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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 antithesis of free enterprise, which was needed to control health care costs and maintain our high quality of care.

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In This Issue:
1. First Nanochips Have Arrived – Med-InfoTech Down to One Billionth of a Meter
2. Losing Patients – A Film Questions Canada's Nationalized Health Care
3. The Other Half of Einstein's Brain - Overlooked for Half a Century
4. HealthCare Illiteracy – What Is the Real Cause? How Can We Correct It?
5. Myths of American Medicine – Who Does White Coat Crime Really Injure?
6. Medical Gluttony – Why Can't I Go to the ER to Have My Shoulder Checked Out?
7. Overheard in the Medical Staff Lounge – A Culture From Another Era?
8. The MedicalTuesday Recommendations for Restoring Accountability in HealthCare & Government

1. First Nanochips Have Arrived – Med-InfoTech Down to One Billionth of a Meter
For most people, the notion of harnessing nanotechnology for electronic circuitry suggests something wildly futuristic, says G Dan Hutcheson, a semiconductor industry analyst. In fact, if you have used a personal computer made in the past few years, your work was most likely processed by semiconductors built with nanometer-scale features. These immensely sophisticated microchips--or rather, nanochips–are now manufactured by the millions, yet the scientists and engineers responsible for their development receive little recognition. So Hutcheson, in his Scientific American article, would like to trumpet their accomplishments and explain how their efforts have maintained the steady advance in circuit performance to which consumers have grown accustomed.

The recent strides are certainly impressive, but is semiconductor manufacture really nanotechnology? Indeed it is. After all, the most widely accepted definition of that word applies to something with dimensions smaller than 100 nanometers, and the first transistor gates under this mark went into production in 2000. Integrated circuits coming to market now have gates that are a scant 50 nanometers wide. That's 50 billionths of a meter, about a thousandth the width of a human hair.

Having such minuscule components conveniently allows one to stuff a lot into a compact package, but saving space per se is not the impetus behind the push for extreme miniaturization. The reason to make things small is that it lowers the unit cost for each transistor. As a bonus, this overall miniaturization shrinks the size of the gates, which are the parts of the transistors that switch between blocking electric current and allowing it to pass. The more narrow the gates, the faster the transistors can turn on and off, thereby raising the speed limits for the circuits using them. So as microprocessors gain more transistors, they also gain more speed.

The desire for boosting the number of transistors on a chip and for running it faster explains why the semiconductor industry, just as it crossed into the new millennium, shifted from manufacturing microchips to making nanochips. How it quietly passed this milestone, and how it continues to advance, is an amazing story of people overcoming some of the greatest engineering challenges of our time--challenges every bit as formidable as those encountered in building the first atomic bomb or sending a person to the moon.

The best way to get a flavor for the technical innovations that helped to usher in the current era of nanochips according to Hutcheson is to survey improvements that have been made in each of the stages required to manufacture a modern semiconductor--say, the microprocessor that powers the computer on which I typed this text. That chip, a Pentium 4, contains some 42 million transistors intricately wired together. How in the world was this marvel of engineering constructed?

To survey the steps and read the entire exciting article on the InfoTech that will carry the processing of all health care data and information research into the decades ahead, go to http://www.scientificamerican.com/print_version.cfm?articleID=000CE8C4-DC31-1055-973683414B7F0000.

The film opens with a nun struggling down the corridor of a crowded ward to administer Holy Communion. Patients, health professionals, even electricians, are tripping over each other, packed into an environment of general confusion. And yet there is another floor of the hospital that is completely closed, thanks to a government directive.

The dying man’s son is a successful investment banker in London. He’s the kind of guy who can wriggle around anything. First he wrangles his way into the hospital’s management offices without a pass and corners the manager, who is completely isolated from the chaos outside. He offers her a bribe to get his father moved out of the zoo and into a private space on the empty floor. She quietly takes the bribe but points out that she can do nothing without the hospital employees’ union. The son pays off the union boss to prepare a private room on the empty floor. Painters, carpenters, and other workers quickly make it up.

Then, because there is virtually no access to PET (positron emission tomography) scans in Canada, the banker takes his father to Vermont to get one. One of the son’s friends in Baltimore -- one of many Canadian doctors who have emigrated to the U.S. -- examines the scan and informs him his father will have a much better chance in Baltimore than in Montreal. Remarkably, the father will have none of it: "I voted for socialized health care," he proclaims, "and I’m prepared to suffer the consequences!"

