Perhaps the purpose of passing health care reform NOW NOW NOW is not so much to institute socialized medicine (as the teabaggers believe) but to get rid of already-existing socialized medicine.

We already have socialized medicine, of a sort, for the poor. The system took hold during those misty pre-Reagan years, when this country was saner, more charitable and more prosperous. The system is inefficient in that it provides only emergency care, not preventative care. And emergency room physicians are required only to stabilize the patient, who may require more comprehensive treatment.

Still, the impoverished need access to that emergency room. They don't pay for the emergency care they receive. They can't be sued for payment, because lack of property makes them judgment-proof; if they are lucky enough to possess an old car, they may be living in it.

Until we return to Keynesianism -- which we won't -- the numbers of the impoverished will continue to grow. That may be the plan. Even if there is no plan, that's where we are going. We will see growing income disparity, growing unemployment, a growing lumpenproletariat to keep wages low and job insecurity high.

Right now, the uninsured are billed three times higher than are insured patients. Usually, the taxpayers pick up the tab. (Michelle Obama helped to run a hospital in Chicago which did this sort of thing routinely.)

You can see the problem -- the real health care crisis. If you double the number of lumpenproles, you double the number of people reliant on socialized (emergency) medicine. The true owners of this nation would prefer for members of the peasant class to crawl into some corner and simply...die.

The Pelosi/Obama bill may, in effect, keep more poor people out of that ER. Call it the GOMER bill. GOMER is doctors' slang: Get Out of My Emergency Room.

Those without regular jobs take any temp gig they can find. Businesses large and small are firing regular employees and hiring freelancers. Right now, there are some eight million "independent contractors" in the work force. Some freelance by choice. Many freelance because they have no other option, because times are tough and a gig is a gig. I strongly suspect that the number of freelancers will swell during the next five years -- it may even double.

The public option is supposed to take care of all those workers not covered by employers or Medicare. Will it?

No.

In the first place, the public option will probably die in the Senate. Even if it survives, the public option will still cost money -- monthly payments which many cannot make. A freelancer may find work only half the year. Millions of Americans are "food insecure" -- that is, hungry. They can't afford health care -- hell, they can't even afford a dollar cheeseburger at BK.

And what about their dependents?

Consider this: If you fall off the social grid for a while -- if you spend a period homeless, living in your car, living in a friend's garage or on a sofa (and millions live such lives right now) -- you will likely stop paying taxes. Shocked? Then you've never been in that situation. When you're sleeping under a bridge, you have other things on your mind besides filling out a 1040.

When those who have fallen off the grid do find some form of freelance or "under the table" work again -- earning maybe $800 a month, just enough to survive -- they avoid filling out tax forms. They hide from the IRS not because they don't want to pay money to the government (they probably will owe little or nothing), but because they fear having to explain their "missing years" to the authorities.

"You see, sir, I didn't fill out my tax form that year because..." Yow. No-one wants to say those words. Ever. Better to stay under the radar as long as possible.

Those in this situation tell themselves that they'll make things right with Uncle Sam as soon as they start earning some decent money -- something more than $800 a month. Enough to hire a lawyer.

How many people are in this situation? I don't know. Perhaps nobody knows. I do know that roughly 140,000,000 citizens filed tax returns last year -- in a country of 300 million.

Consider the fictional case of Ellen. She spent a few years jobless, depressed and pretty much homeless. She got by somehow -- lived with a friend, shacked up with a guy she really didn't like, spent some time sleeping in an old Chevy Cavalier.

Now she's making some money again -- not much, well under $1000 a month. She is an "independent contractor" and the income is insecure. But she is (usually) able to pay $500 a month for rent and utilities in a shared apartment. She's not really back on her feet, but she has regained some small measure of dignity, even though she eats a lot of pasta.

Is she going to pay for health insurance? Probably not. Screw the mandate: This is survival. Will she apply for a hardship exemption? No -- for a reason which you've probably already figured out.

One night, Ellen is eating pork roast. (It's cheap.) And she feels something awful: A blockage in the esophagus. The food has gotten stuck on its way down, and now she feels as though someone shoved a boulder beneath her rib cage. She can't eat another bite. She can't even swallow her own saliva. She's in constant discomfort-bordering-on-pain.

Although she may not know the term, she suffers from a food bolus. A growing number of Americans experience this unhappy phenomenon.

What will happen to Ellen? Well, she could wait it out, despite the extreme discomfort. The bolus might dislodge itself within a day or two. Then again, it could stay right where it is. If it doesn't budge or dissolve, she'll eventually die.

She should go to the ER right away. But will she?

Under today's system of socialized emergency medicine for the poor, she probably would go to the hospital within 24 hours. But under Pelosi's plan, she knows that stepping into that hospital will mean paying an unpayable fine, because she can't afford to be on a health plan. And she's terrified to fill out any forms giving out her personal information, because the last year she filled out a tax form was the year she "fell off the grid."

So she stays home, spitting out her saliva every minute, unable to sleep, feeling ready to die. Maybe she ends up doing just that.

Well, screw Ellen. She didn't pay taxes. She didn't really contribute to the economy. It's not as though society owed her a decent job or a social safety net. Let the bitch die. Too bad the taxpayers have to fork over the money to put her underground.

Ellen's story has millions of variations, and all of them will play out in the coming years.

The jobs are not coming back, because both the Republicans and the Democrats consider the remedies (protectionism, Keynesian job-creation) ideologically impermissible. If there are X number of Ellens out there right now, there will be 2X by 2015. For most of those Ellens, the awful health care system we have now is preferable to the proposed reforms.

Nancy Pelosi and Barack Obama have sent a message to all of those Ellens: Get Out of My Emergency Room!

One final note: What about those who have stepped a few rungs above Ellen on society's ladder? Well, the failed Massachusetts experiment tells us what to expect from Pelosi's hellish admixture of mandates and penalties. Across the nation, we'll be hearing many more complaints like this one:

I am uninsured because even though I work full time I can not afford health insurance. My salary barely covers rent, childcare & utilities so I have not been to a physician in more than 10 years. During that time I have been to the ER once when I needed stitches. I paid for that visit out of my own pocket. Now I'm paying $1000 year penalty to the state on my taxes because I cannot afford to spend 50 percent of my weekly income on insurance. Ditch the whole insurance requirement. it's NOT working.

Eventually, health care reform -- if passed in the Senate -- will fail. The pundits will then all say with one voice: "We tried socialized medicine and it didn't work."

No-one will listen to those fringe-dwelling bloggers who insist that single payer -- the only workable system -- was never given a chance.