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“Like walking through molasses” is how a Massachusetts physician described his typical day.

“It took five minutes to determine what my patient needed,” surmised a local physician, “and hours to get her insurance company to approve treatment.”

The same line of thought was emphasized in a political cartoon when an emergency room physician told a new widow: “We did all we could, but the paperwork was too much.”

Under universal health insurance, physicians will need to contend both with an increasing demand for their services and with increasing bureaucratic attempts to prevent them from providing services.

The key article was published in the 1989 New England Journal of Medicine, “Health Care Rationing by Inconvenience — The Third Party’s Secret Weapon.”

Writer Gerald Grumet, MD, later author of “Taming the Bureaucrat,” made it clear his remarks applied equally to private managed care and government-management of care, stating: “Paradoxically, the savings that ordinarily accrue to an efficiently managed business are reversed in the case of insurance carriers, whose bungling, confusion and delay impede the outflow of funds.”

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Also, “In the managed care arsenal of cost-control weaponry, probably none is more potent except for restricting hospital admission than superseding the physician’s autonomy by a managerial review process in which armies of claims clerks, administrators, auditors, form processors, peer reviewers, functionaries and technocrats of every description insinuate themselves into a complex system that authorizes, delivers and pays for medical service.”

I see nothing in the House and Senate health-care plans that would ameliorate this time-wasting situation. If Congress underestimates the cost of its health-care plan — as usual — the pressure to increase rationing, including rationing through unnecessarily complex administrative procedures, will intensify.

Lawrence S. Riemer, MD

Vandenberg Village

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