With this line, the father speaks for too many Canadians who often wrap their national identity in nationalized health care. This is why Canadian politicians have not had the courage to give Canadians more health freedom. But the pain and inhumanity caused by the Canadian system are starting to make even the most nationalistic reconsider the amount of control over health services that we’ve ceded to our government.

The Barbarian Invasions tells us a lot about the consequences of government monopoly health care. The hospitals are poorly managed, the doctors and nurses are confused, the unions run the show thuggishly, and the patients are all but ignored.
The film has sparked a debate in Canada about the role of the state in health care. Any American who thinks health care in the United States would be improved by implementing a single-payer system would learn much from this film.
To read the article by John R Graham, see http://www.reason.com/0411/fe.jg.losing.shtml.

The father’s reasoning is pervasive in all government-run health care. On a visit to London we went to the Edinburgh Festival on the Virgin Train. The CPA sitting across from us expressed similar sentiments – that the NHS was bad medicine. He had private health insurance. But since he was paying taxes for the NHS, he at times would wait in line to utilize it for minor problems so that he could not be injured by the system.

One of the respected scientists who examined sections of the prized brain was Marian C. Diamond of the University of California at Berkeley. She found nothing unusual about the number or size of its neurons (nerve cells). But in the association cortex, an area responsible for high-level cognition, she did discover a surprisingly large number of nonneuronal cells known as glia--a much greater concentration than that found in the average Albert's head. Mounting evidence suggests that glial cells, overlooked for half a century, may be nearly as critical to thinking and learning as neurons. To read more about how we think, go to http://www.scientificamerican.com/article.cfm?articleID=0002488D-D736-1055-973683414B7F0000.

4. HealthCare Illiteracy – What Is the Real Cause? How Can We Correct It?
Much has been written about medical literacy and how to improve it. Of course we can never know enough about health. But how do we go about improving it? P. Lynne Stockton, VMD, reports in the last issue of the American Medical Writers Association Journal (AMWA Journal) (http://www.amwa.org/) that nearly half of American adults (90 million) cannot understand basic health information, keeping them from the care they need and costing the health care industry billions of dollars. Dr Stockton feels this lack of understanding is mainly because health information is often written well above the level at which most people read. She also points out that many of the consequences of low medical literacy are that patients:

• make more errors with medications,
• are less likely to complete treatments,
• have more trouble without health care system,
• are more likely to be hospitalized.

Among the solutions she mentions is the Plain Language system (http://www.plainlanguage.gov). The consent forms that are reduced to an 8th grade level and further reduced to a 4th grade level are illustrated. However, the primary consent form, which is written at the college level, appears similar to what attorneys tell physicians and hospitals they need. Perhaps one solution is for the clinician to write operative and hospital consent forms and exclude the legal costs? But who would risk it?

Our educational system is not improving medical literacy. Many primary schools no longer offer Health as a subject. A golden opportunity is lost.

But how does American medical illiteracy compare with the rest of the world? We have previously reported on the NCPA study that illustrates how patients in socialized health care countries are satisfied with inferior care because they have no initiative to learn more about what options are available for care. Americans know more about health care because we still have a relatively free health-care system. Since we have been dumbed down by Medicare HMOs and managed care, which is basically corporate-style socialized medicine, medical illiteracy has been on the rise. All the federal programs mentioned in this article, which appear to be excellent, will have little effect without personal motivations or incentives. When managed care or government medicine controls health care, learning how to traverse the health care maze has little relevance. In fact, government may see that as reducing compliance. Medical literacy only increases when patients have free choice and seek out their options. With the current emphasis on consumer-driven health care, patients will learn the benefits of the various options without any government programs.

5. Myths of American Medicine – Who Does White Coat Crime Really Injure?
Madeleine Pelner Cosman, PhD, JD, Esq, in her upcoming book, Who Owns Your Body, gives Nine Myths of American Medicine. http://www.healthplanusa.net/MC-WhoOwnsYourBodyIntro.htm  See the October 26 MedicalTuesday for Myth One (www.MedicalTuesday.net).

Ordinary criminals must act criminally and intend their actions. White-coat-wearers need not intend to commit their alleged crimes nor know that their acts are criminal. Wearers of white coats need not be physically present nor personally commit the crime. The accused doctor should have known that certain acts were forbidden. Ordinary fraud is defined as intentional misrepresentation of material fact for the purpose of causing a person’s injurious reliance and damage. Medical fraud can be unintentional, trivial and not material, not harm and actually help the patient if the crime hurts the medical program by billing it for the patient’s care. Drug dealers, murderers, and arsonists who are tried, convicted, then sentenced under the Federal Sentencing Guidelines are likely to get shorter less savage prison sentences than convicted physicians and surgeons.

