And incidentally, I've had letters from a lot of lawyers who are as glad to see liability law reforms as the rest of us are.
But despite the coming reduction in liability insurance costs, and the marked reduction which that will allow in medical and hospital fees, those fees will still be too high for many families. For one thing, there is the cost of modern high-tech medical equipment.
So there appears to be no prospect that overall medical and hospital costs can be reduced to a level we'd like, without serious reduction in the quality of care. The best we can do seems to be to spread the costs differently, so that no one need go without necessary care or be impoverished by it.
And personally I prefer to avoid a government-operated system of social medicine if possible.
So I am asking this council to assemble a committee of physicians, management specialists, and lawyers to draw up a blueprint for a system of health care that will spread the cost in a blanket national insurance system. In occasional consultation with the Department of Health and Human Services. And if your committee doesn't come up with a complete and satisfactory system by the first of April, I'm going to decree a government-run program of socialized medicine, for which a blueprint is already available.
Because the field of human health is not the sole concern of any one group or profession. We are looking at the matter of life versus avoidable, unwanted death; of human suffering and human dignity. Areas I know most of you feel strongly about, and most of the rest of us too. Areas where inequities can sour a society, make it bitter with a sense of injustice, and weaken its fabric.
Now, regarding competence, the medical profession reputedly has been guilty, sometimes flagrantly guilty, of covering for certain members who are incompetent. Your profession performs a broad spectrum of activities. Some areas often demand very discriminating diagnoses, other areas less. Some require very high surgical skills, some require exceptional recall or high endurance, etc. This is generally recognized. Physicians and surgeons must be restricted to activities at which they are actually competent.
Except of course in unusual emergency situations where no good alternative seems reasonably available. As an extreme example, a veterinarian may never have seen a human appendix, but does have considerable surgical skill and a great deal of knowledge about mammalian bodies. And in an emergency where no physician is available, a veterinarian would be justified in performing an appendectomy to save a human life.
Next I want you to look at something that is only indirectly connected to medical costs and competency. Some of you, let's face it, are not entirely rational on the subject of human life. Frankly, human bodies do wear out. And human beings sometimes wish to be allowed to die. It is neither sane nor ethical to insist on keeping a human consciousness trapped in a painful, nonfunctional,
burdensome
body, when that consciousness, that human beingness, prefers to die. Almost every state has recognized that now, and has enacted law requiring health professionals to honor a patient's preference for death, under certain circumstances and at the patient's specific request. But too many of these laws are inadequate in their protection of the right to die. Therefore the Secretary of Health and Human Services will appoint a committee to draw up guidelines for a national law protecting that right.
The committee will include geriatricians and other physicians, psychologists, nursing home operators, and lawyers, and it will hear representatives from the elderly and the general public. But it will not include or hear representatives of insurance companies. Insurance companies have legitimate and important problems and considerations, and these must be dealt with fairly, but they cannot be allowed to deny the right to die. Their problems must be solved without interfering with that right. We will not allow people to be held in needless, unwanted suffering, against the threat of insurance cancellation, so an insurance company can get a few more premiums before having to pay a death benefit.
Already this is not the problem it once was. We're going to handle it the rest of the way.
I'm sure all of these matters will be worked out in a manner acceptable to the medical profession and the American people. I'll leave you now with Dr. Guzman, our new Secretary of Health and Human Services. She'll talk specifics with you.
And I thank you for your attention.
***
The president switched off the 11 P.M. news from Duluth's KDAL-TV and picked up his cup of the hot buttered rum Lois had made for them. The weather was getting a lot of attention lately, he thought drily. It hadn't been warmer than -12° F for four days in Duluth, hadn't gone as high as zero even in Chicago, and the high and low at International Falls for the day had been —29 and —51. Siberian, he told himself, or damned near. He'd authorized diversions of military fuel oil reserves for domestic distribution—weatherwar was war too, of a kind—but they wouldn't last long. He'd also ordered increased pumping in domestic oil fields.
