Gerald L. Musgrave is president of
Economics America, Inc., and coauthor (with John C. Goodman) of
Patient Power: Solving America's Health Care Crisis. Leigh
Tripoli is managing editor of Regulation. Fu Ling You is the
Ray-Gunn Professor of Health Economics at Haavahd University's
School of Welfare.
We have just returned from a fact-finding mission to the Most Serene Republic of San Marino that was sponsored by the World Food Organization (WFO), and this article constitutes our first informal public report. The WFO will issue a complete formal report later. The trip was designed to be part of a multimillion dollar effort to determine "what works and what does not work in the delivery of food services." It is well known in the world community that food is too important to be left to the whims of competition. Government must control, manage, eliminate, or in some way guide the production and distribution of food. That is, unmanaged supply and demand cannot be relied upon to allocate resources, either efficiently or equitably, in the food sector. The WFO and others point out that the United States is the only developed country, other than South Africa, that does not have a national food system. For that reason much attention is devoted to the analysis of other nations' systems. By adopting a more advanced system, the United States can be brought into the community of civilized nations practicing economic democracy. For example, Canada's "free food system" is often suggested as a model for America. Despite the number of decades it has been in place, little research has been done on San Marino's system of lunch insurance. Our job was to evaluate that impressive system, in light of that republic's crude laissez faire health care system.
The early history of lunch insurance is clouded, but we do know that America's food stamp system was modelled after San Marino's early system, which probably had roots in the bread and circuses program, in which the Roman imperial government issued the masses meal tickets. The Sanmarinese government gave poor people postage stamps--the country's principal product. The stamps were then traded for unprepared food as well as restaurant meals. Restaurants and food vendors, in turn, returned the stamps to the government for cash, and the government sold the stamps to collectors. This way the program was free and did not cost the taxpayers a centesimo. (Although the Sanmarinese use Italian currency, for ease of exposition we shall convert all future monetary figures to U.S. dollars.) Unfortunately, some of the poor people sold the stamps to tourists and used the money to buy wine. This undermined the program because it now took money away from the government so that the program could no longer be financed. Something had to be done.
The modern history of lunch insurance began during World War II, when the Sanmarinese government imposed wage and price controls. Labor supply pressures put defense plants in jeopardy of not meeting quotas. In 1942, however, the War Labor Board ruled that adding or expanding lunch insurance benefits up to 5 percent of wages would not be considered inflationary. Employers began to offer lunch insurance as a way of providing additional compensation that was not subject to government wage controls.
Total enrollment in group lunch plans grew from a few hundred people to 20 percent of the population by the end of the war. There was also a major change in taxation. Previously, much of the revenue was from import duties, excises, and, of course, the production of stamps for collectors. By the end of the war, income tax was the largest source of funds. Exempting lunch insurance from taxable income became a formal reality in 1952, and by 1954 about 60 percent of the population had lunch insurance. By mid-1992 virtually all people had lunch insurance, aside from the 13 percent or so whose employers did not provide lunch insurance--a major social problem.
The Tax System
Under the current system employers can deduct lunch insurance as a valid business expense, but workers do not report it, or benefits received, as taxable income. Marginal tax rates in San Marino
are often over 50 percent when income, Social Insecurity, local income, and the Lunchicare wage taxes are combined. Thus, untaxed income in the form of lunch is very valuable. The self-employed may deduct only 25 percent of their lunch insurance payments. Old workers who believe that they can skip a meal or two and thin folks often accept jobs without insurance. Should they unexpectedly become hungry and present themselves at the emergency lunch room, however, the costs are astronomical. Also, it is believed that not having lunch insurance reduces people's consumption of nutritious food, which causes them to be more hungry and to demand more intensive food services later in life. In any event the tax system is the foundation of why San Marino has employer-provided lunch insurance, since no other insurance has this tax preference status.
If individuals purchase lunch insurance directly, they must purchase it with after-tax funds. Thus, its price is twice that of employer-purchased insurance. Since lunch insurance is primarily purchased by the employers, it serves workers' needs. When a person loses a job, however, the insurance is lost too. The Sanmarinese have a hard time understanding why, when they change jobs, they do not lose their auto liability or their home fire insurance. They are told that this proves that lunch does not obey any laws of economics.