Ordinary criminals have Constitutionally-protected rights to defense. Vigorous White Coat Crime defense is difficult when the doctor’s assets are frozen then taken under Forfeiture laws. White Coat defense lawyers correctly fear being accused and indicted for conspiracy in the medical crime. Ordinary criminals cannot be prosecuted under ex post facto rules. No murderer, arsonist, or rapist can be convicted of a crime that he perpetrated before the law made his specific act a crime. Physicians, however, can be prosecuted under ex post facto laws that define acts not prohibited and not called crimes until the doctor does it.

Medical law wasn’t always this vicious. Law by law, incrementally from Medicare’s inception in 1965, the law shifted slowly and surreptitiously from civil law to criminal law, and each law became more draconian, arbitrary, and punitive than the one before. This chapter reviews seven White Coat Crime threats to physicians’ medical liberty:

• Qui Tam Lawsuits
• Forfeiture Law
• Mail Fraud and Money Laundering statutes
• Medical Fraud definitions
• Federal Sentencing Guidelines
• Ex post facto judgments
• Medical bounty systems

Exemplifying these deadly devices are cases ranging across national geography and medical specialties in which excellent, efficient practitioners were caught in technical infractions of capricious laws literally interpreted and retroactively enforced. A California ophthalmologist convicted of medically unnecessary surgery totaling $65,140 was fined $16,200,000 and originally sentenced to 11 years in prison, reduced on appeal to five years. Family physicians from Kansas were convicted of referral crimes and sentenced to 10 to 40 years in the federal penitentiary. Billing crimes earned an internist from Seattle, Washington, and a psychiatrist from Wisconsin 3-year jail sentences. A Washington, D.C., psychiatrist was convicted of billing improperly under an unknown standard, originally fining him $245,392 and threatening $81,000,000 in penalty.

6. Medical Gluttony – Why Can't I Go to the ER to Have My Shoulder Checked Out?
This week a patient came in complaining of an aching pain in the left side of her neck and shoulder. She had rather significant muscle tenderness over the left trapezius muscle that operates a portion of her neck and shoulder. The pain had been present for about two months. She had done her fall gardening in order to get her potted plants and flower beds rearranged for the winter season. She said the pain was so bad several days earlier that she called 9-1-1, the emergency system for the United States, and was taken to the Emergency Room. The physicians  couldn't find anything seriously wrong and gave her some codeine for the muscle pain. It would relieve the pain for only five or six hours. However,  it was gradually getting better but the neck and shoulder still ached. The diagnosis of myositis (inflammation of a muscle) was quite apparent since the pain was localized to a particular muscle group and could be reproduced simply by compressing that muscle. I immediately gave her two extra strength Tylenol (1000 mg of acetaminophen), completed my examination and excused myself as I saw another patient.

When I returned about thirty minutes after I had given her the Tylenol, she felt much better. In fact, she felt better than she had in the past two months.

Her Medicare HMO obtains a reduction in the emergency room charge to about $500. The ambulance ride to the hospital is also about $500. Her HMO pays me less than $50 for making the real diagnosis. They do not reimburse me for the Tylenol, given as a test sample out of my stock, or the double appointment time I gave her. Since she went to the emergency room via ambulance, she didn't have to make any copayment. She knew that in advance because the senior citizen community has informed each other that if they go by ambulance they avoid the typical two- to six-hour wait. Instead they are given first-class treatment and are usually out in a couple of hours. In case you missed it, by doubling the cost of your unnecessary health care you can get first class treatment without any copayment.

To find out at what level of financial responsibility she would have conserved in medical resources and costs, I asked her if she would she still have gone to the emergency room if she had to pay 10 percent of the $1000 that was spent on her (ER plus ambulance charge)? She said she would have waited until morning to see me instead. She agreed that the care would have been better than what she received in the ER.

As readers of this section of MedicalTuesday know, there are numerous instances where patients impose costs on the system due to lack of responsibility. But speaking with many outside of medicine, there still exists a belief that these cases are relatively infrequent. Even our Congressmen have difficulty believing the frequency of overutilization. However, when I speak with the doctors in the staff room where we have lunch, overutilization is confirmed as occurring in most practices every day. The costs are staggering.

