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Central Pacific Railroad
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Click any image or link to accept the User Agreement. © 2018 Use of this Web siteconstitutes acceptance ofthe which permits personal use web viewing only; no copying; arbitration;no warranty. "A light car, drawn by a single horse, gallops up to the front with its load of rails.  Golden Spike at the Stanford University Museum. Courtesy National Park Service. Two men seize the end of a rail and start forward, the rest of the gang taking hold by twos, until it is clear of the car.  They come forward at a run.  At the word of command the rail is dropped in its place, right side up with care, while the same process goes on at the other side of the car.  Less than thirty seconds to a rail for each gang, and so four rails go down to the minute ... close behind the first gang come the gaugers, spikers, and bolters, and a lively time they make of it.  It is a grand '' ... It is played in triple time, 3 strokes to the spike.  There are 10 spikes to a rail, 400 rails to a mile, 1,800 miles to San Francisco — 21,000,000 times those sledges to be swung: 21,000,000 times are they to come down with their sharp punctuation before the great work of modern America is complete." –, , Savage. Golden Spike Ceremony

, May 10, 1869,
(Detail of Savage and Ottinger , ".")
Chief Engineers for CPRR () and UPRR (). 
Courtesy .  Also see the .

The was completed when the rails of the , reaching westward from Omaha, Nebraska, and those of the Central Pacific Railroad, reaching eastward from Sacramento, California were joined, completing the coast-to-coast connection.  The telegraphsignaled a waiting nation:  ""

Sacramento photographer and artist documented the in .

" ... The Central Pacific company had thirty locomotives gayly decked rangedon the city front, and at the signal of a gun announcing the driving ofthe last spike on the road the locomotives opened a chorus of whistles,and all the bells and steam whistles in the city joined."

A. J. Russell View at Promontory Summit. Courtesy National Park Service. The Central Pacific Railroad Company of California was organized on June 28, 1861by a group of Sacramento known later as the "" (, , , and ); also called "," they are best remembered forhaving built the western portion ofthe first transcontinental railroad ("the Pacific Railroad") through California,Nevada, and Utah.  Viewat Promontory Summit. Courtesy National Park Service. (Right)

Cape Horn. Carleton Watkins. Courtesy Royal Geographical Society.A for the rail line was first conceived and byDutch Flat, California gold prospector and drugstore owner andengineer, , who obtained the financial backing of the and won federal support in the form of the , signed in 1862 by former Abraham Lincoln.  View at . Courtesy . (Left) []

Government ,required to be of construction, were issued to the CentralPacific and Union Pacific Railroad Companies as they completed construction milestones,and they were sizable parcels of alongthe entire length of the track as an added incentive, placing the CPRR and UPRRin competition — a race to the finish at an undetermined meeting point.

The Central Pacific from Sacramento, California in ,and the UPRR Ground Breaking, Newark Daily Advertiser. Courtesy Glen Pierce.Union Pacific started laying track westward from Omaha, Nebraska,two years later in July, 1865.  To meet its manpower needs, the CentralPacific hired thousands of ,including many recruited from farms in Canton.  The crew had the formidabletask of laying the track crossing California's and had to blast fifteen to accomplish this.  The crew of the Union Pacific, which was composedlargely of Irish immigrants and veterans, had to contend with and the Rocky Mountains.  On May 10, 1869, after completingmiles, 4,814 feet (2,859.66 km) of new track, the two rail lines.
Courtesy and Bruce C. Cooper.

on Turntable  (detail of A. A. Hart Stereograph #139)

© 2018 Reproduction in whole or in part without is prohibited. By clicking any image or link, I acknowledge that I have read and agree to the .

was the First Assistant Chief Engineer, later the Acting Chief Engineer, 
and also was the Chief Locating Engineer 
of theCentral Pacific Railroad!

L. M. Clement signature   Railroad Commissioners
As second in command of the most formidable engineering project ofthe 19th century, Lewis M. Clement was in charge of locating and constructingthe first transcontinental railroad over California's Sierra Nevada Mountains,including blasting the Summit through1,660 feet of solid granite using black power, and building 40 miles ofSnowsheds to keep the track clear during winter blizzards. 
Tunnel No. 15
Muybridge Stereoview

Lewis Metzler Clement was the engineer in direct charge of the final location, design and construction of the CPRR Division between Colfax and Truckee (miles 75 to 120), by far the most difficult section of the entire Pacific Railroad which included Cape Horn, the Sierra , and the snowsheds. 

