“Hola, Amigo! Pack your bags, we’re going to Mexico!” bubbled Dr. Franklin Peterson Comstock III, faux physician and money-maker.

“Yeah, I could use a decent vacation,” I replied, figuring he’d pay for both of us since he had just set the world record for the most nose jobs in a 24-hour period.

“What vacation?” he said. “I’m setting up practice.”

“And give up catering to rich people with inflated bank accounts and deflated ethics?”

“Don’t have a choice. I’m getting laid off.”

Comstock had been a rainmaker for the Megabucks Happy Health Care Medical Center for the past decade. There was only one reason I could think of why he’d be laid off.

“Megabucks tired of paying your malpractice insurance?” I asked.

“Not just me,” he said. “Hospital’s laying off most of the staff, making the rest work overtime, and hiring outside contractors. They said it was hard to survive when the profit was down to only 20 or so million a year.”

“I didn’t realize it was that serious,” I said. “You planning to set up private practice to help the poor in Mexico?” I asked admiringly. 

“Not a chance! Gonna get rich working for Megabucks!”

“You just said you were laid off.”

“Been laid off in the U.S.,” said Comstock while putting a frozen burrito into the microwave.

“Megabucks/Mexico just hired me. There’s cheaper labor down there.”

“You crazy?” I asked. “You’re the cheaper labor.”

“Obviously you don’t know American business,” said Comstock haughtily.

“Megabucks/U.S. closes its auxiliary operations, and then contracts with Mexican companies for a fifth of the cost in the U.S. They do the work, ship it back to the U.S., and Megabucks bills Blue Cross the full rate as if it was done locally.”

“So where do you fit in?” I asked.

“Just as before. Nose jobs. Breast augmentations. Tummy tucks. All the important medical procedures. But this time, I do it in Cancun.”

“To rich Mexicans,” I said disgusted.

“To rich Americans!” said Comstock. “If they want the best care, they’ll take their private jets to Mexico and then deduct the trip as a necessary business expense.”

“And what about the impoverished and middle-class Americans?”

“If they can sneak across the border, they can also get medical care.”

“What about prescriptions?”

“Megabucks contracted with some of the best drug dealers—I mean pharmacists and chemists—in Mexico. Quality is just as good and it’ll only be four or five times production costs. Unlike the U.S. there’s no TV advertising and six-figure MBAs and lawyers that require drugs to be 30 or 40 times production costs.”

“With prices that low, how do you know there won’t be mass rushes by Americans to grab everything they can?”

“Because there’s security! Every hospital and pharmacy has armed guards with the best automatic weapons smuggled through the God-fearing 2nd Amendment patriotic Southern states.”

“Is Megabucks outsourcing all its operations?”

“Keeping the ER. After tummy tucks and butt lifts, that’s the hospital’s ‘cash cow.’”

“So, then, it’ll have to keep some services like X-Ray and the lab,” I said. “Maybe even a doctor or two.”

“Too expensive,” said Comstock. “Megabucks will hire more residents and foreign-educated doctors, and work them 18 hours a day. More work, less time to complain. Residents will do anything to get experience to pass their boards. May even hire a couple of hospitalists. You know, the ones who graduated at the bottom of their class and can’t even get work in a Free Clinic.”

“I suppose they’ll also do the lab work?” I asked.

“Do you know some of those lab techs are making as much as $30,000 a year! Made sense to lay them off, too.”

“So how will the ER know a victim’s blood chemistry, or if there’s internal injuries?”

“Technology,” said Comstock. “They scan the blood here, and send digital X-Rays to Mexico. Mexican lab technicians—you know, the ones that don’t know about unions and will work for only a few bucks a day—will analyze everything, then text the results back to the U.S.”

“This sounds like it’s not only a way to maximize profits, but also a way to avoid dealing with the President’s health care reform program.”

“Obamacare!” spit out Comstock. “Nothing but socialized medicine.”

“Most countries have forms of socialized medicine,” I countered, “and they not only have good health care but affordable prices to their citizens.”

Comstock put his hands to his ears and began chanting, “We’re Number 1, We’re Number 1.”

“Number 37,” I corrected him. “The World Health Organization ranked the U.S. just below Costa Rico.”

“They’re all Commies,” replied Comstock. “Besides, that study is a decade old.”

“Last year, the independent Commonwealth Fund compared the nations of the United Kingdom against the U.S., and the U.S. ranked seventh of the seven.”

“Yeah, like Americans will go to Canada? It’s covered by snow and run by a queen who can’t even speak English.”

“You and Megabucks are crazy!”

“Possibly,” said Comstock, “but outsourcing is the American way. By the way, do you put ketchup or mustard on a burrito?”

Dr. Walter Brasch isn’t licensed to practice medicine, but he goes to some excellent physicians who are—and they’re just as frustrated with the costs, insurance companies and myriad forms as anyone else. His current book is the critically-acclaimed mystery novel, Before the First Snow.