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Communications for telemedicine requires substantial bandwidths to provide timely transmission of large data sets. To provide rural America with modern telemedicine requires very high bandwidth resources that may take decades to appear. Satellites provide the natural choice for communication between the rural primary care centers and the tertiary care hospital. However, there are problems if TCP, as required for Internet access, is to be the protocol of choice. Analysis of multistation satellite access clearly argues for distributed non-random methods and, hence, for appropriate handling of TCP data streams.