" ... The ... crews worked round the clock ... Then, at one in the morning on May 3, 1867, a great, noisy crumbling took place at the east facing, and light from torches in the west could be seenflickering through the dust. ... The Summit had been pierced. TheSierras had been bested. ... young Lewis Clement, the engineer incharge of Summit Tunnel, strode into the now widened bore a week after thebreakthrough, surveyor's instruments in hand. With torchbearers stationedevery few yards in the 1,659-foot bore, Clement began his first series of observations in the damp and eerie tunnel. During the preceding two years' work he and had been measuring under conditions never taught about inengineering schools. They had made their calculations under poor visibility ona wildly uneven tunnel floor, plotting a bore not only divided into four distinctparts, but one that had to gradually rise, descend, and curve as it penetratedfrom west to east. ... theexpected margin of error was large, and if the various bores were seriouslymisaligned, many months of expensive remedial work would have to be done,delaying the Central Pacific Railroad's progress east. ...As Clement finished his measurements and worked out the geometric statistics at a rude desk near the tunnel mouth, he found his most fervent prayersanswered. Summit Tunnel's four bores fitted together almost perfectly, with atotal error in true line of less than two inches. The seemingly impossible hadbeen achieved. The longest tunnel anyone had cut through natural granite, cutat a daunting altitude in an abominable climate, had been bored by a small armyof Chinese thousands of miles from their ancestral home. The Sierras were trulybreached and ... the great race across the continent was on. ... " —

In addition he had similar charge of the final 200 miles of the line across Nevada and Utah ending at Promontory Summit.  In February, 1869, Clement was appointed as one of four members of the to and approve the railroad’s location and construction and help to determine the very sticky issue of where the CPRR and UPRR would finally meet.  Once the line opened in 1869 Clement added the duties of CPRR Superintendent of Track, a position he held until 1881.

L. M. Clement went on to design and (also using ) the line , and also worked on many urban and lines.  Among his works in the area was the design of thecable car turntable at the foot of Market Street in San Francisco. Leland Stanford also sought Clement's help to set up the Mechanical andElectrical Engineering Departments at .

In an 1887 submitted to the , Lewis M. Clement summarized the challenges and great obstacles — both physical and financial — which had to be overcome to build the CPRR:

"At the beginning of the construction, the company, knowing the political and commercial necessities demanding the rapid completion of the railroad, determined that nothing which was in their power to prevent should for a single day arrest its progress.

CP-UP Timetable, 1881CP-UP Timetable, 1881"With this determination in view all energies were bent,fully realizing the physical obstacles and financial difficulties to beovercome.

"The financial difficulties were not lessened by the opinionscirculated to the effect that the obstacles were insurmountable; that therailroads then constructed in Europe were as bagatelles compared with thedifficulties to be met in constructing the Central Pacific Railroad, andfailure was clearly written on the rocky sides of the cañons andthe bold granite walls of the Sierra Nevada mountains.

"Not only was it impossible to construct a railroad acrossthe Sierras via Donner Pass, but owing to the great depth of snow, someyears reaching an aggregate fall of nearly 50 feet, would be impracticableto operate, and if built must be closed to traffic in the winter months,which would have been the case had not the road been protected at greatcost by snow sheds.

"Against these utterances from men of railroad experiencethe company had to battle in financial circles, forcing them to show thatthey were not attempting an impossibility, though always realizing thegreat difficulties."