Before the institution of lunch insurance, the Sanmarinese ate three meals a day. Now they eat one--lunch. The central political issue in the nation is lunch. Almost 14 percent of the GDP is allocated to lunch. The best and brightest desire to be chefs, with others entering the allied lunch professions and the support occupations. Salaries are escalating in every area. "Wait professionals," WPs as they are called by law, are in extremely high demand. "Bus people" must now be called "lunch device recycling professionals" or LDRPs. WPs must have master's degrees, and LDRPs must have bachelor's degrees. Dishwashers are called "toxicogenic hazardous material disposal professionals." Food left on a plate is placed, by these moonsuited daredevils, into red plastic bags, flash frozen, and held in hermetically sealed containers for 366 days as a precaution in case there is a mallunch accusation. After that period of time, the bags are burned in a special incinerator at 5000 degrees centigrade. Lunch waste is becoming one of the nation's most important environmental problems.
Lunch professionals are the best in the world. The facilities where they care for the hungry are the most magnificent structures in the nation. Leaders from every nation go to San Marino if they need the best in lunch care. Although the Sanmarinese are the best fed people in the world, they are deeply troubled by the system. To show the problems, we take you inside a lunch delivery complex.
San Marino has the most modern, well-equipped, technological and labor-intensive dining structures in the world. They are like the Space Shuttle, a Trident submarine, Air Force One, and Club Med rolled into one splendid exaltation of man's accomplishments. Every square foot contains computers, electronics, live entertainment, and colorful paintings and sculpture.
When you walk into the main lobby, you are immediately challenged by the licensed "lunch intake and hosting professional," who demands your insurance card. If you have a card, you receive a pleasant smile and are asked to sit down. You and the hostess exchange pleasantries, an imprint of your card is made, and you sign the bill in advance. Then you are escorted to a separate room where you meet with a licensed nutritional diagnostician, who discusses your lunch needs. Because there are several types of lunch insurance, this step is far from simple and will be discussed later.
After your lunch needs are determined, and usually reviewed by several levels of authority, you are admitted to the actual eating facility. You receive a wristband with your name and other needed information, such as the exact minute you arrived. This is critically important because every resource you use will be billed to your insurance.
The chef enters, after the playing of Aaron Copeland's "Fanfare for the Common Man," which is now required by the National Lunch Society (formerly the Cooks' Guild). The chef informs you that the preauthorization committee has approved your lunch! This is a definite relief. Most people have now come to accept that verdict, sign the release, and consume their meal within two or three hours. The entertainment is excellent, and several representatives from various governmental agencies tell you how effective their programs are and how well they are spending your tax money. No questions may be asked; it is considered unprofessional to ask or answer questions once lunch has begun. That is how it usually works. But a behind-the-scenes look shows a somewhat different view.
Insurers noticed that lunch was formerly consumed from about 11 A.M. to 2 P.M. For some strange reason, however, there has been pressure to extend hours. Now lunch is served from 5 A.M. to 11 P.M., with emergency lunch being served from 11 P.M. to 5 A.M. Another strange result is that technology has invaded every floor of the lunch facility. Computerized robots monitor the activities of every professional, and every step is performed by elaborate scientific food preparation equipment. Ovens cost tens of millions of dollars, a single copper sauce pan costs tens of thousands of dollars. Most of the costs are absolutely necessary because of the level of quality control needed and, of course, the absolute necessity of government regulation.
In the crude prewar days anyone, just anyone, could open a "lunch room," as the barbaric places were called. People would just walk in and order; but all of that has changed. Now every facility must be accredited by the Joint Commission on Lunch Facilities. This costs millions of dollars, and some estimate that it adds 20 percent to annual operating costs alone. Of course, this assures quality, something competition could never do. But long before accreditation is received, the lunch facility must receive a "Certificate of Need" (CON). Here the other facilities, and at least one level of political oversight, must agree that a new or expanded facility is needed. For some strange reason, although the lunch sector is not economically driven, most of the other facilities oppose the new establishment's application.
Some people attempt to compare the cost of lunch facilities with the cost of hotels or hospitals. This would be silly since the services these other structures provide are not insured and thus are not so important or so critical as lunch. To justify the cost of the structure, lunch administrators explain that its costs are derived from the cost of the services it provides. Experts in the San Marino lunch sector explain that lunch is so different, so much more critical, and so much more demanding that a half-day in a lunch facility should cost more than several days in a luxury hotel or an intensive care hospital.
