Cell (33 page)

“So to answer your question,” Thorn went on, looking directly at George, “the glitch has not been removed, in the sense that it is still collating the data. It is still selecting people according to its logic, but not terminating them.”

George and Paula exchanged yet another glance, a bit overwhelmed by what they had been hearing.

“Listen,” Thorn continued, “as I said, Amalgamated and the rest of the health insurance industry do not need ‘death panels.' It is the country and the world that need some rational approach to end-of-life care. Amalgamated will not promote any particular methodology. If the government wants it as part of the Medicare-iDoc package, then that is the government's decision, not ours.”

Thorn looked down the table at Clayton, who took the cue. “Cooperation on your part will bring other benefits, George,” Clayton said. “I will have you reinstated as a fourth-year resident. The charges of HIPAA violations will be dropped immediately. I'm sure you're aware that a number of health care professionals have been convicted of similar violations and are now in prison.”

“Likewise, the hacking charges against you will also be dropped,” Thorn added. “You will also be given stock in Amalgamated to compensate you for having the initial conceptual idea for iDoc. And you, Paula, will be given additional stock added to your already sizable holding.”

George leveled a gaze at Thorn. “That sounds like a bribe.”

“Think of it as appropriate compensation. There will be time in the future for both of you to voice your feelings about the iDoc algorithm, but only after iDoc has been given its final FDA approval and has been at least distributed nationally.

“George, your second contribution is that you have underlined our need to correct iDoc sooner rather than later, saving iDoc from a media frenzy that might have put off its adoption for years. Amalgamated owes you a vote of thanks.”

George and Paula both appeared shell-shocked.

“Now,” Thorn said, “if you don't have any more questions, we will let you discuss the situation in private. Then you can let us know how you feel about what has been said.”

George wasn't done. “I do have another question. Was Amalgamated responsible for my friend Zee's death?”

MENTAL HEALTH FACILITY

HOLLYWOOD HILLS, LOS ANGELES, CALIFORNIA

MONDAY, JULY 7, 2014, 9:58
A.M.

T
hank you for asking,” Thorn replied. “I meant to bring up the issue earlier, as we were certain you assumed that we were, but we weren't, at least not directly. What happened was we hired professionals to monitor you, to find out exactly what you knew or suspected, then Zee Beauregard entered the picture. We assumed he was helping you, especially when he managed to break into our iDoc servers. When he suddenly bolted early Saturday morning, we knew we had to follow him and bring him here along with you. He was trailed as he drove north, and we would have picked him up when he stopped. Unfortunately, that was not the way things worked out. Somehow he realized that he was being followed, and he apparently panicked. He pushed his car to unsafe speeds. I was told that it was an old vehicle. We believe he just lost control of the car and hit the concrete abutment of an overpass.”

“Why did the media report that he had a stuck accelerator?”

“No idea. You'd have to ask them. We guess it was because of his vehicle's make and age and the fact that he was traveling over a hundred miles per hour, and it was the kind of accusation that would sell papers and up TV ratings. But, again, that's just a guess.”

“You were going to have me picked up Saturday morning?” George asked.

“I was told that that had been the plan. But unfortunately when a backup team returned to your apartment, you had been arrested for hacking. That put us in a tailspin. We were very concerned you were going to tell the police, alerting the media in the process and putting the whole iDoc program in jeopardy, after all. But then things began to look up when you got out of jail so quickly, eventually leading us to Paula's house.”

“How did you follow me to Paula's house?”

“We personally didn't follow you. The professionals did.”

“I thought I was being careful.”

“Well, they are, by definition, professionals. I assume they merely tracked your cell by GPS. Either that or they put a GPS tracker on your car.”

George looked at Paula, who raised her eyebrows as if to say “I told you so.”

“Now, if there are no more questions . . .” Thorn looked back and forth between Paula and George, waiting.

At first neither Paula nor George moved. Then Paula piped up: “When the, quote, ‘professionals' invaded my house, they blew my front door off its hinges. What do you plan to do about that?”

“Already taken care of. The door is back on, restored to normal, as is the security system.”

Thorn waited a few beats before adding, “Well, then, the ball is in your court. We will leave you two alone to discuss the situation. But remember, we believe that now is not the time for the general public to hear about the ‘glitch' issue. The public is not ready for the debate about resource allocation, and iDoc should not be made a hostage to it. That's why you two must agree not to expose iDoc's problem, at least in the short term, until iDoc is introduced on a national scale and included with Medicare and Medicaid. At that point, the government and Amalgamated will respect your input.”