For instance, if there is one such gluttonous behavior per day in each of 500,000 practices averaging $1000, this adds up to a half billion dollars per day or well over $150 billion per year of unnecessary costs. These are costs that cannot be reduced through practice guidelines or imposed controls because no lawmaker will restrict what patients think are emergencies. The emergency rooms will always do enough testing to rule out serious illness. At the age of Medicare coverage, many patients have serious illnesses even if it isn't the one that brings them in. However, a 10 percent copayment on emergency room charges would appear to eliminate more than a $150 billion dollars of health care costs. A Congressman told me this topic is too hot to touch. Hence, we must accomplish it in the Medical MarketPlace by introducing market incentives, such as percentage copayment (not fixed copayment), so that hospitals and doctors will compete for the lowest possible charge.

7. Overheard in the Medical Staff Lounge – A Culture From Another Era?
A colleague had just returned from Israel and came across a second-grade reading book used in an Islamic country. A recitation exercise was as follows: Teacher: Who are the Jews? Children: They are the enemy. Teacher: What do we do with the enemy? Children: We kill them. Is this the hatred expressed by an uncivilized culture from another era?

Another colleague remarked that on talk radio he had heard a caller from Marin County, California, report that his second grader stated that they were asked to vote in a practice election last Tuesday. The child reported that President Bush got two-thirds of the vote. The children were then asked to tell the class why they voted the way they did. Essentially all the children that voted for Senator John Kerry said that they did not vote for him because they liked Senator Kerry, but they voted for him because they hated Bush. When asked why they hated Bush? The children replied, "Because mommy and daddy hate Bush."

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, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log onto http://www.ncpa.org and register to receive one or more of these reports. MedicalTuesday members and readers are knowledgeable with Twenty Myths about Single-Payer Health Insurance which we reviewed in this newsletter the first twenty months of its existence. Please read a review of their new book, Lives at Risk, http://www.healthcarecom.net/JGLivesAtRisk.htm, the definitive work on Single-Payer National Health Insurance around the World. It shows that the United States has the best health care system in the world. The book can be ordered at http://www.ncpa.org/pub/lives_risk.htm. To read the current status of Reforming Medicare, go to http://www.ncpa.org/pub/st/st261/. We look forward to hearing Dr Goodman speak at the California Health Care Leadership Academy in LaQuinta next week.

• The Mercatus Center at George Mason University (http://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. Mercatus Scholar and George Mason University Economics Professor Laurence Iannaccone is doing research in the Economics of Religion. To see an overview of the new "Association for the Study of Religion, Economics, and Culture," visit http://www.economicsofreligion.com/. To help understand the Middle East, read his article on Rational Extremists at http://www.mercatus.org/capitolhillcampus/article.php/556.html and his article, The Markets for Martyrs, at http://www.mercatus.org/globalprosperity/article.php/822.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 http://www.galen.org. This week she discusses how Ownership of Health Insurance and Health Care clearly will be advanced by President Bush as part of the “ownership society” he is cultivating to give consumers more tools to create a properly functioning market in the health sector that will increase choice and reduce costs. To read this recent newsletter go to http://www.galen.org/ownins.asp?docID=743. We look forward to hearing Grace-Marie speak at the California Health Care Leadership Academy in LaQuinta next week.

• 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 newsletter that is distributed every Tuesday by logging onto http://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 Health Savings Accounts (HSAs). Writing on the eve of the election, Greg reminds us that the mission of the Galen Institute and the Center for Consumer Driven Health Care will remain the same. We do not look to politicians for leadership when it comes to reforming health care. The real impetus for transformation comes from the broader community of consumers, physicians, employers, and others who realize our current system of third-party payment is not working very well and are willing to think boldly about changing it for the better. Read the newsletter at http://www.galen.org/ccbdocs.asp?docID=717. We look forward to hearing Greg speak at the California Health Care Leadership Academy in LaQuinta next week.

• The Heartland Institute, http://www.heartland.org, publishes the Health Care News, Conrad Meier, Managing Editor. There is a time for everything in life according to Conrad, who enters the eighth decade of his life and has decided to step down as managing editor. He states: I have also learned that today's industrialized nations with government-run health care systems are introducing more and more private-sector health care options, having become aware that government is not the solution. Ironic, isn't it? As other nations back away from a statist approach to medical care, a loud and politically active minority in the United States seeks to limit our freedom of choice, using Orwellian newspeak slogans such as "Health Care for All" and "Everyone In, No One Out." I have also come to understand how bureaucrats have legislated this country's free-market health care system almost to extinction ... and then used the very problems they created as a justification for government-run health care.

