Running With The Big Dogs: Sybil Norcroft Book Six (6 page)

“Despite every effort by the Obama and subsequent administrations, there are still 45 million Americans without health care insurance; and they remain a prominent drain on our economy and siphon off money from the pockets of those who have insurance. The percentage of free-riders will continue to increase, according to CEA projections—consider what 72-75 million uninsured would do to our economy by 2040. That is a very real projection largely based on the rate of small businesses being unable or unwilling to provide healthcare insurance to their employees. Inefficiencies, rewarding medical inputs—fee-for-service—waste, inappropriately high administrative costs, incompetency in focusing on cure rather than prevention, fraud, and defensive medicine take a huge toll, and the impact worsens every year. In a sense, none of that will matter in three or four years, because we will be bankrupt; and only the very rich will be able to afford good medical care. Much of that care will be obtained outside the borders of the United States.”

Sybil paused to sip some water.

“So, Madam Surgeon General, we are all pretty much aware of the downside of our current failing system and of our responsibility to educate the public about that, but what can we do about it? I mean, what would a National Health Service do?”

“Excellent question. Americans are justifiably dubious about the role of government in medical care because—for one thing—they point to the many and obvious inefficiencies in government already present, many of which are related to political patronage issues. It will be necessary to return to basics and to have a board of managers which is impervious to political influence and is monitored regularly to ensure against bribery, undue influence, and graft. A dedicated law enforcement agency to investigate, arrest, prosecute, and try the managers and their employees for malfeasance will be a necessity. The board will have to operate under a mandate to control costs. That will involve real and objective scrutiny of practices, procedures, devices, drugs, and inefficiencies.

Outcomes must be clearly defined and based on verifiable evidence rather than on popularity or deep-seated personal beliefs on the part of care givers or patients. We must not be the first to try something new nor the last to abandon an old and established practice. That will be an ongoing study, and will take courage on the part of the managers to stand up to drug and device manufacturers, established medical groups, litigation attorneys, and representatives of the public including—dare I say—minorities.

“The system must be simple, clear, and understandable by even relatively undereducated people. There must be compassionate, firm, and well-informed help available. Electronic record keeping and communications among patients and their care givers and with other providers must become routine. We do not need to do even a quarter of the cardiac procedures that we currently do. Spine surgeons do not need to do fusions with the implantation of ghastly expensive hardware in anywhere near as many patients with back pain. Hysterectomies as stand-alone operations should be largely abandoned in favor of much less expensive and efficient robotic procedures to include re-attaching the structures involved in pelvic prolapse, despite the upfront costs of the machinery. Tort reform is critical.

Those are just a few of the examples of cost cutting combined with superior evidence-based performance requirements that must be implemented in the National Health Service law and will reduce costs and increase performance drastically, which is the result we must have. Every single individual in the country must have health insurance; and those who are able must pay for it. We must make it less difficult for healthy people to receive actuarially reasonable rates.

“As Jesus said, ‘the poor will always be with us,’ and we will always have to factor in the costs of care for them. What we have now is disastrously expensive, and even an increased humanitarian contribution will be less costly. We must do all of this within weeks, not years. It is time posthumous that we did away with the fiddle-faddle which has consumed our efforts at healthcare delivery reform over the past nearly ten years. The people must be educated; the brain trust of the government and our universities must go into high gear; the Congress must act; and finally, the implementation program must be fully ready before a date certain of the switch over to a National Health Service is announced. We will not survive another debacle like the one that took place when the Obama PPACA was pronounced ready for patient participation.

“Ladies and gentlemen, my friends and fellow Americans, I thank you for the privilege I have been given to serve with you. In this and all of your endeavors, I wish you fair winds and a following sea. In the final analysis, I wish you success. As NASA control radioed back to Apollo 13 when things were going horribly wrong, and it appeared that three very good men were going to die, ‘failure is not an option’.”

Chapter Eight

Wisconsin Avenue, NW, Georgetown, Washington D.C., December 31, 2019, 1900 hrs.