Some entrepreneurs have opened luncheonettes as a cost-containment strategy. Here the less technically demanding lunches can be served, and the facility need not be so complex. At first, the major facilities opposed the creation of luncheonettes. Now many of the majors have their own "chef in a box" operations, as they are nicknamed. Of course, there is great pressure to regulate them so that they will not have a cost advantage.
Most people have a lunch insurance card that pays the bill. As we saw, people sign the bill before any discussion of lunch itself. This type of insurance is called "first dollar" coverage. As demand has grown, however, insurance carriers have instituted deductibles and copayments. Here one must pay the first $100 a year, and then 10 percent of the bill out-of-pocket. For some strange reason, these cost-control measures have not significantly diminished the consumption of lunch, which proves again that the laws of supply and demand do not apply to lunch care services.
The least popular type of insurance is "indemnity" coverage. Here one goes to the facility and need is assessed. The insurance pays a fixed rate, say $50 for chicken soup, $90 for a fried egg, or $500 for a steak and lobster. This insurance is not popular because sometimes it does not cover all the costs, and it encourages people to consider reimbursement in choosing a meal or a facility. That is, if one craves an oryx roast, but the cost is $1,000 and the insurance pays $700, he might choose roast beef that costs $500, of which the insurance pays $450.
The best known type of insurance is the "service benefit" policy called the "Blues," named after the famous blue-plate specials. Here the insurance essentially covers all of the cost of the lunch facility. The individual has little or no out-of-pocket expenses and has free choice of facility, chef, and menu. These "Blues" are nonprofit, so they are much more cost-effective and less greedy, and they justly receive special regulatory treatment by the government.
From the point of view of the facility and the chef, the Blues have been the best insurance, but conditions are changing. In the past, if the facility served 50 percent of its meals to Blue Cardholders, the insurance would pay 50 percent of the facility's total cost. Sometimes the Blues could extract a better deal because of their market power. If the facility's total lunch census was 70 percent, the Blues might pay 65 percent of the facility's total cost, and the remaining 5 percent would be "shifted" to other insurers, the uninsured, or the government. As we shall see, however, the government is much more effective as a power shifter than any private plan.
The remaining alternative forms of lunch insurance were at one time considered "market competition" for the Blues, but that era is long gone too. The best known form is called a lunch maintenance organization (LMO). These organizations charge a fixed amount per person per year and cover all the person's needs for that fixed amount. This is the "all you can eat" lunch insurance. In the past, LMOs were almost always in separate facilities that served lunch cafeteria-style. But lunchers noticed that the trays of food were not the same as the a;ag la carte menus offered by the other plans. Lunchers demanded trays of peacock drumsticks rather than Monte Carlo fried chicken. The only way costs could be controlled was if nutritional counselors advised lunchers on their meals. Now LMOs are not uniquely located in their own facilities. They do not have the cafeteria-style service any longer. But their negotiated capitated rate still exists and is considered their principal advantage. They argue, "This way chefs are not rewarded for serving extravagant meals." But lunchers often get that hungry feeling that the food portions are a little smaller or the quality a little lower since the LMO makes money by being "more efficient, cost conscious, and of course by not delivering `unnecessary' lunch services." A version of the same idea involves a group of insurers and chefs who jointly offer discount meals to business firms. They offer insurance on a capitated basis or on a fee-for-service basis and offer cut-rate lunches. These organizations are called PPOs or preferred provisions organizations. All in all, none of these groups has been able to retard the skyrocketing cost of lunch. This is one more proof that the laws of economics do not apply to lunch.
The Blues and other cost-based financing methods dominate the lunch industry. Such forms of insurance reimburse whatever actual direct costs the facility incurs plus an amount for overhead, which is why their payments are called "cost-plus" reimbursement. There is a small segment of the lunch trade called "boutique brunch" or "cosmetic cuisine" that is not considered to be nutritionally necessary. These meals are not insured, and unit prices are charged. People simply walk in, order, eat, and walk out. Lunch economists in San Marino have not researched this unusual market. But leading scholars assure us that a special ad hoc price theory will certainly be needed if we are to understand this aberrant sector of the market.
