I know what time you get off work,' Ms. Davy recounted. She felt compelled to telephone the police. In fact, the office now has a direct hot line to the police.
  “'Because they are paying national insurance, people feel they are entitled to service,'" Ms. Davies said.” How audacious!
  So this is where it leads: Angry patients paying high taxes for universal access to health and dental care, only to be turned away after sleeping on sidewalks all night, with dentists calling the police to protect themselves from desperate patients. . . .
  The battles continue between advocates of government-run health care and those, like us, who are trying to build a consumer-driven system organized through competitive, free markets.
  Yes, Americans are frustrated with the health care system - millions of uninsured, high costs, and bureaucratic intrusion. But more bureaucracy and centralized control in an era of dramatic new medical treatments and technologies simply can't prevail. The United States has an obligation to lead the world to a better system, not turn back to the failed systems of the last century.  For the full article, see http://www.galen.org/happenings/081503.html.

• 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 or read this week’s issues by logging onto www.galen.org and clicking on Consumer Choice Matters archives. This is the flagship publication of Galen's new Center for Consumer-Driven Health Care and is written by its director, Greg Scandlen. This week we bring you Greg’s News Release in response to the JAMA article cited above.
 Single-Payer System Rejected Time and Again. Alexandria, VA - It is hard to imagine anything more boring than yet another push for a single-payer health care system. This hackneyed idea has been proposed about once a decade for the past 70 years at least. It is soundly rejected by the American people every time it rears its ugly head, most recently on the ballot in Oregon last year where it was defeated by a 4 to 1 vote.
 "Yet a group of left-wing physicians have expressed their desire to once again push for a single-payer system in an article published today in the Journal of the American Medical Association," said Greg Scandlen, director of the Galen Institute Center for Consumer Driven Health Care.
  Countries that have adopted the approach are racing to change it. Surveys by Dr. Robert Blendon of Harvard University show a similar level of discontent among the people of Canada, the UK, Australia, New Zealand, and the U.S. Popular support in Canada has plunged in the past ten years.
  These countries see that a single-payer approach leads to rationed care, high rates of taxation, and the virtual banishment of new technology and innovation. "It is time for single-payer advocates to join the 21st Century and support empowering consumers instead of relying on Command and Control bureaucrats to make decisions for Americans," said Scandlen
  A consumer driven health care system would improve the health of Americans and make health care more affordable, without the dictates of government control. For the full article, see http://www.galen.org/news/081303.html.

• Martin Masse, Director of 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 will allow you to brush up on your French. You may also register to receive copies of his webzine on a regular basis.
 The recent message: “Government Is the Rule of Black Magic” (Part One), by François-René Rideau in which he asks the Questions: Are there any rational justifications to the existence of government? Is government the answer to the problems it claims to solve? He answers that the government does not solve the problems it claims to solve, but it creates these problems to begin with. In the current issue (Part Two) he describes Black Magic and White Magic as two opposite poles in the universe of attitudes that humans can have toward Life. . . So as to assess the effects of various attitudes and deeds, we must examine the respective influences of Black Magic and White Magic in human behavior. Black Magic always wins in appearance; you will always see it dominate the established institutions, glorified by formal rites and astonishing shows. But it is White Magic that actually makes the world go round, even if it requires discernment to see that. Black magicians are expert in wishful thinking, idle imprecation, and deception of themselves and other people; but only through the dedicated work of white magicians does the world actually progress. All creation stems from the principles of White Magic. White Magic serves as the basis for civilization itself. And Black Magic itself can survive but as a parasite to White Magic –– for if there is no creation, there soon remains nothing left to destroy. The entire article is worth reading and digesting. It can be found at http://www.quebecoislibre.org/030816-12.htm. Perhaps it will help us see the right and the left in perspective.