Paula had another question. “How long do we have to make up our minds?”

Thorn shrugged. “As long as it takes. Let's just say as soon as possible. If you have any additional questions just let the attendants know. There's a large common room where you'll be allowed to spend most of your time. And a dining room where you will take your meals. Nights will be spent in the rooms you occupied last night. You will not be bothered. At the moment you are the only . . .” He searched for the right word, finally adding, “Guests.” He rose from his chair. Langley and Clayton followed.

“We hope to hear from you both soon,” Thorn said with a forced smile.

With that Thorn, Langley, and Clayton filed out of the room, closing the door behind them.

George and Paula eyed each other, mouths agape.

“That was one of the weirdest experiences I've ever had,” George said, shaking his head.

“Agreed,” Paula responded. “I don't know what I expected but that certainly wasn't it. I don't know whether to be thankful or mad or both. Hell, they could have just phoned us rather than sending in the goon squad.”

A minute later the door opened and several of the attendants reappeared. They motioned for George and Paula to follow them to the common room.

MENTAL HEALTH FACILITY

HOLLYWOOD HILLS, LOS ANGELES, CALIFORNIA

MONDAY, JULY 7, 2014, 10:35
A.M.

G
eorge and Paula cast their eyes around the large, very institutional-looking common room, which was furnished with several aged couches and a smattering of club chairs that faced an old TV set. The TV was tuned to a morning game show. In addition, there were four game tables and two bookcases, with a collection of dated books—mostly old
Reader's Digest
condensed editions—and magazines and board games. To complete the functional decor, the windows were barred.

Standing off to the side, near the entrance to the room, were four of the original six attendants, keeping an eye on their charges. On the other side of the entrance was the hallway leading back toward the conference room, and farther on, in the same direction, were the rooms where George and Paula had spent the night.

Paula and George were not watching TV but left it on to cover their muted conversation. They were settled into a couple of the chairs, as far away from the attendants as possible.

Paula was still incensed. “I cannot believe that they are treating us like this, holding us captive in this fifties-style mental institution.”

“The whole affair defies imagination,” George stated. “But I have to say that right now I'm feeling a lot better and a lot more relieved than I expected I'd be feeling.”

“I guess I have to agree.”

“I wonder if there are any other inmates or patients here despite what Thorn said.” George looked back toward a glass-fronted nurses' station. Inside was a desk, where one of the attendants was doing paperwork.

“If there are other people, then they must be in isolation,” Paula said, her eyes following George's as they took in their surroundings for the hundredth time.

“Okay,” George said, turning to face Paula. “We have had time to recover from our shock at seeing Thorn, Langley, and Clayton. We have to talk! What's your gut reaction to Thorn's lecture?”

Paula shook her head. “I haven't had time to completely internalize it. I still feel so shell-shocked about the whole affair that it's hard to think clearly. All at once I have much more of an appreciation of post-traumatic stress.”

“Me, too. But we have to make an effort. I imagine they expect to hear from us fairly soon.”

“You're probably right.” She reached out and touched his hand reassuringly. “Listen! I don't know how I feel about it all, but at least there are some compelling aspects to their offer.”

“What do you mean?”

“I mean the part about needing some kind of rationing of health care for the last months of life. Ironically it has always existed, but behind the scenes. I mean, the demand for health care, or should I say sick care, is near infinite. Rationing has always been around in this country. And I must say it's been unfair, since it has been based on ability to pay or celebrity status. People with money and power have always gotten the health care they needed or desired. I don't know for sure, but maybe Mickey Mantle's liver transplant is a case in point. Possibly the same for Steve Jobs's.”

“Are you buying Thorn's premise to let sleeping dogs lie?”

Paula shrugged. “I'm not buying anything. I'm just thinking out loud. I was blown away by Langley's explanation that iDoc actions were responsible for the deaths. Like you, I thought for sure it had to be hackers. It never occurred to me that it came from the iDoc algorithm itself. I mean, I did know about all the subjective aspects Langley mentioned regarding cost control and quality of life that had been taken into consideration when the iDoc program was designed, but I never would have made the leap to think that iDoc would be analyzing these considerations and making the decision that it's best to get rid of people. Yet rationing has always been around. Maybe there is something to letting an algorithm, which is completely nondiscriminating, handle the matter. What could be more fair?”

