Russell Madden
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It Mattered
Russell Madden
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Hardcover, $34.95
(Preview. Also available in a digital edition, $5.63.)



Review: Implant

by F. Paul Wilson


Russell Madden


Implant, F. Paul Wilson. Forge Books, 1995, $6.99.

A young medical resident resists pressure from hospital administrators to discharge an elderly woman exhibiting vague yet disturbing symptoms. Eventually succumbing to the wishes of his superiors, the doctor reluctantly sends his patient home. Soon thereafter, the woman dies.

In Implant, F. Paul Wilson confronts the current trend in medical care in which treatment decisions are increasingly dictated, not by what is best for the needs of the individual patients, but by hospital and political bureaucrats primarily concerned with impersonally imposed guidelines designed to curtail expenses. In the course of this novel, Wilson also dissects Congressional committees which listen more to the the self-serving prattle of incompetent, non-practicing doctors than to those who face the gritty, often messy details of daily hospital life.

The deterioration in the delivery of medical care in this country is a continuing saga with a long history. At it's most fundamental, all the programs, all the fixes to the programs, and all the fixes applied atop the last "fix" arise from the mistaken notion that health care is a right. The unquestioned assumption in most discussions of this issue is that because health care is a "right," people can claim it as their due. This belief is supported by the widespread acceptance of altruism, which states that morality should be based on the needs which people have.

Such a morality, however, can only consistently be practiced by using force against those who are to fulfill the perceived needs, regardless of their own desires in the matter. A free person and a free society, however, rejects the initiation of force: only voluntary interactions are permissible. Any "right" must apply to all people equally.

The way most citizens view health care, however, implies that one group of people can -- and should -- be able to demand that doctors and other health care workers give up their time and/or money to serve those who cannot -- or will not -- provide for their own needs. But, of course, those doctors and other taxpayers who pay their own way in life cannot, in return, place any such requirements upon their stridently self-righteous patients.

The endless parade of government subsidized -- and controlled -- health care programs began with Medicare in the Sixties. The program has swollen beyond all bounds. First it covered retired citizens. Then it was expanded to cover kidney dialysis and transplant patients. Clinton and Gore advocate spreading its coverage to younger people as a prelude to their hoped-for nationalization of the entire medical industry.

Medicaid -- Title XIX -- offered to provide coverage to poor people. Now -- through clever exploitation of loopholes -- even relatively well-off citizens can make use of its services by ridding themselves of their assets.

The politicians complain that "too many" people -- and especially "the children" -- live perilous existences without health care insurance and announce new programs to cover them. They never bother to inquire why these uninsured walk this particular tightrope. A politician eager to expand the power of government does not want to hear that many of these uninsured are young people who choose to spend their money on other goods and services. He does not want to become aware of the fact that even most of the insured obtain the health care they need. Nor does the bureaucrat want it widely known that the pool of "uninsured" does not consist of an unchanging set of people. Young people grow older, take on family responsibilities, make more money, and move into the realms of the insured.

The lie is the same the State uses when discussing the poor. Even if the total numbers don't change, the people involved do. But collectivists care little for such realities. To them, we are all interchangeable cogs, identical members of this group or that.

The State destroys the free market in medicine then uses the destructive results of their own actions to call for even more restrictions. Mandated coverage of various medical conditions and of even voluntary risks such as pregnancy, mandated portability, mandated packages of services (even if irrelevant to a particular person), and risk pools dictated by the State raise prices and increase usage. Special tax breaks for employer-provided health coverage created third-party coverage, eliminating the direct financial linkage between health care provider and customer. Not only has this tax-subsidized, low deductible approach led to loss of restraint on the part of many consumers (imagine if car insurance paid for oil changes and routine maintenance!), it has led to skyrocketing costs for those few individuals who do purchase their own insurance, those who are self-employed or who have no job-related fringe benefits.

As common sense and economics tell us, any subsidized activity or good will be increasingly consumed over time. So Medicare and "private" health insurance costs zoom higher and higher. Taxes increase. Reimbursements from the government are decreased. More and more rules are imposed in misguided efforts to contain demand. Health care providers find themselves squeezed. They cut staff or services. De facto rationing occurs.

