Hi...

This is serious, please follow along if you can. This is to the folks who are wailing with disbelief that an unconstitutional requirement in the "health care" (I use the descriptor loosely) bill was found unconstitutional, and that we are all now going down the tubes....that we are killing sick children and more blah, blah... Listen up.

The single payer advocates among you, who think it is the holy grail of social justice. Who are adamant that everyone who needs a liver transplant will get one, who don't understand rationing.... Well, listen carefully.... it is happening NOW, TODAY, and if you're a smarty boots, you'll find one of these companies and buy stock. I know for a fact, that there is a booming market for medical businesses that advise hospitals on which medicare/medicaid patients to admit, and which to treat and release. How I know is that I have acquaintances who have begun work with said businesses, and have moved like lightning up through the ranks. You need a job? Find one of these businesses. They are desperate for personnel. I am serious. Medical/technical training is the preferred background.

It is subtle, but here's a simple version of how it works. A medicare/medicaid patient comes into an ED (formerly ER) and is evaluated by a ED doc...he/she does the usual H&P, and begins treatment for the problem. If the hospital has an "account" with said business the ED case manager will call the intake personnel (who do nothing, but answer the phones and take information), and will walk though a list of evaluation questions, developed by the company to discern whether M/M will PAY for an admission. The information is passed to a doctor who is an expert in the rules of M/M and he/she sends his recommendation to the hospital. If it is determined that the admission will not be covered, the patient is treated and released. The ED doc (who really must focus on her/his medical evaluation), does not usually override this decision. You see, even a tiny hospital in podunk can lose over a million dollars a year on denied medicare/medicaid admissions. Most hospitals run on razor sharp margins, and cannot afford this kind of deficit. So they contract with a business whose job it is to keep abreast of medicare rules, and then they are billed per case. As medicare sets the bar higher for admission and treatment, the business responds. Hospitals save millions, even with the contract and case billing. My "informant" tells me that they are now also evaluating for certain diagnostic testing. It makes my blood run cold, really.

So how easy would it be for this to be extended to the rest of the unwashed masses in a single payer system? Our treatment would be based on whether or not the system will pay. And as $$ get tighter, the options will decrease. As someone who can actually see medicare in the future, it makes me sick...but then what?

ETA: So I guess Obama, Pelosi et.al., were right!! It will decrease unemployment!!