T
his was to have been Cerisse’s first New Year’s Eve away from home since she was adopted by Charles and Sybil Daniels five years ago. However, she relented and persuaded her boyfriend, Drake Farrer, to come to the house for dinner and to get to know her parents better. He compromised with her that they could go out after dinner to the Howard Science Students’ New Year’s bash. She liked it that he was willing to accommodate her, and he was strong enough to wrest a compromise from her. She pretty much liked everything he did.

After dinner, Charles Daniels invited Drake to come into his study; so, they could talk. It was so provincial that Drake and Cerisse shared an amused little laugh, but kept her parents from seeing their mirth.

“Have a seat and relax, Drake. This is not the fuddy-duddy old father having
that
conversation with his precious daughter’s new boyfriend. On the contrary, Cerisse’s mother and I are pleased with how the two of you are getting on. From everything we can learn, you are a fine upstanding man with a bright future. It’s that future we’d like to discuss with you. So that I don’t make unwarranted presumptions, would it be all right if I asked you a few questions?”

“Of course, Sir.”

“To start off, I think ‘Sir’ is too stuffy. Would you mind just calling me ‘Mr. Daniels’ and calling Sybil’s mom—her Mama—Dr. Norcroft. The Daniels part came after she got her M.D., and so the doctor goes with Norcroft rather than Daniels to be technical about it.”

“Sure.”

“I hope you are okay with me calling you by your first name.”

“I prefer it.”

“Great. Now to the questions. This is not a grilling, nor do you have to feel obligated to answer anything. If you are unsure, a simple, ‘I don’t know’ will suffice.”

Drake nodded.

“Are you and Cerisse serious? Are you exclusive with each other?”

“Yes to both questions, Mr. Daniels.”

“I’m glad to hear it. I guess that leads to the next things I would like to know. What are your plans for your future education and how do they include Cerisse?”

“That’s something of a tough one, Mr. Daniels. If it were a perfect world, I would like for us to get married at the end of this school year. We’ll both be twenty at that time. I’ll be frank with you and answer a question you have been too polite to ask. We have not had intimate relations with each other. I am crazy with desire for her, and I think she feels the same way about me. We want to be virgins when we get married; but we are only human; and we can’t wait a whole lot longer. Therein lies the rub. My family is not at all well-to-do. We are comfortable. I work outside school, but I can’t afford to get married and finish my undergrad work and get into medical school. At best that would bog Cerisse and me down with debt before we ever got started and would probably derail my education and also hers. We are planning to have a serious talk this week about what we are going to do. We are on the horns of a dilemma.”

“Drake, you said that you and Cerisse want to remain virgins until you are married. I applaud that. But I have to ask an indelicate question. Are you aware of our little girl’s childhood in the Congo?”

“Mr. Daniels, I am aware of everything. Cerisse stopped me from having even another date after it began to look serious for us. She told me that she had to tell me something and that she would understand if I didn’t want to have anything more to do with her. I was kind of stunned, but told her that nothing but her happiness mattered to me. Then, she poured it all out. I understand that I am the only person other than the two of you she has ever told.”

“How did you react, Drake? That had to have been a shocker.”
“It was. It might sound silly or girlish to you, but I cried. She looked into my face to see what my tears meant, and it was clear that they were an expression of my sympathy, my deep hurt that she had been so maltreated. She cried too. I told her that none of it—none of it—mattered. None of it was her fault. She is a virgin to me. That was really important to her, and I would never violate her in the slightest degree now that we have shared such a profound secret and pain.”

He looked directly into Charles’s eyes.

Charles shed a few tears. He had no further questions for Drake. The young man had won him over completely. Cerisse and her parents would be privileged to have a man of Drake Farrer’s depth of character to be Cerisse’s husband.

“Drake, it has to be obvious to you that Sybil and I accept you whole heartedly. We could not have asked for a better man for our precious little girl. She has been through a lot; she is tough and resilient; but there is a tender core in the girl. If you nurture that core, she will be the best wife a young doctor could ask for. If you treat her well, I will do all in my power to help you realize your dreams, if you will let me.”