One final point on these matters is in order. There seems to be an absence of low-cost meals. Since lunch is free at the point of consumption, there seems to be a wee bit of an administrative problem. Hamburgers are almost never "nutritionally necessary"; usually steak is needed. Ethnic specialties are flown in from around the world. Because of regulations, every lunch from gefilte fish pizza to hummingbird tongue or spotted owl pa;afte;aa must be served on a twenty-four-hour basis. All of the food, as well as the equipment, must be certified (via elaborate government procedures) as being safe and effective. The government's recent ruling that chateaubriand for two was "experimental" and not covered under the government's Lunchicare system created an outcry in both the provider and consumer community. Nothing since the ruling that lumpfish eggs could be substituted for beluga caviar as "therapeutically equivalent" has created such an outrage in the nation.
Employee Lunch Insurance
A shocking revelation to most business executives, and all government officials, is that most large businesses have no real lunch insurance! Of course, every large firm issues a lunch "insurance" card to every employee. Nevertheless, there is not one cent of "insurance." Almost 80 percent of the large corporations have what is called ASO or administrative services only. This means that the "insurance" company simply processes claims and sends the bills to the employer once a month or once a quarter. In effect, the employer is "self-insuring" its own employees. That is, it is simply purchasing lunch through a prepaid insurance scam. It simply launders the income in the form of lunch insurance through an insurance company front. This, of course, allows the company to deliver insurance at about half the after-tax equivalent as compared with the same coverage if purchased by the employee directly. Of course, there is the minor administrative problem that workers are not spending their own money. For some strange reason, when employees go into a lunch facility, they behave as if they were shoppers in a fancy mall with someone else's charge card. This administrative difficulty is being managed by the insurance carriers and, as we shall see, by the government.
The lunch profession has always been held in high esteem. Insurance companies recognize the need for twenty years of formal education to prepare eggs Benedict. (Lemuel Benedict, who invented this dish during his residency at San Marino's Waldorf Astoria, recorded his original recipe in Latin, which he studied in preparation for entering the Culinary Institute of San Marino.) Paraprofessionals often argue that the educational requirement could be reduced to fifteen years of training to boil water (especially now that exact standards for lunch practice are available and less skill is required), but local regulators, who are close associates of the experts, will have none of it. Boiling water must be done by licensed chefs and no others.
Lunch chefs wear white toques and are given the respect they justly deserve. Long ago cookbooks were banned from public sale. In the days of Lemuel Benedict, recipes were written in Latin to keep the uneducated from harming the public. Today people who cook for others without a lunch degree and a license to practice lunch are fined and jailed.
Every provider group (except chefs) is represented by strong unions in wage negotiations with the lunch facility. Chefs are above economic concerns and earn about $150,000 a year. Since no one in San Marino really knows the secrets of food preparation, or how to operate the highly technical equipment, these wages seem appropriate. The National Lunch Society has an extremely extensive program to keep North American and French cooks out of the country to protect the quality of lunch. They are proud to say that not one hot dog nor one quenelle has been served.
The preparation of hummingbird tongue is a highly skilled lunch profession specialty. A chef must receive board certification to practice that specialty. Recently, the lobby representing that specialty joined with the lobby representing the spotted owl pa;afte;aa preparers to pass special legislation mandating that this combination meal be covered by all insurance policies. The San Marino College of Fowl Preparers vigorously supported that legislation, as did the Spotted Owl Ranchers Association. Almost 900 such mandates are now in place. The cost of mandates has greatly increased the cost of lunch. Costs became so high that about 25 percent of the people without lunch insurance were without insurance because of the effect of the mandates. In response, the government established new controls over the lunch sector.
There are two major existing programs, Lunchicare for the young and Lunchiaid for the poor. The young are the big eaters and have become a dominant force in politics in San Marino. It began with their initial coverage in 1965. Now the election laws have been altered to allow voting on lunch issues at the age of ten and all issues at the age of thirteen. As some public choice experts forecast, the government now takes children quite seriously. In fact, the mere suggestion that children will not receive their taxpayer-funded, cost-of-living increase in their allowance created a national crisis. No politician and neither of the two major political parties dares to take a stand against children's receiving Lunchicare. One critic asked, "Why should children from families where the parents earn millions each year and have assets of over a billion dollars have their lunch paid by the general taxpayer?" The answer came from the nation's most powerful political group, the San Marino Association of Young Persons. They say, "When children grow up, they will pay into the system just like the rest of us. They will pay into it in the future, and they are entitled to the insurance now. It's our intergenerational compact." With the rapidly growing population of children, almost 50 percent of the lunch sector is devoted to the young--with much more growth to come.
