The Rationing

by Charles Wheelan

  “Sixty-five?” the Acting Secretary asked.

  “Let’s just say sixty-five and move on,” the Senate Majority Leader offered.

  “Agreed,” the President said.

  “There is a case to be made that it should be lower,” the Defense Secretary said.

  “Make it sixty-five for now. Move on,” the President said, more emphatically this time.

  The Acting Secretary wrote >65 in red on the board.

  “Just to clarify, does someone who is sixty-five get the Dormigen or not?” the Chief of Staff asked.

  The Acting Secretary answered, “As I’ve written it, only folks over sixty-five are excluded. So if you’re sixty-five, you get the Dormigen, but we could say that you have to be under sixty-five.”

  “I was just asking,” the Chief of Staff said.

  “Boy, that would make your sixty-sixth birthday really suck, wouldn’t it?” the Strategist interjected. “Happy birthday, Grandpa, I bet you wish you were one day younger.” He was back to his old self.

  “Okay, next,” the Acting Secretary said, looking around the table. “Or are we done?”

  “Who else do you want in the bunker?” the Defense Secretary asked.

  “College graduates?” the Chief of Staff asked.

  “That would exclude about sixty-five percent of the country,” the Speaker of the House pointed out, after which a silence settled over the table.

  “Do you want college graduates in the bunker with you or not?” the President asked.

  “I’ve met plenty of college graduates who couldn’t find the entrance to the bunker if it had a sign over it,” the Senate Majority Leader said.

  “You can say that again,” the Defense Secretary added.

  “Well, what about high school dropouts?” the Chief of Staff asked, hoping to move the discussion along.

  “Have we made a decision about college graduates?” the Acting Secretary asked, his red dry erase marker poised over the big whiteboard propped up on the easel.

  “It might be easier to think about this going the other direction,” the Chief of Staff said. “Maybe high school dropouts are excluded?” Her tone suggested some reservations with the idea.

  “You can’t get into the military without a high school degree,” the Defense Secretary pointed out.

  “There is a significant difference between getting into the military and getting the medicine that might save your life,” the Speaker of the House said sharply.

  “I was just providing information,” the Defense Secretary said.

  “Do you know what the impact would be on our minority populations if we were to exclude high school dropouts?” the Speaker asked.

  “I’m not sure this should be about race,” the Defense Secretary said.

  “Pardon me?” the Speaker of the House said, her faux-Hispanic hackles clearly up.

  “We’re trying to decide what to do here based on what’s best for the country. I don’t see what race or ethnicity has to do with it,” the Secretary of Defense said calmly.

  “Of course you don’t,” she replied accusingly.

  “Easy,” the President warned.

  The Strategist said, “If I may state the obvious, passing out Dormigen using any kind of educational credentialing as a criterion is going to have a huge adverse impact on every minority population in this country. The same is true if we exclude felons. Your ‘bunker’ is going to be full of old white guys.”

  “They can’t be over sixty-five,” the Acting Secretary interjected with flawless timing. There were uncomfortable smiles around the table.

  “We are not excluding anyone from receiving Dormigen based on race, sex, or ethnicity,” the Defense Secretary said firmly. “I’m proposing a criterion based strictly on educational attainment. That’s entirely defensible. The racial implications are what they are.”

  “You don’t think it would be a problem if our stocks of Dormigen went disproportionately to white middle-class Americans? Or is that the point?” the Speaker asked.

  “That’s out of line,” the Defense Secretary said.

  “I agree,” said the President.

  The Strategist interjected, “There are a fair number of people, especially minorities, who don’t attend college, or don’t graduate, because they can’t afford it. Obviously we would be compounding that disadvantage.”

  “I agree,” the President said.

  “On the other hand,” the Strategist continued, “the Swedes and the Canadians, and I think some of the other Nordic countries, have built their entire immigration strategy around this idea of giving preference to the most desirable. You get points for having an advanced degree, points for having a job, points for speaking the language. You literally add up the points to see if you qualify for a visa.” This was one thing the Strategist was famous for: holding elaborate arguments with himself.

  “That’s different,” the Chief of Staff said, almost reflexively.

  “Is it?” the Strategist asked. “I’ll be honest, I’m still agnostic on all this. But those are some pretty enlightened societies. They have a finite allotment of visas, and they have no problem giving preferential treatment to those most likely to succeed.”

  “If you define success strictly in economic terms,” the Chief of Staff said.

  The Strategist replied, “It’s not like high school dropouts are knocking it out of the park in other respects.”

  “And you die if you don’t have enough points?” the House Speaker asked.

  The Strategist shrugged. “I’m just saying: It’s not crazy to give advantage to the most productive citizens. We’re trying to put people in lifeboats here and we don’t have enough seats.”

  “Perhaps we should set the education question aside for a minute,” the Acting Secretary said. The eyes around the table turned back to his whiteboard, which still had only two criteria on it, age and felony status.

  “Dropping out of high school is different,” the Senate Majority Leader said. “That’s a personal decision, and it tends to have a high cost for all of us.”