“I’m not sure what you’re saying, Mr. Daniels. I do very much appreciate your wholehearted acceptance of me and of Cerisse and my intentions—as murky as they are—for the moment.”

“I would like to clarify some of that murkiness. I know something of what it takes to be a doctor, especially to become a neurosurgeon. The hurdles will be all that much greater with both of you getting your educations. I would like to make you an offer.”

“Yes, Mr. Daniels?”

“I understand and appreciate your passion and your dilemma. Of course Mrs. Daniels and I will always think our little child is too young to get married, but we can be objective enough to learn differently. If the two of you decide that marriage is the best thing for you, and money seems to be the only major hurdle, then I would like to help you get through your educations—no strings attached.”

“Like a loan?”

“No, think of it as a wedding gift—one that keeps on giving. When you become rich doctors, you can take care of the doddering old folks at home.”

“I don’t know what to say. That is the most incredible piece of luck in my entire life.”

“There is no such thing as luck, Drake. I compete in a dog-eat-dog business world and have done so for a long time. You have earned my offer. I ask only that you continue to earn it.”

“I will take care of Cerisse all the days of my life. I will protect her, love her, and make her as happy as it is possible to be. Your offer is life to me. I will owe you forever. Thank you so much.”

They shook hands on the most important bargain two men can make.

While the two men were in the study having their talk, Sybil took Cerisse aside in the sitting room outside hers and Charles’s bed room.

“I know what Daddy is doing, Mama; I just hope he isn’t too old-fashioned and stodgy with Drake.”

“You know your daddy better than that, Cerisse. I will bet you a milkshake that they come out of that room all smiles.”

“I certainly hope so.”

“There’s something else I need to talk to you about alone. You know about my new job.”

“Of course, Mama, everybody in the country—probably in the world—knows that you are the new director of the CIA.”

“Yes. You have to understand that we are in very unsettling times. What you might not know is that I have been receiving lots of threats lately, ever since the impeachment proceedings. I am not popular because of my participation in the imposition of martial law three years ago. Now, there are a lot of people who threaten me and my family because of the new efforts to stave off national bankruptcy, especially my role in pushing forward a plan to start a National Health Service.”

“But, you’re out of that, right? How come Secretary Margoles and the people in the SEC and the Medicare and Medicaid agencies testified before the congressional committee that it was all the president’s and your ideas. They got scared and blamed you, right? I thought they were your friends.”

“Cerisse, my dear, there’s a saying that has a lot of truth to it—’in Washington, if you need a friend, get a dog’. That’s cynical but seems accurate.”

“It’s not fair, and it’s nasty.”

Sybil nodded.

“The people who are blaming me are just covering themselves. They will continue to work for the National Health Service and probably to blame me. I don’t really care so long as they do their jobs and get the nation’s health care delivery back on track. I am no longer actively involved; but the hatred and threats from the radical right-wing people have not let up. You recognize that our security guard unit has doubled in size and that we have to obey some rules about where and when we can go out and with whom. Incidentally, presuming that you intend to keep company with Drake, he will have to have his own guards. The president has signed a special order to provide our whole family—including Drake—with a very serious security force. I have got to trust you to comply with the requests—yes, the orders—of the Secret Service agents. Will you do that for me?”

“Yes, Mama. I won’t like it, but I understand that it is necessary. Will things ever get better?”

“Frankly, Cerisse, I don’t think they will until I complete my term—which is indefinite—as the DCIA. I am going to tell you a family secret. You are an adult, and a very intelligent and serious one. There have been threats from the Russians against me and a lot of other U.S. officials because of some financial crimes they tried to get away with.”

“From the Russian government?”

“Certainly not directly, but there have been very direct ones from the Russian mafia who want to extort concessions from our government to let them have a free rein to invest in our stock markets. They will destroy us if we let them do it, and all of us in the federal government are absolute in our opposition to them. That is probably as important a reason as any to have the security units protect us. I repeat; will you do what I ask and what your guardians tell you without making it difficult?”

“I will, Mama. I swear on my love for you that I will.”