Hospitals used to care for us until we got better — even if it took a couple of weeks. Then we went home. But almost 20 years ago, Congress passed a little-known law that changed all this by changing how hospitals get paid. Until the mid-'80s, hospitals were paid for every day we were there. But then the law changed, and hospitals began getting a flat fee based on our diagnosis. A heart attack had one price tag, a broken foot another. If we recovered quickly, the hospital kept the leftover dollars as profit. If we lingered, the hospital took a loss.

Like magic, hospital lengths of stay plummeted. Patients were discharged "sicker and quicker," often to nursing homes, which became centers of rehabilitation — a much less expensive setting than hospitals. Home-care agencies flourished.

The Health Services Restructuring Commission's proposal to improve "clinical efficiencies" through the discharge of patients "sicker and quicker" to "home hospital care" will have an absolutely devastating affect on our community.

Others worry that the government's new payment system for Medicare — under which hospitals are reimbursed a set amount for each case, according to the diagnosis, regardless of how long the patient is hospitalized — encourages hospitals to discharge patients "sicker and quicker."