by John Dalmas
"What is there to say?" asked the president.
Father Flynn shook his head. He couldn't think of anything.
FORTY-THREE
Sergeant Kurt Marais stood at the .50 calibre pintle gun, knees slightly bent, braced against the movement of the solitary armored personnel carrier as it rolled down the graveled South African road. The summer rains had been sparse, and six large tires and the air stream raised a long, conspicuous train of dust.
Except for themselves, the road seemed abandoned. Apparently every white in the region who hadn't been called up in the mobilization, or killed, had headed south.
The APC was traveling at 20 mph, fast enough considering they weren't going anywhere in particular, and the low speed conserved fuel. The day before, they'd found the Hoopstad base abandoned and its diesel fuel gone. The company had pooled the fuel it had with it then, abandoning six of its sixteen vehicles, carrying the extra men mostly on top, and headed south for Bultfontein. A bunch of bloody kaffirs with rockets and automatic weapons had ambushed them from a hillside, and been routed of course, but not before the company had lost two vehicles and twenty-eight men.
They'd found Bultfontein abandoned too, with no more fuel than there'd been at Hoopstad. So again they'd pooled what they had left, filling the tanks of three and partly filling another. Then Captain Temborg had asked for volunteers to go on foot, to go shooting kaffirs until they were dead themselves or out of ammunition. Every man had shouted or growled his readiness—they were all from Pretoria, and most had had family there. Temborg had chosen the youngest.
They'd spent the night at Bultfontein. There'd been kaffirs about, their calls eerie in the darkness. But there hadn't been enough of them to feel like attacking the APCs. At dawn the men on foot had moved out. Most of the rest had headed south for Bloemfontein—it was anyone's guess what they'd find there—but Marais' machine, the one with less than half a tank of fuel, would never make it. So with Temborg's blessing, Marais had driven off with his squad, on their own, to kill kaffirs.
Only once had they seen any near enough to go after. The ground there hadn't been difficult—a field of fresh-cut sorghum stubble—and the APC had given chase. He'd ripped eighteen with the pintle gun, its huge slugs killing almost every man they'd hit. Or as good as killed them. But mostly the kaffirs seemed to be keeping away from vehicle roads, staying to rougher country. So Marais had shot cattle, any he'd seen within range; they were all kaffir now anyway. And soon he'd be out of fuel. Then they'd have to abandon vehicle and pintle gun, so there was no reason to spare its ammunition.
Most farms they'd passed had been burned out, and a couple of times they'd seen recognizably human bones scattered about, picked clean by the vultures or jackals. Only the scraps of clothing suggested whether they'd been black or white. Marais had seen several burned out cars and trucks, too, and an abandoned tank—an ancient Comet holed and scorched. What it had been doing where it was, was anyone's guess. Its fuel tank was empty, of course.
The Willemsdaal couldn't be far ahead, Marais thought, though how near he wasn't sure; the kaffirs had pulled down and burned the road signs and mileage signs. His fuel wouldn't last long, and there should be a live stream in the Willemsdaal, where they could camp, and plan what to do next.
Marais watched carefully as they approached a set of fire-gutted farm buildings with trees in the yard, about a hundred meters from the road. Even at that distance, the whitewashed walls were soot-grayed. He caught a glimpse of movement there, but before the sound of gunfire could arrive, before he could swing his machine gun toward it, a bullet slammed him. His knees gave way and he slid down inside the APC, shocked semi-conscious for a moment, then felt the vehicle speed up as two of the men untangled his limbs and pulled off his shirt. A moment later the vehicle turned toward the buildings, lurching across the dry and shallow ditch. Old Brant had clambered up to man the pintle gun, and Marais heard its deep staccato slamming, drowning out the lighter sound of kaffir automatic rifles.
Then the APC braked, stopped, Brant continuing to fire the .50 calibre as the others went out the troop door, their own automatic rifles in hand. All but a cursing Celliers, who'd slapped a pad of surgical sponge on the hole in Marais' upper chest and was wrapping him round with bandage. The firing intensified; a grenade roared, and another. Then it quieted. There were a few single shots.
Marais felt no great pain, but it was getting harder to breathe, and he was weak and dizzy. Something fell on him, something wet. He was on his back, and focused his gaze on the gun hatch. Brant too had been shot, had fallen partly over the coaming, and blood had run down his body, his leg. Now it was starting to trickle off his boot.
The squad was returning, men climbing back into the vehicle, swearing excitedly or mechanically. Marais was going to ask if there were any more casualties, but it was too much work to speak, almost too hard now to keep his eyes open. It occurred to him that he was dying.
***
The president's January 26 address on health, before the executive council of the American Medical Association.
Thank you, gentlemen, for allowing me to talk to you. I should point out that what I say here is being said not only to you but to the rest of the nation, although the subject will be more immediate to you than to most people. The topics I'll talk about specifically are malpractice suits, the cost of health care, the assurance of medical competency, and the right to die.
Regarding malpractice suits: I presume that most of you know about the changes in our legal system. Malpractice suits will no longer be a rich field for harvesting by unethical attorneys. A physician can no longer be successfully sued when he is without fault, and attorneys now have a strong incentive to avoid clearly groundless suits. Punitive damages will no longer fatten an attorney's bank account.
The insurance industry has been informed of what the government expects from them in the way of rate reforms over the full spectrum of liability insurance, including medical malpractice insurance. Exactly what the new rates will be, we should know very soon. They will be a lot lower.
Physicians will continue to be held responsible and accountable for their competence and ethics, of course. Legal reform does not change that. The main effects of legal reform on the area of malpractice will be to avoid wrongful lawsuits and help relieve the profession and the general public of unconscionable costs.
Modern medical costs remain intolerably high. This is not a serious problem for the wealty, of course, but the great majority of Americans are not wealthy. Medical costs for middle-income Americans can be a crushing, impoverishing blow, or in some cases a constant impoverishing drain. The poor may find free treatment available to them, but involving such difficulties of transportation, for example, and occasionally such resentment on arrival, as to discourage seeking and receiving it.
At the same time, competent physicians deserve a high level of reward. The cost and demands of their education, and of equipping a medical practice, have to be recovered. Their work is often very demanding and their hours can be long.
Also the development of a new medicine can cost a pharmaceutical company many million dollars, which they have to earn back. Hopefully those companies will be more willing to work on development when they don't have greedy litigation lawyers hanging like hyenas around their perimeter, hoping to get rich off some rare, unpredictable, and unavoidable side effect.
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. Ho
w 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....