Monitor Calibration Grayscale. Courtesy of an Anonymous Donor; reproduced by permission.
© 2018 By clicking any image or link, I agree to be bound by's which permits personal use web viewing only; no copying; arbitration; no warranty. List of readings about the history of the transcontinental railroad. (Image courtesy <>.)Read about Transcontinental Railroad History:
    • Appletons' Guide
    • : ; ; ; ; " Courtesy .
    • "Virtual Field Trip: Promontory, Utah Golden Spike National Historic Site." by Tom Allen, Old Dominion University. Adobe Acrobat PDF format
    • , , , , )
    • ": ; CPRR: , Big Five– , , , , ; UPRR: , , , ."22
    • Book"The Last Spike is Driven." Utah Historical Quarterly, 37(1), Winter 1969.
    • Book"Epic of the Overland." by Robert Lardin Fulton. San Francisco, A. M. Robertson, 1924.
    • Book"The Railroad Photographs of Alfred A. Hart, Artist," by Mead B. Kibbey. California State Library Foundation, 1995. check
    • Courtesy of .
    • Book"The Silver Sunbeam: ... Photographic ... Collodion, Albumen ... Stereography." 1864.
    • 19th Century Stereo Camera
    • Book"Nineteenth Century Photography: Stereo and Albumen Prints." Scovill, 1888.
    • Book"Oliver Wendell Holmes – His pioneer Stereoscope and the later Industry." by George E. Hamilton, Newcomen Society, 1949.
    • Abraham Lincoln reading to his son Tad. J. Carbutt CDV. Courtesy Larry Mullaly.
    • Book"Memorial of Asa Whitney Praying for a Grant of Land to Enable Him to Construct a Railroad from Lake Michigan to the Pacific Ocean." 1848.
    • Courtesy .
    • : by Horace Greeley, 1859. Courtesy .
    • Book"The Policy of Extending Government Aid to Additional Railroads to the Pacific by Guaranteeing Interest on their Bonds." Report of the Majority of the Senate Committee on Pacific Railroad, 1869.
    • Book"Official Explorations for Pacific Railroads, 1853-1855." By George Leslie Albright, 1921.
    • Book"Jefferson Davis, George McClellan & the Pacific RR Explorations & Surveys."  War Dept. Instructions, 1853.
    • Book"Report to the President." Secretary of War, 1854. (From the Library of T. D. Judah.)
    • [] []
    • Book"Geographical Memoir Upon Upper California in Illustration of his Map of Oregon and California, by John Charles Frémont." 1849.
    • Book"Col. Fremont's Exploration of the Central Railroad Route to the Pacific." 1854.
    • Book"A Report Relative to Captain Gunnison's Survey, &c." War Department, 1854.
    • BookPacific RR Surveys Beckwith Report (Utah-Nevada-California), 1854.
    • Book"Lewis Metzler Clement: A Pioneer of the Central Pacific Railroad."
    • BookLewis M. Clement’s Statement to the U.S. Pacific Railway Commission, 1887
    • Courtesy .
    • []
           by civil engineer John Debo Galloway
           by R.M. Utley & F.A. Ketterson, Jr., 1969.18   / / /
    • Book"Pacific Railroad Acts." 1862, 1864, ... 1874.
    • Book"California Supreme Court: California Pacific Railroad Company v. Central Pacific Railroad Company of California." 1870.37
    • Book"The Separation [unmerger] of the Central Pacific and Southern Pacific Railroads." by Fred G. Athearn, Esq., UPRR, 1922.
    • Book"Building the Central Pacific Rail Road of California–1863-1869" from by Norman E. Tutorow, Ph.D., (Ch. 6, pp. 213-303), © 2004. [] Courtesy and .
    • CPRR Schedule, 1865
    • "Tracklaying Record of the Central Pacific by Days, 1868-1869." by Lynn D. Farrar.Adobe Acrobat PDF format
    • Book"Reminiscenses of Alexander Toponce." Autobiography, c. 1919.
    • "Grand Railroad Celebration in Honor of the Completion of the National Railway Across the Continent." 1869. Adobe Acrobat PDF format
    • []
    • Adobe Acrobat PDF format
    • Book"Beyond the Mississippi."  by Albert D. Richardson, 1869.
    • Book"Where to Emigrate, and Why." by Frederick R. Goddard, 1869.
    • Book"Our First Century:  Completion of the Pacific Railroad."
    • Book"'The Last Spike' A Painting by Thomas Hill ..." 1881 (Description by the Artist).
    • ; () and
    • Book"Railroad Reorganization: Union Pacific." By Stuart Daggett, Ph.D., Harvard Economic Studies, 1908. Adobe Acrobat PDF format []
    • Book"The Railroad Builders." by John Moody, 1919 —
    • Book"Henry Root, Surveyor, Engineer ... Personal History and Reminiscences ... 1921."