Congress creates Health Maintenance Organizations. The HMO's make inroads on costs by also cutting reimbursements, coverage, and choices. Then Congress uses the howls of complaints to clamp on further restrictions and controls.

But the monster created by the State cannot be tamed by more of the same...not that the State actually wants any of its "reforms" to work. Just as with gun control laws, if such actions achieved the stated goals, there would be no more opportunities for meddling and diminishing our freedom.

In Implant, Wilson holds even good doctors partially responsible for their plight. The unpleasant reality of today's society requires that concerned physicians step forward and become political activists in order to defend the integrity of their profession. Only in such a fashion do they have any hope of resisting and overturning the destructive regulations fencing them in. Abandoning the political arena to the hacks and power-grabbers will only ensure the defeat of pro-freedom approaches to health care.

The fault in the approach of most doctors also extends back for decades. Licensing laws and restrictions on what nurses and non-traditional practitioners could do served to protect the doctors' livelihood by limiting competition. The original Medicare program was defended by many doctors. Too few denounced its implicit slavery and the altruistic premises supporting it. Too few doctors declared their lives to belong to them, not to the State or their patients. Too many doctors hoped to wield the power of the State to advance their own positions, both professionally and economically. Unfortunately for them -- and the rest of us -- the beast they thought they had chained instead proved to be master. It was the doctors and the entire medical community which one day awoke to discover its shoulders weighted down by those same chains they had helped to forge.

Implant's protagonist is Dr. Gina Panzella -- a young woman determined to accept the challenge of taking the reins of her life into her own hands, the kind of doctor who should be the rule, not the exception in her field. Though it costs her in terms of friendships and ease of life, she seeks to alter the status quo by becoming a staff member on the (fictional) Joint Committee on Medical Ethics and Practice Guidelines. In doing so, she must counter the opposition of her mentor and employer, Dr.Duncan Lathram.

Lathram is a plastic surgeon who refuses to treat any patient using government regulated and/or financed insurance to pay for his services. Because of his discretion, extraordinary skill, and "exorbitantly" high fees, Dr. Lathram attracts many influential patients from the Washington scene who desire to project a younger, more active facade for their constituents and colleagues.

In an era when the government has tried to penalize doctors who treat Medicare-eligible patients who pay with their own funds, Lathram's approach is a refreshing one. A medical center -- or doctor -- brave enough to reject government rules, demands, and red-tape would be able to cut costs drastically and offer better medical services at lower prices. Unfortunately, in Implant, Lathram does not stop there.

When a number of Lathram's prominent patients begin suffering inexplicable and seemingly random accidents, the book's suspense and mystery ratchet into high gear. In the process of uncovering the truth about her mentor and his activities, Gina finds her own career and life in jeopardy from both Lathram and the authorities.

Author Wilson is a (pleasant) anomaly on today's best-seller scene. A medical doctor and a self-styled libertarian, Wilson got his start writing science fiction stories. From there, he moved on to a highly successful series of horror/thriller novels beginning with The Keep (which Hollywood transformed into a movie). Most recently, he has dipped into his other career for inspiration and produced a number of medical thrillers with a philosophical bent. His previous novel, The Select, dealt with the question of what constitutes ethical medical research.

In Implant, Wilson has created appealing characters in Gina Panzella and the FBI agent -- Gerry Canney -- who comes to trust and befriend her. As the reader learns the sad reasons behind Dr. Lathram's intense hatred of government involvement in the medical field, he can sympathize -- perhaps even empathize -- with the surgeon's tragic situation...even if the doctor's clever scheme for exacting his revenge (justice?) must ultimately be rejected.

For readers seeking a good, suspenseful read combined with that rarity in best-selling novels, an argument for more freedom, F. Paul Wilson's Implant will not disappoint. We can hope that one day, the social conditions which form its backdrop and the motivations for its characters will appear as outdated and quaint as surgery without anesthetic now does to us.


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