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THE MONITOR LIZARD

    Once a monitor lizard came to wield considerable influence at a leading health maintenance organization.
    The lizard was responsible for “gate-keeping” patient admissions to hospitals for medical treatment. It performed those duties well. So well, as a matter of fact, that it was able to reduce the ratio of health-needs-to-health-costs dramatically and thereby increase return on investment in the HMO’s shares just as dramatically.
    Being by nature a cold-blooded creature, the monitor lizard had a definite advantage when responding to those it suspected of spending their days scheming to sneak into hospitals for open-heart surgery or high doses of chemotherapy, to name just two of the opportunities it saw for flagrant abuse of the system. In its crusade for economy, it was always on the alert for questionable accounts of pain and suffering.
    “Is the patient near death at this moment?” was the lizard’s most frequent reply to appeals for help, followed by, “Have you sought another opinion from a physician on our B List of care providers?” While for psychiatric cases, it might say to great effect, “If the patient hasn’t assaulted anybody yet, call us back when that happens.”
    But the lizard’s true value to the HMO became clear only during an annual meeting of shareholders. The gathering started off well enough, with a glowing report on projected savings as a number of treatment programs were phased out in the future and the recently passed HMO Protection Act came into full force. But the atmosphere grew more tense as investors began to voice their concern about long-term prospects if more patients than expected sought medical care or survived for unanticipated periods of time while being treated. 
    “Can you guarantee us the present high share price will be maintained?” the Chairman of the Board of Directors was asked.
    “Even better. We have every confidence shares have nowhere to go but up as the aging population grows and we transition to new cost-cutting measures.”
    “That’s very easy to say, but can you guarantee it?”
    A question from another part of the hall touched on the same concern. “What assurance can you give us long-term of doubling, tripling, even quadrupling money invested in sick people?”
    “What does market research say about incentivizing patient-to-doctor figures beyond the 1,000 mark?”
    Before the chairman could answer, another shareholder shouted out impatiently, “Forget that! Can’t we limit treatment to patients who cost less?”
    “Or else streamline the entire system? Make it more reflective of market fundamentals?”
    And that was when the monitor lizard rose from its own seat and offered the suggestion that brought sustained applause throughout the hall and put its face on the cover of the annual report. 
    “Suppose we simply began converting hospitals into morgues.”