  The Chief of Staff stared thoughtfully at the whiteboard. “I just need to say that I’m uncomfortable with this ‘bunker’ idea that we’ve implicitly adopted. I’m not sure it’s our job to pass out a lifesaving medicine based on merit.”

  “You can choose whatever metaphor you like,” the Defense Secretary said. “We’ve just got to pass out a finite amount of Dormigen.”

  The Chief of Staff said, “We don’t administer any other kind of health care that way. That’s not how an emergency room works. If there has been a shoot-out, and a police officer and a gangbanger get brought into the ER at the same time, nobody asks who is who.”

  The Strategist said, “It’s usually pretty easy to tell.”

  “Come on, you get my point,” the Chief of Staff insisted. “With triage, we always ask who needs care most urgently, not who deserves it most. The drunk driver gets care, right next to the family he crashed into.”

  “That doesn’t make it right,” the Senate Majority Leader said. “Most of my constituents would say that we ought to leave the drunk driver lying on the table until everybody with even the smallest scratch has been treated.”

  “Hold on,” the House Speaker said. “When did high school dropouts become drunk drivers?”

  The Senate Majority Leader replied, “I’m just saying that I don’t necessarily have a problem using merit as a criterion here.”

  The President leaned forward in his seat and tapped his pen several times on the table. He did it unconsciously—the pen-tapping—but the rest of us had learned, perhaps unconsciously as well, that he did it right before he was about to speak. “This situation is different than an emergency room,” the President said. “The thing about an ER is that you don’t have time, and some people are always in worse shape than others. So it makes sense to use scarce resources wherever they are likely to do the most good. We have some time—not enough, but we can make a plan here that
prioritizes who gets care, if we so choose.”

  The Acting Secretary pointed at the whiteboard with the marker. “What about disabilities?” he asked.

  “What do you mean?” the House Speaker asked.

  “Should that disqualify someone from getting the Dormigen, or make them lower priority?” the Acting Secretary asked, his voice perfectly steady, so as not to offer any opinion one way or the other.

  “What kind of disabilities are we talking about?” the Senate Majority Leader asked.

  “We’re not talking about anything yet,” the Acting Secretary said, “but I guess I would start with profound physical or mental illness.”

  The House Speaker exclaimed, “That’s repugnant. It’s like Nazi Germany.” Someone entering the room might mistake the Acting Secretary for a staffer, the designated scribe for the group. Yet he had deftly steered the discussion in the direction he had hoped it would go. The group was marching steadily along the branch to where the stick bug had disguised itself, waiting silently.

  The Strategist said, “Well, letting a healthy sixty-seven-year-old die is no picnic. The bottom line here is that we don’t have enough Dormigen—”

  “We might not have enough Dormigen,” the President interjected. “This is all hypothetical.”

  “It’s making me sick,” the House Speaker said. “We should agree to the China deal right now. This is horrible, horrible—and unnecessary.”

  The Chief of Staff said calmly, “We need to have this discussion in order to frame our options.”

  “Let me just add one thing.” At first I could not tell where the voice was coming from—not from the table. The White House Legal Counsel had been sitting against the wall, behind the President. This was the first time he had spoken, other than private conversations with the President and the Chief of Staff. He was slim, with a neatly trimmed gray beard, almost overly neat, like an affectation. He had been an appellate lawyer with a long and distinguished record of arguing cases in front of the Supreme Court before the President asked him to join his staff. I had a vague recollection that they knew each other from law school, or perhaps college. Those of us around the table turned toward the voice; the President had to turn his chair around. The White House Counsel continued, “I do not believe any plan that excludes felons would pass constitutional muster.”

  “Oh, Christ,” the Senate Majority Leader exclaimed.

  The President nodded, acknowledging the possibility. “Okay, walk us through that,” he said.

  All eyes went back to the White House Counsel, who paused for a moment as he gathered his thoughts. “Denying felons Dormigen, or ex-felons, would be perceived—correctly, to my mind—as part of their sentence,” he explained. “You have been sentenced to two years for assault, for example, and now, in addition to that prison time, we are making you ineligible to receive a lifesaving drug. In the eyes of any federal judge, liberal or conservative, that amounts to changing the sentence for a crime after the fact. That would be constitutionally prohibited, for violating due process and probably for creating a law ex post facto.”

  “This would be considered part of the sentence, and you can’t change the sentence after the fact, especially after someone has already served their time,” the Strategist said, translating the legal-speak for the rest of us.

  “Yes, more or less,” the Legal Counsel said.

  “Now you’re telling us that?” the Senate Majority Leader said, exhaling audibly.

  “What about using an age limit of some sort?” the President asked.

  “I think you would be on firmer legal ground there,” the White House Counsel answered. “But it’s not bulletproof.”

  I looked to the other end of the room, where the Acting Secretary was still standing near his whiteboard and easel. For all our meandering discussion, there were still only two items on his list: >65 and Felons. Now, without saying anything, he drew a red line through Felons.