The latest emergency powers repeal bill had been killed in committee, just as Lynch had anticipated.
He wondered how much fuel oil had been saved by the installation of GPCs in power systems. Not a lot yet; nothing compared to what it would be next year at this time. If there was a next year.
The Soviets had a certain advantage in a war like this one: so many households there heated and cooked with wood. Of course, a lot of wood-burning stoves had been sold in America during the past year, but probably not more than ten percent of American homes could heat with wood or coal. He'd seen TV features on families that had moved into the garage these last few days, had cut or broken a smoke-hole below the roof peak or in the roof itself, and kept a fire going on the concrete floor. Camera operators had gotten tired of showing people carrying or wheeling home bundles of firewood or bags of coal from distribution yards. The neighbor who owned a wheelbarrow, one commentator had observed, was more valued then the neighbor with a Cadillac.
It was going to be a bastard of a winter if the Soviets didn't back down, but he would not escalate this covert war.
When you find yourself running low on options
, Haugen told himself,
you look to your long shots.
And Bulavin had gotten back that evening; Cromwell and LaMotte would be debriefing him now. Maybe there'd be good news in the morning.
FORTY-FOUR
The poshed, command model Kamov Ka-25 helicopter hurried along about one hundred and fifty meters above the undulating steppe toward Voronezh. It might almost as well have been at 3,000 meters, because General Serafim Petrovich Gurenko wasn't giving the snowbound landscape much attention now. In two days of hopping from base to base, he'd already seen and heard all he needed to. This morning it was time to return to Moscow.
That the roads were plugged with snow was bad enough. But in the Soviet Union, the railroads were far more important than highways, and on them too, almost nothing moved. Trains were nearly buried by drifts, visible mainly where the winds had scoured the snow away. Snowplows chuffed and pushed so slowly that their sooty coal smoke formed no plume, but simply rose up, then spread, to settle on and around them. Most were not rotary plows, but pushed and punched their way behind tall, V-shaped blades. When they came to a grade cut, they hunkered, virtually stalled, for the cuts were drifted full, the depth of the snow equalling the depth of the cut, be it three meters or six.
Military traffic was utterly stopped—supplies, troop trains, all of it. And there was little sense of urgency. Urgency comes with purpose, desire, and there was little of that beyond the purpose and desire to survive. In the cities they might riot, but the time-honored peasant rule was tighten your belt, wait, persist. And on the collective or in the city, those whose purpose reached beyond simple survival were mostly ignored, unless they had authority, and even authority was heeded mainly until it was out of sight.
Gurenko's eyes paused on a village, one of many on the steppe. It was the coal smoke that had caught his attention, pooled over the low buildings by the frigid inversion layer. Snow had blown across the open plain until it met some obstruction or depression; there it had been dumped by the wind eddies. Thus, beneath its smoke, a village appeared as little more than a complex pattern of drifts and scour holes, with walls and roofs showing mainly on the windward sides.
By now the peasants would have dug, tunneled where necessary, to the shed to feed and milk their family cow. But the collective's livestock would still be waiting, hungry and freezing, in their lean-to shelters.
Gurenko had not visited the rangelands of Kazakhstan; that had been out of his way. But the conditions there would be worse. The death toll of cattle and sheep could only be guessed until spring uncovered them, but it would be bad. How bad depended on how many had found their way to shelter, or been driven there when the storm warnings were broadcast. No doubt many herdsmen had died too, caught by blinding blizzard, unable to find their way to safety.
Ahead, low hills appeared now, and patches of scrubby woods. Voronezh would soon be in sight. There he would transfer to something faster than this machine, fly to Moscow, and do what had to be done. Or try to. For the storm, and this bitter cold that Pavlenko had brought upon them, had forced him to look, and to see more surely, how deeply his country had foundered these last few years. Till now, he'd equivocated, rationalized. Now it was time to place his life on the line.
