If nobody else mentioned Desiree, hedecided, he was not going to be the one to break the ice.
Gawaine was called upon next to give thegroup an update on their newest endeavor — legislation that would enable thehealth insurers to decide what treatment was appropriate and not appropriatefor patients with terminal illnesses. Kevin continued to watch him closely,noting how he shuffled papers and fidgeted with a pencil as he spoke. SirButtondown was uncharacteristically nervous. No doubt about it.
'Please note,' Gawaine said, 'that I referto patients with terminal illnesses rather than terminally ill patients. Oncewe are allowed to define what illnesses can be considered terminal, we plan toturn our attention to determining when the treatment for those conditions is nolonger cost effective. We need the right to cut off coverage for those patientswho are taking up costly hospital beds and specialist care when there isultimately no hope for them. Of course, the sooner in that process we can stepin, the better. The legislative climate is excellent right now. Tristram hasbrought the commissioner back into the fold, so he won't be a problem. We'vebeen nibbling at this thing for years, convincing the legislators and thepublic that since we're footing the bills, we should make the treatmentdecisions. Now it appears that we are ready to take a much bigger bite.Lancelot, do you want to go on to your part?'
Lancelot set his half-smoked cigar asideand cleared his throat. He never actually lit up a cigar during a Roundtablesession, but he was rarely without his prop. He gave Gawaine a puckish grin andan A-okay sign. Tristram noted that Gawaine barely responded.
'The neat part of this program,' Lancelotexplained, 'is a network of facilities we are calling palliative centers — PCs.These are the places where patients we determine to be terminally ill can besent for inexpensive, barebones care. The ultimate hospice — something on thecontinuum after a hospital and a nursing home, but much less expensive to runthan either. No treatments, no IVs, no therapy of any kind. Pain medicationonly, administered around the clock in a totally humane way. And the best partis that we are moving ahead with designing these PCs and even setting up thecorporations that will eventually run them. In some cases, we're actuallypurchasing the facilities that will one day house them.'
There was half an hour of discussion onthe palliative centers, and then Merlin took over.
'This has been a hell of a meeting,' hecheered. 'A hell of a meeting. Well, I'm pleased to say that the news from myfront is good, too. We've implemented the employment modification program on alimited basis, and tonight I'm prepared to present the results and projectednumbers on the first ten cases. The policyholder in each of these cases hasbeen terminated from employment. Some have found new employment with companiesdoing business with insurers other than Roundtable members. Others continue asallowed by law to pay their premiums themselves for eighteen months. Still othersnow qualify for Medicaid. But in most of these cases, we're already out of theloop as their insurers. Off the hook, so to speak.'
Loomis could not remember anything calledthe employment modification program. Apparently, Merlin was using The Roundtable'smoney and influence to arrange the firing of costly policyholders. If so, itwas the first time that specific individuals had been targeted by the group. Hescanned his copy of the printout Merlin had passed around. At the top was theheading 'Qualifications' — the factors used by the computer to select cases.Below that were ten names, and beside each of them was an insurance carrier, adiagnosis, and a dollar amount. The smallest amount was $200,000, the largest$1.7 million. The fourth of the ten names was a Crown Health and Casualtysubscriber.
4. DeSenza, Elizabeth Ryan Crown
Head Injury
$1,300,000
Kevin stared at the name, struggling tokeep his expression bland. Beth DeSenza was a production line worker at a largegarment factory just outside the city. Her son, Ryan, had suffered a freakcardiac arrest and subsequent brain damage after being hit in the chest with abaseball. Thanks to her company's comprehensive insurance coverage, Ryan was a patientin the most highly regarded — and most expensive — brain injury rehabilitationhospital in the area. Kevin had engineered the coverage agreement with herunion. Beth was the only policyholder in all his years with Crown who had takenthe trouble to find out his name and to write and thank him for his role inproviding care for her child. She included a picture of Ryan before theaccident, bat poised, smiling self-consciously from beneath a baseball cap thatseemed two sizes too big.
Nancy had taken the note and had it mattedand framed. Now, Beth's coverage for her son, at least at the level provided byCrown, was over. The individual-policy premium was extremely expensive — almostcertainly too expensive for her to continue the coverage even for the periodallowed by state law. Tristram felt ill.
'. . From early indications,' Merlin wassaying, 'provided the program is not overutilized, once we get up to speed ourcompanies can realize a comfortable ongoing saving of three to six milliondollars a month. Not exactly a bonanza, but hardly chicken feed.'
There were appreciative pen taps fromaround the table.
'I was just wondering why the companiesholding the policies weren't consulted about these individuals before they wereterminated.'
There was a deathly silence in the room.
'Tristram, I don't believe I understandwhat you mean,' Merlin said finally.
His tone and expression werenonjudgmental, yet Kevin felt his pulse pounding in his ears. Everything seemedto be happening in freeze-frame. The six faces fixed on him were like those ina wax museum — imbued with expression, but not with life.
Then suddenly, his gaze was drawn tomovement. Gawaine, sitting across from him, was shaking his head ever soslightly. His eyes, locked on Kevin's, blazed. Loomis watched his lips move andheard the unspoken word as if it had been shouted into his ear.
With the others focused on him, Loomisfelt certain he was the only one who had picked up on the warning.
'I … um. . I'm sorry,' he said. 'WhatI meant to ask was why you hadn't checked with each of us for more names.'
'Ah, I see,' Merlin responded. 'Thank youfor clarifying that. I did misunderstand.'
'Perhaps I can answer your question,Tristram,' Kay said, 'since I designed the program to select the clients. Thedecisions, purely business, are made by computer to keep them as rational anddispassionate as possible. As you can see from the list of factors considered,a great deal of data is evaluated before a selection is made. Each time,thousands upon thousands of policyholders are screened. This process would bevirtually impossible for any of us to do on a regular basis, and certainly notwith the accuracy of a computer.'
The knights' attention had shifted to Kay,except for Gawaine, whose gaze remained fixed on Kevin. His face was tight andwaxen. The unspoken warning continued flashing from his eyes.
'I understand,' Tristram said, forcing asmile. 'I understand completely.'
The Roundtable meeting concluded withoutfurther incident. The knights left the Stuyvesant Suite in the inverse order oftheir arrival. Kevin considered trying to waylay Gawaine and demand anexplanation. But he did not know the man's room number, and the danger ofdiscovery in hanging too close to the meeting room was too great. Instead, hereturned to his own room, his feelings roiling.
Kelly, wearing only her panties, lay onthe bed watching a movie, eating grapes left over from dinner. She seemedcompletely at ease.
Kevin tossed her dress across her lap.
Go,' he said.