  The sun had dropped low on the horizon, creating a softer light in the Cabinet Room and reminding us of how long we had been in that room. “Should we stop to order dinner?” the Chief of Staff asked.

  “I think we can finish up,” the President said. “I’d like some closure here.”

  “Maybe a short break?” the Chief of Staff asked.

  “Let me float an idea first to see if we can get some consensus,” the President replied, more genial than usual. “Remember, we are only adopting a contingency plan. We are not recommending a course of action. We can decide what we want to do vis-à-vis China in the morning—or, I guess, by the end of day tomorrow, is that right?” The Chief of Staff nodded yes, and the President continued. “So this would be our recommendation if we have to ration the available Dormigen. We will do everything in our power—everything responsible in our power, I guess I should say—to avoid such a situation. But this would be our plan, should the need arise, yes?”

  The House Speaker said, “I still believe this is a decision for Congress. I want that to be clear.”

  “You’ve made that abundantly clear,” the President said. “Believe it or not, I agree with you.” The House Speaker looked surprised, and then vaguely suspicious. The President continued, “A decision of this magnitude ought to come from Congress, even if that’s not where the authority over the Dormigen technically resides. On the other hand, I think any discussion in Congress would be longer, more contentious, and less productive than what we’ve been sitting through this afternoon.” The President looked at the House Speaker and then the Senate Majority Leader. “Would you agree?” he asked.

  “I think that’s right,” the Senate Majority Leader said.

  “What are you saying?” the House Speaker answered, wary of walking into a trap.

  “I would propose that this group make a recommendation for Congress to approve. Maybe it’s an up-or-down vote. Maybe there could be some modest amendments. I would leave that to the two of you.”

  “What exactly are we recommending?” the House Speaker asked.

  “We’re not there yet,” the President said. “This is just about process. I want to agree on a process first.”

  “I would be comfortable with that,” the Senate Majority Leader said. “I think it’s a sensible approach.”

  “What about China?” the House Speaker asked. “That’s how we make this whole problem go away. There is no need to be rationing anything.”

  “China is my decision,” the President said firmly. “Congress has no authority over foreign policy decisions, and, frankly, I don’t have confidence that Congress would be in a position to weigh the long-term implications of our complete capitulation in that part of the world.”

  “But you can?” the House Speaker said.

  “I don’t have to get reelected,” the President asked.

  “Maybe that’s a problem,” the House Speaker said.

  The President ignored her and continued, “As I was saying, if we get into a position where we have to ration Dormigen, I would like this group to make a recommendation with regard to how we allocate the available Dormigen, and I would like Congress to ratify that decision, perhaps with modifications—I’ll leave that to the two of you.” He looked first at the Speaker and then at the Senate Majority Leader. The latter nodded in agreement; the Speaker waited warily to hear more. “There is no way Congress can take up this issue from scratch, in a short amount of time,” the President said. “I think the Acting Secretary has made a powerful point here this afternoon, namely that any attempt to ration Dormigen using anything more than the most basic criteria is fraught with problems. If necessary, I propose that we ration Dormigen based on age alone, drawing a cutoff as necessary depending on the size of our shortage.” The President paused and looked around the table to take stock of the room.

  After a moment, the Secretary of Defense said, “In my heart, I believe there has to be a better way, but for the life of me I can’t seem to pin it down. I’m persuaded that we ought to keep it simple. I support what you�
�re proposing.” The others nodded in agreement.

  The President continued, “If the plan to ration by age is rejected, either in the courts or by Congress, then I think the only alternative is to use some kind of lottery. We should make that explicit up front.” The President looked to the Speaker and the Senate Majority Leader. “Would you be comfortable taking that to the Congress?” he asked.

  “It would be an unnecessary tragedy to get to that point,” the Speaker said.

  “One step at a time,” the President said. “I need to be wheels-up for Canberra at about this time tomorrow.”

  “I would be comfortable presenting that plan to the Senate,” the Majority Leader said.

  “Yes,” the House Speaker agreed.

  There was a moment of palpable goodwill in the room, a sense that we had taken a long journey and arrived at our destination. Although the view at the top may not have been as glorious as we had hoped, we were nonetheless standing there together. I began to admire the President’s style. He did not row, he steered. The rest of us thrashed about, hour after hour, as he sat at the end of the table saying relatively little. Then, when the destination was in sight, he pointed toward a spot on shore and urged us to make the last few strokes necessary to get there. The Chief of Staff said, “Thank you, everyone. I know it’s been a long day. We’re going to talk through the China option in the morning—”

  The President cut her off, his geniality gone. “We’re not done yet. How bad is it? What’s our death toll?” There was no answer from the table. “From Capellaviridae,” he added. “I assume we have data on this.”

  “Our Dormigen stocks are still robust everywhere,” the Chief of Staff assured him.

  “But they’re not going to the hospital,” the President said emphatically, almost yelling. “This family in Hawaii . . .” He looked to the Director of the NIH. “How many?”

  “The data are very rough,” the NIH Director replied. “Any estimate at this point is just an approximation.”