***
Marshall Premier First Secretary of the Communist Party of the Soviet Union Oleg Stepanovich Pavlenko walked down the wide and polished corridor noticing neither its grandeur nor its beauty. He was not much given to aesthetics. Nor did he notice the ever-present guards standing stiffly at intervals along the polished hardwood wall panels, their AKM rifles at present arms.
He had seen the reports, from every republic, every oblast. No one was doing anything! No one but the army! They were all waiting for someone to do it for them; their God maybe! Waiting for spring to come! By God, they should be out there with their shovels, with tea spoons if that was all they had, clearing the railroads! He knew these damned people; they wanted him to do it for them!
Well, he
had
done it for them. He did not remember the names of the exact places, but his technologists knew. Nor had he asked the concurrence of the others; now he would simply tell them. He was tired of that puking Predtechensky, who wished always to argue; and Makarov, who always nodded but who, behind his back, whispered and plotted; and Goncharov, who seemed to be turning against him lately....
Today he had taken the irreversible step. Today they would either overthrow him or they would get on their bellies. And tomorrow he would begin making a nation of those treacherous and willful minorities, and of the disobedient, bull-headed Russian people who could so easily say
yes
, then turn around and do the opposite.
He was the only one who had any sense of history, of destiny. The first since Comrade Stalin. The rest of them, one after the other, had been nothing but apparatchiks.
His aide opened the door for him, held it, and Pavlenko stepped through into the council room. The others were there ahead of him. A haze of cigarette smoke was already forming. He nodded curtly and took his place at the head of the burnished Circassian walnut table.
His hawk eyes swept the congregated Politburo. Three were there besides the members: Bogoslovsky from the Transport Ministry, a whiner; Morozov of the Armed Forces Inspectorate, who'd grown surly of late; and Feldstein of the newly reconstituted OGPU. Being a Jew by birth, Feldstein was vulnerable to certain prejudices, thus his loyalty was more reliable.
They sat there with each his own trivial business to press. In a minute he would tell them what he had ordered, and they would forget all about what they'd wanted to say. His eyes moved to the clock on the wall opposite him: 0906 hours. It would be happening just about now! Leering, he rapped his gavel on its ceramic plate and called the meeting to order.
***
When the president went to bed, he'd plunged deeply into sleep. It was less than an hour and a half later, at 0116 hours, that the phone drew him unwillingly awake. He fumbled the receiver from the cradle.
"This is the president."
"Mr. President, this is Jumper. A heavy quake has hit the San Andreas Fault, actually two of them almost simultaneously, at 7.7 and 7.3 on the Richter Scale. The first reports are that San Bernardino's in bad shape, and San Francisco's taken a lot of damage. L.A.'s taken some too."
Jesus Christ!
Haugen found himself thinking,
let it be natural.
But it couldn't be, not two at once.
"A lighter one hit Seattle at almost the same time," Jumper continued. "It was still fairly strong—it read 5.3. The epicenter was where the Juan de Fuca plate rides beneath the North American. All three were artificially triggered."
"Right. Jumper, is Bulavin with you?"
"He's in the debrief room; we were almost finished when I got the call."
"Call Gupta right away and get him on a security conference call with you and me and Bulavin. I'm going down to my office right now."
He disconnected and got off his bed. Lois was staring at him from her own. "Pavlenko's given us an earthquake, Babe," he said. "Three of them in fact. Be glad the White House isn't in San Bernardino."
Frank and Will were the Secret Service men on duty in the Stair Hall. They followed the bathrobed, slippered president down the stairs. "Big quake in California," he told them. The rest of the way he was silently blessing the nation's luck: Seattle's and Tacoma's especially. The geologists had worried for years that enormous stress had built up along the Juan de Fuca subduction zone—it was either that or subduction had been unusually smooth. The fear had been that when it let go, the quake might be close to the theoretical maximum of nine-plus on the Richter Scale! With an actual reading of 5.3, apparently it had been smooth.