“It sounds like you have made up your mind.”

“No, but I have to say, talking about it does help. When I think about the individual cases, I mean, there is no way that they should have been murdered, because that
is
what happened. Yet at the same time they may not have wanted to be tortured with any more drugs that wouldn't have cured them and might have had horrific side effects. Maybe there is a place for assisted suicide or at the very least for expanded hospice care.”

George nodded. He could see Paula's point. “I have to admit that I have never given much thought to the issue.”

“Well, maybe it is an issue that can no longer be swept under the rug.”

George ran a nervous hand through his hair. “Health care is changing so fast with Washington mandating private health insurance. What the government should have done is make health care a function of government alongside education and defense, like medicine for everyone.”

“That was never going to happen,” Paula said. “That unfortunately got mislabeled as ‘socialized' medicine way back when none of our politicians had enough courage to take it on.”

“Well, we doctors should have been for it, but we were too afraid of losing control of the profession, which now is going to happen via the digital revolution. Maybe we deserve it, having tried to support the fee-for-service paradigm for so long.”

“I couldn't agree more,” Paula said. “Doctors certainly have been dragging their feet about informational technology in general. It is just another reason why iDoc is going to be a huge plus.”

“It's not going to be a huge plus if, as you say, it murders people.”

“Let's put that behind us for a few minutes,” Paula said. “I'm inclined to do as they wish. I committed the last three years to developing iDoc. Maybe you should feel the same, since it was your germ of an idea that started it all.” With raised eyebrows she looked over at him and studied his face.

George was taken aback. “I hope you are not suggesting that you and I bear some of the responsibility for these deaths.”

“Hardly. But I am beginning to think that they are, as Thorn has suggested, an unfortunate consequence or growing pain of a new and improved system that is going to have an enormous positive effect on the health of the public. A few people die in all sorts of medical studies, particularly drug trials. As long as the unintended killing has stopped, I think I can live with keeping quiet about this glitch, at least in the short run. What about you?”

George sighed. “You know, I have a real problem because one of these murdered souls was someone I loved, and another was one I cared about as a friend. That makes it hard to think of them as unfortunate ‘growing pains' or statistics. What would I have paid to have had six more months with my fiancée. But maybe she would have wanted to avoid the pain and suffering. Still, I would much rather that the decision had been hers and not an algorithm's. . . . Jeez!” George lifted his hands in a gesture of frustration and confusion.

“These issues are a thousand times more troublesome when they are imbued with emotion. I can understand. And I'm sorry.” She touched his hand again, this time leaving her hand resting on his.

George glanced at the attendants, then leaned closer to Paula. “Thorn also said that the government doesn't want the glitch to go away.”

“But the killing has stopped.”

“But it is only a click away if the glitch, as they euphemistically call it, remains.”

Paula removed her hand from George's. “I see your point.”

“This Independent Payment Advisory Board is a scary behind-the-scenes organization. Its members are appointed, not elected, and this Universal Resource Initiative is even more of an enigma.”

“Agreed. But Thorn said that what the government does with the glitch is an open question and that our input will be respected.”

“True. But the secrecy worries me. And when you get down to it, the federal government is going to do what the federal government wants to do. If our input doesn't line up with their intentions, who do you think wins?”

“Well, we can agree not to let it remain a secret. Meanwhile, I think we should get out of this place. We can tell Thorn that we agree in principle to what he's asking, meaning we won't go running off to the media. That will get us out of here, and we can continue talking at my place, which will be a hell of a lot more pleasant.”

“Do you think Thorn will buy it?”

“I do! I'm taking him at his word. We have no other choice if we want to walk out of here.”

“Letting the glitch persist makes me feel I have taken the first step on a slippery slope. It's like the beginning of herding up the weakest among us for a future cull.”

“That may be, but as long as no more people are murdered, we can afford to continue thinking about it. I
have
to get the hell out of here. And you need to finish your residency instead of going to prison.”

“Okay!” George said. “Okay!”

“Okay what?” Paula asked.

“Okay, I guess it is worth a try. I hope I can make it sound convincing.”

“All we are promising is not to go to the media right now. We can sound convincing because that is exactly what we are doing, and for the moment at least, it's all they're asking.”