We cannot expect to repeal, at least not anytime soon, years of ineffective social policy and layers upon layers of mandates and regulations that confound not only us, but even those who wrote the laws in the first place. So instead of reform, we must seek to transform our system into one that reacts to consumer demand instead of regulatory demand--a system of health care financing and medical care delivery truly dedicated to consumers, not political expediency. It is worth your time to read his evaluation of our current health care predicament at http://www.heartland.org/Article.cfm?artId=15691.

• The Foundation for Economic Education, http://www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom’s Magazine, for over 50 years, has Richard M Ebeling, PhD, President, and 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 we peruse a number of important articles on their opening page including the plans to give the environment a free-market tilt.

• 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.” CAHI Director Dr. Merrill Matthews congratulated President Bush on his re-election to a second four-year term. His press release http://www.cahi.org/article.asp?id=475 explains how Bush’s Policies will give Americans more access to affordable health insurance.

• 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 read be sure to check the Medical Follies on the latest woeful tale in government-run health care at  http://www.factcheckers.org/showArticleSection.php?section=follies.

• The Independence Institute, http://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/HCPC_Oct_2004.aspx with special attention to the Stupid health care study of the month.

• The National Association of Health Underwriters, http://www.NAHU.org, The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page. Be sure to go to the "About NAHU" page and read the Code of Ethics which I believe the thousands of physicians, nurses, allied health specialists, medical writers, insurance executives, actuaries, accountants, administrators, business people, patients, and attorneys that read MedicalTuesday can support. Be sure to review the roadmap to the future of health care in America at http://www.nahu.org/government/Election_Results_2004_seminar.pdf.

• Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Québécois Libre. Please log on at http://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 the Musings by Maddocks: With very rare exceptions the UN, and its various agencies, have always been a sorry bunch of accomplished illusionists representing countries whose interests lie not in improving the human condition à la Universal Declaration of Human Rights, but in creating and sustaining in perpetuum a stage where their leaders may strut and a trough in which their recycled, self-serving unelected officials may bury their snouts. http://www.quebecoislibre.org/04/041015-6.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 where their recent publications and editorials are listed at http://www.fraserinstitute.ca/health/index.asp?snav=he. This week, be sure to read the executive summary of their latest publications by Sally C. Pipes, Miracle Cure: How to Solve America's Health Care Crisis and Why Canada Isn't the Answer at http://www.fraserinstitute.ca/shared/readmore.asp?snav=pb&id=713.

• 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 for review at their site. This week, if you’re interested in why Americans cited morality as three times as important as health care in their voting last week, see Matthew Spalding’s commentary at http://www.heritage.org/Press/Commentary/ed110504c.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 http://www.mises.org to obtain the foundation’s daily reports. This week, Mark Thornton has an unusual article on Government: Trafficking in Failure, where he expounds on the universal truth that governments cause problems whereas markets solve them. 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 (http://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. This week read his editorial: Medicare should be reformed before retiring baby boomers force Washington to raise taxes or cut benefits. He feels that Republicans have a duty to reform Medicare after making its problems 33 percent larger when they added the new prescription drug entitlement.

• The Ethan Allen Institute (http://www.ethanallen.org/index2.html) is one of some 41 similar but independent state
organizations (click on "Links") associated with the State Policy Network (SPN) (http://www.spn.org/newsite/main/). 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.

• 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 http://www.hillsdale.edu to register for the annual week-long von Mises Seminars, held every February, or to register for their famous Shavano Institute. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, be sure to read the current issue of Imprimis by Midge Decter weighing in on the current debate on Civil Unions at http://www.hillsdale.edu/newimprimis/default.htm. The last ten years of Imprimis are archived at http://www.hillsdale.edu/imprimis/archives.htm.

Stay Tuned to the MedicalTuesday.Network and Have Your Friends Do the Same
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William James: A great many people think they are thinking when they are merely rearranging their prejudices.

Michael Goodman, MD: Midlife Bible - A Woman’s Survival Guide: http://www.healthcarecom.net/bkrev_MidlifeBible.htm.

On this date in 1802, Elijah P Lovejoy, the fiery abolitionist during the days of slavery, was born in Albion, Maine. He established a newspaper in Alton, Illinois which irritated the townspeople, and his presses were destroyed many times. On November 7, 1837, he was murdered by a mob while trying to defend his newspaper. It is comforting to realize again that times have changed.

On this date in 1989, the Berlin Wall, built in 1961 by Communist East Germany, crumbled. Built to create a captive people, it still could not prevent some brave souls as they leapt to their freedom.

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