    • "The Sacramento Locomotive Works of the Central Pacific and Southern Pacific Railroads, 1864-1999." by Gordon Chappell, CRM #10, 1999.Adobe Acrobat PDF format
    • [
    • "Rendezvous at Promontorry: A New Look at the Golden Spike Ceremony" by MichaelW. Johnson PDF
    • Book"UP Locomotive #119 & CP #60, Jupiter at Promontory Summit, Utah, May 10, 1869." by Roy E. Appleman, 1966.18
    • Book"Utah's Role in the Pacific Railroad." by John J. Stewart, 1969.
    • Courtesy of the author.
    • Book"The Central Pacific Railroad and the Legend of Cape Horn." by Edson T. Strobridge, 2001.6
    • .
    • ; ;  ;  ;  ;  ." by .
    • BookStation Book: "Southern Pacific System: List of Officers, Agencies and Stations. 1899." Courtesy Lynn D. Farrar.
    • Book"The Pacific Railroad Open.  How to Go: What to See."  Samuel Bowles, 1869.
    • Book"Trans-Continental." 1870 Excursion On-board Newspaper.
    •   [] [] []
    • Book"Gretchen Schafer's 1871 Diary: Travel on the Transcontinental Railroad."
    • Book"California: For Health, Pleasure, and Residence. A Book for Travellers and Settlers." Charles Nordhoff, 1872.
    • from
    • Book"Between the Gates." by Benjamin F. Taylor, 1878.
    •  : ; Adobe Acrobat PDF format
    • iTunes
    • Transcribed by .
    • Book"Bits of Travel at Home."  1887.
    • Book"Historical Souvenir of San Francisco, Cal." View Book by C. P. Heininger, San Francisco, Cal., c. 1887.
    • Book"Souvenir of the Palace Hotel" An Illustrated Booklet published by the Palace Hotel, San Francisco, c. 1895.
    • Modeling the World's Largest Ferry Boat, the CPRR "Solano"Adobe Acrobat PDF format Courtesy Thomas Rubarth.
    • "Gungl's railroad galop, as played by Willis' Band at the Mechanics' Industrial Fair." [Score] 1869. Adobe Acrobat PDF format
    • []
    • [Lesson PlanAdobe Acrobat PDF format]
    • []
    • Book"Pacific Coast Railroad Gazetteer." H.S. Crocker & Co., Sacramento, May, 1870.
    • Book"Nelsons' Pictorial Guide-Books: Central Pacific Railroad." 1871.
    • Book"Travelers' Official Railway Guide for the United States and Canada. June, 1870."
    • Book"Nelsons' Pictorial Guide Books: Scenery of the Union Pacific Railroad." 1871.
    • Book"Nelsons' Pictorial Guide-Books: The Yosemite Valley, and The Mammoth Trees and Geysers of California" c. 1871.
    • Book"Crofutt's Trans-Continental Tourist's Guide." by George A. Crofutt, 1872.
    • Courtesy .
    •   [CPRR: - - ; UPRR: - - ]
    • Courtesy
    • Courtesy .
    • BookCentral Pacific and Union Pacific Railroad Timetable, 1882, with fare schedule and route map.
    • Book"Souvenir of Pennsylvania Railroad Sceneries."
    • Book"Pacific Coast Souvenir." View Book by E.S. Denison, Oakland, California, 1888.
    • Book"The Overland Trail: From The Golden Gate to The Great Salt Lake, Along the Southern Pacific – The Road of a Thousand Wonders."
    • Book
    • Book
    • New! .
    • Book"State of Railroads ... including the Prospects for a Pacific Railroad."  Seventh U.S. Census, 1852. 
    • Book"Annual Report of the Commissioner of the General Land Office to the Secretary of the Interior, 1861."
    • Book"First CPRR Annual Report with Theodore D. Judah's Chief Engineer's Report." 1863.
    • Book"Report of Board Convened to Determine on a Standard for Construction of the Pacific Railroad." Interior Department, 1866.
    • Book Courtesy of Lynn D. Farrar.
    • Book"Report of the Special Commissioners upon the Central Pacific Railroad ..." February 27, 1869. [Also asAdobe Acrobat PDF format]
    • Book"Credit Mobilier." Congressional testimony of C. P. Huntington, 1873.
    • Book"Condition of the Union Pacific Railroad." 1869.
    • Book"Report of the Survey of the Central and Union Pacific Railways." 1877.
    • Book"Report of the Government Directors of the Union Pacific Railroad for the Year Ending June 30, 1877."
    • Book"Transcontinental Railroads.  History of Construction." Commissioner of Railroads, 1883.
    • Book"Report on Transcontinental Railways." Secretary of War, 1883.
    •   > Volume: [] [] [] [] [] []
    • []
    • Book"CPRR Annual Reports", 1863-1866; "Routes Explored, ... Surveys," T. D. Judah, et. al., 1863-1868. [Also see ]