The second governmental program is Lunchiaid for the poor. The government, in effect, insures their lunch. People who are poor receive a Lunchiaid card, but lunch facilities are not required to accept it. Lunchiaid only pays about half-price for most meals, and a number of facilities simply do not accept the card. Others that accept the card appear to offer a different menu or different chefs to those cardholders. Lunchiaid folks are frequently finding it necessary to queue up at the emergency lunch room, where all lunchers must be accepted. Many facilities have closed their emergency lunch rooms rather than offer meals at half-price.
In an attempt to combat price increases that now make lunch the single largest program, the government has taken some interesting steps. First, they instituted a DRG (diagnosis related grub) system, where each meal was classified and given a number from 1 to 892. These DRGs are the basis for the government's reimbursement, and now the private sector's as well. In effect, their compensation is a fixed rate based on cost for every meal served. Over time, Lunchicare pays about 80 to 90 percent of a meal's cost and Lunchiaid pays about 50 percent. So some facilities have been accused of reclassifying a grilled cheese sandwich to a more complex Welsh rarebit (actually flown in on the Concord from Wales). Other lunchers complain about smaller portions and about being pushed out the door "quicker and hungrier." In fact, all the Chinese dim sum DRGs were rebased so that readmission to the facility a few hours after eating would not be considered an indictable offense by the inspector general.
In a related matter the government plans to completely duplicate all knowledge in the area of lunch education. They simply want to study "what lunches work, what lunches don't work, and which ones are not cost-effective." They will report that information to the chefs and possibly the public. One result will be practice guidelines that chefs can follow so that they know they are doing the right things. The new agency ALCPR (Agency for Lunch Care Policy Research) promises to be one of the largest in the government. It promises to do cost-benefit studies on virtually every lunch known. Billions will be spent to tell chefs how to prepare lunch. No one has asked what the role of lunch universities is if not to teach and conduct research concerning what works and what does not work. Indeed, almost every major lunch researcher is in line for a large grant. The first results seem to show that chicken soup is not cost-effective as a lunch, but as a medical treatment it is super. So transferring it from the insured lunch sector to the free market health care industry could reduce costs by millions of dollars every year.
The government denies, but we expect, that the government will forbid the coverage of non-cost-effective lunches. How could taxpayers be expected to pay for something that was not safe, not effective, and not cost-effective? This new agency will simply protect lunchers from the greedy, the fakes, the unknowledgeable, and the incompetent and from the self-interest of chefs and other lunch providers. Economic competition could never achieve those goals. Clearly the government's plan is to develop an industrial policy for the lunch industry and bring San Marino into the forefront of managed capitalist states.
Because lunch is now 14 percent of GDP, something must be done. Wages in the lunch industry are rising faster than those in any other industry. Something must be done. Lunch adds more to the cost of producing postage stamps than the cost of paper. Something must be done. Thirteen percent of the working population has no lunch insurance. Something must be done. The best brains from the San Marino Guild of Government Economists have produced the answer--more government spending, more government regulation, and more direct government control.
San Marino is governed by two captains regent. Each holds office for six months at a time. They have somewhat different philosophies in general, but in the area of lunch they agree. Something must be done. There are four major proposals being debated, and we shall outline each of them. Because our mission was financed by an international organization, we cannot get into politics. Therefore, we simply note that one captain regent is left-handed and the other is right-handed. So we shall refer to the plans as Left and Right. (Nothing personal, and we recognize that both appear to be ambidextrous.)
The Left has two main plans to offer to the public. First, they offer universal lunch care. This is either direct nationalization of the lunch industry or indirect nationalization via national lunch insurance. In the old days it was called "socialized lunch," but now that does not seem to be politically correct. The basic idea would be to have national lunch rooms as in England or provincially based lunch facilities as in Canada. These plans are called "insurance," but that is simply a politically correct euphemism for "government lunch."
The second Left proposal is called "pay or play." Here all employers must either pay their employees in terms of lunch insurance or "play into the hands of the government" by depositing 7 percent of their workers' wages into the regent's coffer. Since most employers now pay more than 7 percent of wages in private lunch insurance, they plan on playing into the government's hands. Thus, most lunch care would be provided under a government program. It would be called Marinocare, to eliminate the stigma associated with Lunchiaid. Nevertheless, the program would operate in much the same way as Lunchiaid, but under "pay or play" 60 percent of the population would be treated as charity cases.
