The Society

executives in New England. He was just halfway through his initial presentation when Roselyn Morton announced that he had one minute left.

Surprised and flustered, Will tried to sift through his notes to those facts he felt would have the most impact. What he succeeded instead in doing was to shove most of the sheets over the edge of the podium, where they floated to the floor like mutant leaves. For the first time since he began his presentation there was a reaction from the audience-a collective gasp, peppered with some sympathetic whispers and some not-so-sympathetic laughter. For a frozen moment, Will stood there, uncertain whether to go for his notes or to try and ad lib one or two final points. Instead, with a mumbled thanks, he scooped up the sheets and returned to his seat.

“You did great,” Lemm whispered.

“Did you like that little touch at the end? Inspired, I think.”

“Who hasn’t dropped something in their life?”

“I’m sure they’re all thinking that very thing, Tom, and not something like, He’s a surgeon? ”

Boyd Halliday, smiling, strutted up to the microphone, his white hair glistening beneath the elegant chandelier.

“Rumor has it,” he began, “that the President is going to create a new cabinet post to oversee managed health care. However, Congress has insisted that the secretary he appoints will only be allowed to hold office for three days.”

Will groaned. Two seconds and the man had already won over the audience with self-deprecating humor. A minute later, Halliday switched on a film, possibly done by an Oscar winner, which made managed care seem responsible for everything that was good about America and American medicine. Where Will’s data was presented in PowerPoint, with a character occasionally moving aimlessly on the screen, Halliday’s film, Together We Can Make a Difference, used Disney-level animation and a score that had some in the audience tapping their feet. Where Will presented columns of statistics, Halliday showed smiling children and scrubbed Midwesterners, each relating a heartwarming account of how their managed-care company came to the rescue during their darkest hour. What statistics he did present had to do with unchanged maternal/child health despite strict HMO limitations on their hospital stay together, and patient satisfaction that exceeded surveys done when fee-for-service was the way to go.

Halliday’s final minutes were spent looking at cost savings for various medical conditions since the managed-care revolution. By the time he had finished, Will doubted there was a soul in the hall who wasn’t a believer in the man’s cause. Both Will and Lemm took notes for the rebuttal period, but there was so much flash and so little substance in Halliday’s presentation that it was hard to find any point on which they could gain much purchase.

You want to do this part? Will wrote on the legal pad before them.

You’re doing fine, Lemm wrote back. Just relax a little bit, and you will succeed.

If Will succeeded at anything over the minutes that followed, it was at not embarrassing himself any further. Rather than attempt to refute the glossy-but-vacuous picture painted by Halliday, he completed his factual presentation and added some of the data they had not included on the PowerPoint program. He felt a bit more animated, but the audience still seemed lost to his point of view.

Before taking over the microphone, Halliday held a prolonged, whispered conversation with Marshall Gold. For a moment, Will thought Gold might take over as a gesture of fairness to their thoroughly beaten opponent, but it was Halliday who again stepped to the mike. This time, the CEO of Excelsius Health took him on point by point in a structured, mechanical defense of the positions of managed care. Round two was much less of a defeat for Will and the Society than round one had been, but it was a defeat nonetheless. It had to have been bookish Marshall Gold who had so quickly and effectively organized Halliday’s rebuttal phase, and Will found himself grudgingly admiring the man.

The questions submitted by the audience and chosen by the Wellness Project panel were all softballs, which both Will and Halliday handled without a hitch, though also without doing any significant damage to the other. Will rated round three as a tie, but weighted it significantly below the first two in terms of impact. Time had just about run out.

Halliday’s summation was a nifty, professionally done PowerPoint show that made the one Will had presented look at best unimaginative.

Efficiency and cost-cutting are not the least bit incompatible with compassionate health care. .

While HMOs may at times not have an extensive choice of physicians, patients can rest assured that those we do select have been carefully screened not only for ability, but for a history of psychiatric, drug, or alcohol problems. .

Statistics have shown that our restrictions on length of hospitalizations have not compromised surgical outcome in the least. .

Statistics also show no change in morbidity or mortality even though we are paying surgeons less than they earned per case under fee-for-service. .

Smug son of a bitch, Lemm wrote on the yellow pad.

He has reason to be, was Will’s reply.

“Well, here are the notes for your concluding statement, Will,” Lemm whispered, handing over a stack of five-by-seven cards, some of which Jeremy Purcell had prepared. “I think this’ll be pretty good.”

Halliday concluded his remarks and returned to his seat accompanied by generous, appreciative applause. Will remained in his seat for several seconds after his name was called out. The night was nearly over, and in truth, from what he could tell, he hadn’t accomplished a damn thing. It wasn’t as if he had mortally wounded himself or the Hippocrates Society and its goals, but he certainly hadn’t helped to promote them, either. He carried the file cards to the podium, then took a few more seconds to scan the crowd. It was, he realized, the first time he had made any real contact with them.

Yes, of course, facts, Halliday had said. That will be refreshing. . Dr. Grant, I intend to be civil with you only as it suits my purposes. .

Suddenly, with barely a hint from inside himself that he was going to do it, Will took the stack of note cards and set them aside. Then he lifted the microphone from its stand and carried it to the side of the podium.

“Mr. Halliday has spoken a great deal tonight about statistics,” he began, with no clear idea where he was headed. “I took biostatistics in medical school. I was hardly a legend in the course, but I did pass. One thing I learned was that well-designed, truly meaningful, unflawed clinical studies are about as rare as. . as a day without dozens and dozens of conflicts between physicians of every specialty and the insurance companies charged with deciding what they can and cannot do for their patients, and how much they will be paid for doing it. Put another way, if you happen to be the person being shipped from one ER to another because your HMO doesn’t perceive your illness to be life-threatening, statistics that say you’ll make it through your crisis without dying don’t mean a hell of a lot.

“In addition to biostatistics, I also took a course entitled ‘The Art and Practice of Medicine.’ That one I did do quite well in. Basically, what we learned about in the art and practice of medicine was people-not the kind of actors we saw in that movie, scrubbed and healthy and happy, but people who are sick. . or injured. . or confused-real people often at the very crossroads of their lives. People like Roy, a ten-year-old boy hospitalized by his pediatrician for profound malnutrition. Fifty-four pounds he weighed. It took an extensive, delicate evaluation, but finally the diagnosis of anorexia was made-an unusual though not unheard of occurrence in a boy of this age. Tube feedings and intensive family therapy helped the pediatrician and psychiatrist and nurses to save his life. Imagine if this was your child and he had died. Imagine the devastation to the survivors. But doctors doing what they had studied and trained to do kept that nightmare from happening. The point? Well, through a clerical mistake, Roy’s discharge diagnosis was listed as anorexia, not malnutrition. Same boy, same illness, same miraculous outcome, different word. Alas, whereas the family’s HMO would have paid for the lifesaving hospitalization if the diagnosis was written as malnutrition, the bureaucrats who decide such things adamantly and forever refused to pay for anorexia-a diagnosis they considered psychiatric, and therefore not covered by the family’s plan.

“Recently, Karen, a registered nurse in a hospital not far from here, with fifteen years of unblemished service, committed a fatal medication error. An investigation concluded that she was exhausted and harried because