    • Book"Pacific Railroad. Speech of Hon. Leland Stanford in the Constitutional Convention of ... Nevada ..." 1864.
    • Book"The Pacific Railroad. A Defense Against its Enemies, with Report ... to ... San Francisco." 1864.
    • Book"Report of ... Receipts and Expenses and Estimated Revenue ... " CPRR, 1865.
    • Book"Statement made to Senate Committee of the Nevada Legislature." CPRR, 1865.
    • "Central Pacific Railroad Statement Made to the President of the United States, and Secretary of the Interior, on the Progress of the Work, October 10th, 1865." H.S. Crocker & Co., Printers, 92 J Street, Sacramento. Adobe Acrobat PDF format
    • Book"Report of the Chief Engineer upon Recent Surveys and Progress of Construction of the Central Pacific Railroad of California." December, 1865.Adobe Acrobat PDF format Courtesy L.D. Farrar.
    • Book"A Statement Made by the Central Pacific Railroad of California for the Consideration of Capitalists." by C.P. Huntington, 1865.
    • Book"Railroad Communication Across the Continent." CPRR Bond Prospectus, 1868.
    • Courtesy .
    • Book"Report to the Stockholders of the Union Pacific Railroad." 1871. [; ]
    • Book"To the Bondholders of the Central and Western Pacific Railroad Companies." Fisk & Hatch, Bankers, 1871.37
    • Book"Union Pacific Railroad Annual Report, 1876." [; ; ]
    • Book"Annual Report of the Board of Directors of the Central Pacific Railroad Co. to the Stockholders, For the Year ending December 31st, 1878." Adobe Acrobat PDF format
    • Book"Annual Report of the Board of Directors of the Central Pacific Railroad Co. to the Stockholders, For the Year ending December 31st, 1883." Adobe Acrobat PDF format
    • Adobe Acrobat PDF format Courtesy .
    • Abraham Lincoln Signature. Courtesy of The History Attic.Index to The Abraham Lincoln Papers at the Library of Congress (Pacific Railroad).3
      signature courtesy of .
    • Book"A History of the Chinese in California:  The Railroads."
    • Book"Chinese by the Numbers," Chapter 4, from Nameless Builders of the Transcontinental RailroadPDF by William F. Chew, © 2004, Courtesy of the author.
    • Book"Fusang:  The Chinese Who Built America:  The Chinese Railroad Men."
    • Book"California: A Book for Travellers and Settlers."  by Charles Nordhoff, 1873.
    • Book"Report of the Joint Special Committee to Investigate Chinese Immigration." U.S. Senate, 1877.
    • []
    • Book"Cathay in Eldorado: The Chinese in California." Keepsake Series, 1972. [] Courtesy .
    • Book"The Chinese in America: Transcontinental Railroad," by Iris Chang, 2003.
    • Adobe Acrobat PDF format
    • Book"Gazetteer: California, & Travel via Nicaragua, Panama, Cape Horn & Overland." by John Hayward, 1851.
    • Book"Gazetteer: A Physical, Political & Economic Description of the Utah Territory and Salt Lake City." by John Hayward, 1851.
    • Book"Horn's Overland Guide, from ... Council Bluffs, [Iowa] ... to ... Sacramento, California ..."  1852.
    • Book"The Prairie Traveler.  A Hand-book for Overland Expeditions." Capt. Marcy, 1859.
    • "Dutch Flat and Donner Lake Wagon Road Co. toll house report." Adobe Acrobat PDF format
    • []
    • Book"Buyers' Guide and Mechanics' Manual for the use of Railway Officials." 1874.
    • BookRailroad Fiction: "A Thrilling Tale. Running a Time Table. A Brakeman's Story." 1873.
    • BookFavorite Railroad Fiction: "The Night Operator." by Frank L. Packard, 1919.
    • Book"Protection of Trains on the Overland Route." War Department, 1867.
    • Book"Behind the Scenes in Washington ... the Crédit Mobilier Investigation" by E.W. Martin, 1873.
    • Book"Observations on the Report of the Committee of the Senate of the United States Respecting the Credit Mobilier of America." by J.W. Patterson, 1873.
    • Book"The Railroads and the Centennial Exhibition of 1876."
    • Book"Information for Travelers by Rail," 1876.
    • Adobe Acrobat PDF format Courtesy CSRM.
    • Book"Extracts from the Report of the U.S. Pacific Railway Commission, 1888." By Robt. E. Pattison.
    • , from 1905. Courtesy .
    • - -
    • from Caution
    • Book"The Old Central Pacific Hospital." By J. Roy Jones, M.D.
    • Today!
    • Courtesy .
    • Ogden, Utah HistoryPDF from
    •   - - -
    • - - from .