The Right has two main proposals to offer the public, and their developers call them "market-oriented." The first one was developed in one of the outbuildings of the right-handed regent's mansion. It has several desirable features, such as allowing small business to form groups to purchase insurance at a discount and allowing self-employed people to deduct all of their lunch insurance from their income tax. It also has some strange features, one of which is to protect the uninsured. Those without lunch insurance could simply show up at a facility and say they were hungry. The facility would assign them to an insurance company in a risk pool. The luncher could not be refused, and the insurance company could not charge a higher rate than is charged to the general public. The luncher could cancel the policy the next day. The concept was to allow everyone to be covered by insurance. At a White Mansion meeting, a reporter asked why anyone would purchase lunch insurance on an annual basis when people could just go to a facility when they were hungry. There was no answer, and the White Mansion experts are working on one.
The second Right proposal was developed by a private organization called the Hermitage Foundation. The plan is based on replicating the government employees' lunch insurance plan. Here a large number of regulations (free-market, of course) would be placed on lunch insurance, thus making it perfectly competitive. The plan rests on the well-known economic principle that if right-handed people develop the central planning and there are enough managed delivery and enough restrictions on individual and business decisions, then as long as the government is in the Right hands, the result is perfect competition. A second principle is that public policy should be devoted to expanding high-pay, restrictive work rules, legalistic procedures, and lavish lunch benefits associated with government employment. That is, the general public should always aspire to the level of the bureaucrats, rather than have the bureaucrats live like average taxpayers.
Under the Hermitage plan every employer would have to provide lunch insurance, and the government would require every insurance company to offer every policy to every employee. The government would apply strict rules and regulations so that every policy covered all of the most expensive lunches available. The government would be involved with the terms and conditions of every policy. Almost in their own words, ";obt;cbhe problem with the lunch situation is that we need more market competition in the lunch insurance industry and we will push for any regulation, any restriction, any rule needed to guarantee that lunch will be provided from those with the ability to those in need."
A fifth proposal is from a small group called the Liberteens for Lunch Bunch. They suggest that people be allowed to save for their own lunch expenses in a special Lunchisave account. It would receive the same tax preference as does lunch insurance. The account would issue a card, and people could use it to buy lunch. But if a person did not spend the money, it would be his to keep, and the account balance would grow until retirement. People who opted for the Lunchisave account would be required to purchase a cata-strophic lunch policy, just in case the real hungries hit. Both the account and the policy would be personal and portable. So when one changed employers, he would not have to change insurance. The Lunch Bunch say that if people had an incentive to economize on lunch, costs could be contained. These Lunchisave cardholders would push for deregulation, lower-cost alternatives, and more appropriate utilization of scarce lunch facilities and personnel. They say that if people were selective and cost-conscious, a couple could retire with a handsome nest egg.
The Lunch Bunch are believers in what they call Musgrave's Iron Law. The law is that "the economizers must benefit from the economizing." They say that while all the other plans call for individuals to give up something--benefits, choice, quality, or security--people receive nothing in return. No plan is sustainable under those conditions, they argue. In the other proposals the benefits go to the employer, the government, the chefs, and the lunch facilities, but not to those who must accomplish the economizing. They advocate a whole nation of economizers--not one or two in the White Mansion. The Liberteens say that the other plans will either fail or be considered Draconian, discriminatory, or inhumane because the economizers do not benefit from the economizing.
Unfortunately, the existing experts scoff at this idea. "Lunch is different from all other goods and services" is the received wisdom in San Marino. Their national motto, painted over the entrance of every government building, is "THERE SHALL BE FREE LUNCH [INSURANCE] FOR ALL."
Kent, J. Elements of Lunchometrics. New York: Random House, 1992.
Malbraith, J.K. and Thorough, L. Frank Lloyd Wrong: The Architect of Modern Lunch Insurance. Cambridge: Haavahd and Mitsubishi Press, 1992.
Ray-Gunn, R. An Inquiry into the Nature Causes of the Poverty of Nations. Simi Valley, Calif.: Ray-Gunn Library, 1776 and 1980 to 1988.
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