• The Heritage Foundation, Edward Fuelner, PhD, President and CEO, was founded in 1973 as 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.  We want an America where it is safe and secure; where choices in education, health care and retirement abound; where taxes are fair, flat, and comprehensible; where everybody has the opportunity to go as far as their talents will take them; where government concentrates on its core functions, recognizes its limits and shows favor to none. And the policies we propose would accomplish these things. We believe that ideas have consequences, but that those ideas must be promoted aggressively. So, we constantly try innovative ways to market our ideas. We are proud of our broad base of support among the American people and we accept no government funds. The Center for Health Policy Studies supports and does extensive research on health care policy that is readily available at their site, http://www.heritage.org. You may email topics to your friends or receive regular updates.

• 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.
 Last week’s message by Christopher Mayer is about William Sumner's Forgotten Classic. Sumner packed penetrating observations about the nature of political relations and the incessant struggle of power against liberty. Of particular interest, is Sumner's widely known (but not as widely understood) concept of the Forgotten Man. The Forgotten Men are those who work and save and otherwise mind their own business. Whatever the government spends, it can do that only by " . . . taking it from some other man, and this latter must be a man who has produced and saved it. This latter is the Forgotten Man." But it is upon the backs of such men that civilization advances and the standard of living is raised. Sumner understood that capital was the building block of civilization. . . .  Going after the successful individuals or placing limits or penalties on accumulating wealth are shown to be the work of sheer folly, likened to "killing off our generals in war," as Sumner points out. . . . For Sumner, society needs no supervision imposed upon it by force and each man ought to be free to seek happiness in his own way. As a result, the only reforms Sumner advocated were those that would undo the work of the statesmen of the past. Sumner advised, "If the social doctors will mind their own business, we should have no troubles but what belongs to Nature. Those we will endure or combat as we can. What we desire is, that the friends of humanity should cease to add to them . . .  "  It may seem odd that a man writing at the tail end of the nineteenth century should have anything to teach us as we sit here in the opening years of the twenty-first century. However, timeless insights like Sumner's never grow obsolete. Today our government continues to play judge and jury with the fruits of other men's labors and many people think nothing of it. The Forgotten Men are still forgotten. Capital is still underappreciated or else confused . . .  The entire essay is worth reading and pondering and can be found at  http://www.mises.org/fullarticle.asp?control=1306&month=60&title=Sumner%27s+Forgotten+Classic&id=60. 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.

• CATO. The Cato Institute 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. Toward that goal, the Institute strives to achieve greater involvement of the intelligent, concerned lay public in questions of policy and the proper role of government. There are many studies available on various health care issues: http://www.cato.org/healthcare/index.html.  Last week’s lead article, from the Houston Chronicle, researched tuition costs at private schools and found them much less than most people think. The most recent figures available from the U.S. Department of Education show that in 2000, the average tuition for private elementary schools nationwide was $3267. Government figures also indicate that 41 percent of all private elementary and secondary schools - more than 27,000 nationwide - charged less than $2500 for tuition. . . . Many school districts spent twice that much taxpayer’s money per student at public schools. We must remember that health care problems can never be objectively understood by the public as long as we send our children to schools where the teacher is dependent on taxpayer funds for salary and support. It jeopardizes the entire orientation of a free society.

• The Ethan Allen Institute is one of some 41 similar but independent state organizations associated with the State Policy Network. 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. Click on “links” to see the other 41 free-market organizations throughout the U.S. & Canada. Today we would highlight Reason at http://www.reason.org, the monthly print magazine of “free minds and free markets.” It covers politics, culture and ideas through a provocative mix of news, analysis, commentary and reviews. Reason provides a refreshing alternative to right-wing and left-wing opinion magazines by making a principled case for liberty and individual choice in all areas of human activity.

• Hillsdale College, the premier small liberal arts college in southern Michigan with about 1200 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 Institutes. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. Read the current issue by Dr Edward J. Erler, professor of political science at California State University, San Bernardino, on “The Michigan Affirmative Action Cases: An Historical Perspective” at http://www.hillsdale.edu/imprimis/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