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Laying Last Rail, Promontory, Utah, May 10, 1869 (detail of A. J. Russell Stereograph #540)

Central Pacific Railroad
Photographic History Museum

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First Construction Train Passing Palisades, Nevada
(Detail from Hart Stereograph #338.)
Courtesy .

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CPRR of Cal. Lock and Key, 1880's (Courtesy of "saxaphonekevin" on eBay)

"All of us live better than John D. Rockefeller"

– that you on the :

is ; ; ; (and factories and ; ) , (", Americans spent "), and ; (; ); ) because of such as the transcontinental railroad and the internet (; a , and is ); due to , the ; ), and and , while ; ; and (i.e., in the past 30 years US personal income has risen 8x, twice as fast as ; actually by making it by 1860 to continue them for the used for illumination and to lubricate locomotives; ); can , as it does for ; ; , , with ; (); , and is , ) . the .
Warning, is and (since a jungle became a "rain forest" and a swamp became a "wetland") , , , , , , , or is , being a "" that – :
• ; ("" ; ); this .
• because of misguided hatred of (actually, all crops & farm animals are genetically modified). ...

• "" – ; .
Policy Resources: , , , , , , , , , , , , , ,


Edited by Bruce C. Cooper, with from the , 2004.

An anthology of Nineteenth century first person accounts of overland travel on the Pacific railroad between 1865 and 1881 with fourteen sections in the bookeachof which can easily be read in one sitting.  Also includes 93 period engravingsand other illustrations, eleven maps,and another sixty pages of appendicies.

Bruce C. Cooper, Editor, 2010

by Jack E. Duncan, 2005

Cover of Volume I of "The Governor: The Life and Legacy of Leland Stanford"
Cover of Volume II of "The Governor: The Life and Legacy of Leland Stanford"

by Norman E. Tutorow.

Courtesy and . © 2004.

about this
Table of Contents.

Author reports that "Empire Express was the main
selection of the Book of the Month Club."

"The definitive story of the heroism and heartbreak thatproduced a railroad, changed the landscape of the country, and altered the horizonof the nation." —The Wall Street Journal
Across Nevada


Ambrose, "Nothing Like It in the World," book cover #1 -  New York TimesBest Sellers List

Author Stephen Ambrose's book [] 
[Interview Download Realplayer®]


Historical/Medical/ perspective:


":Belonging to the Railroad Company is alarge, airy and comfortable building,located near the shops, where their menare taken care of when sick or disabled.It is well conducted, a credit to the company,and of incalculable benefit to thoseunfortunates who are obliged to seek itsshelter. The company grounds cover15 acres ..." —.

"Be careful about reading books. You may die of a misprint." —Mark Twain

Why are so much faster than workers' earnings? CPRR Hospital In contrast, health care costs are spiraling out of control (↑1,000x!) today because – ignoring the "" principle – when it eliminated health care and made American healthcare consist of by imposing paid for by reduced salaries, . This has resulted in the – World's Smallest Political Quizdriven by – of bureaucratic "third party" reimbursement of health care costs by or the government, with endless regulations and paperwork causing a , and that and prevents them from expressing their true preferences, and so defeats the needed for health care providers to be able to , i.e., The out of control also result in of people being (which is because insurance is further , due to costly government-mandated coverages, and out-of-control malpractice litigation), and leads to a . This also produces "" (preventing people from changing jobs to avoid losing their health plan). Patients paying directly for their health care ("first party") see the expense directly and won't allow costs to rise out of control ( and ). The Central Pacific Railroad Hospital experience (the world's first multi-location HMO) shows that with direct employer provided ("second party") health care, costs can also be stable over long time periods (for eighty years at /year!), because the costs are not hidden. However when insurance company or government meddling makes medical care not provided directly by the employer appear almost free to patients (low co-payments and deductibles – ), the and the bill for such a plan with hidden indirect costs, , rises , unless by inferior () or HMO type plans with either (; with ), or controlled by and are so complex and dysfunctional that, for example, correctly . (By analogy, your own meals, or – like the CPRR medical plan – buying a pre-paid monthly meal plan at the company cafeteria is workable, but meal cards entitling you to unlimited "free" – or "almost free" – meals at any restaurants of your choice will be completely unaffordable – i.e., ".") Recognizing this, patient empowering portable have recently been enacted into U.S. law in an attempt to reintroduce to health care, as affordable (even for "" patients), where patients get to .
Policy Resources: , , , , , , , ,

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