This is the fifteenth installment of an exploration of some of the possible futures discussed on this blog, using the toolkit of narrative fiction. Our narrator visits another school, catches the flu, and has his first encounter with the Lakeland Republic’s health care system…


I made some phone calls the next morning and got my schedule sorted out for the next few days. Now that President Meeker had gotten things sorted out with the Restos, I had a lot of things to discuss with the Lakeland government, and I knew they’d want to know as much as possible about what was going to change following the election back home.

By quarter to nine I was climbing the marble stairs in front of the Capitol, passing a midsized crowd of wide-eyed schoolchildren on a field trip. The morning went into detailed discussions with government officials—Melanie Berger from Meeker’s staff, Stuart Macallan from the State Department, and Jaya Patel from the Department of Commerce—about the potential reset in relations between their country and mine now that Barfield and the Dem-Reps were out on their collective ear. They were frankly better prepared for the discussion than I was; I’d taken the precaution of printing out the position papers from Montrose’s transition team before I got on the train in Pittsburgh, and reviewed them the night before, but it was pretty obvious that the Lakelanders weren’t used to looking things up moment by moment on a veepad and I was.

We had lunch downstairs in the congressional dining room, a big pleasant space with tall windows letting in the autumn sunlight, and then it was up to Meeker’s office and a long afternoon talking with the President. I have no idea to this day if Isaiah Meeker plays poker, but if he does, I pity the other players; the skill with which he tried to lure me into saying more than I should, while gracefully evading any question of mine he didn’t want to answer, was really quite impressive. I’m pretty sure that he ended up with a clearer idea of the incoming administration’s foreign-policy plans than anyone outside of Ellen Montrose’s inner circle was entitled to have, though in exchange I think I got a good sense of how his administration was likely to respond to some of the impending changes in inter-American relations—including some I was pretty sure he didn’t know about yet.

Dinner was at a really pleasant French place two blocks from the Capitol: Berger, Patel, her husband Ramaraj, and me—Macallan had to attend some kind of event at the Texan embassy. The conversation stayed deftly on the edge between too little politics to be interesting and too much to be safe. When I finally got back to my hotel room that night, I sat at the desk writing down my impressions until well past midnight, and then fell into bed.

The next morning I’d scheduled a visit to the Capitol Atheist Assembly’s school, and showed up at nine AM promptly just as classes were getting under way. The drill was nearly the same as at the school in Hicksville; I went to the office and signed in with the secretary, they found someone to show me around, and I sat in the back of the room and watched a couple of classes. I’d wanted to see their math and science classes, and I got my wish, but what I saw wasn’t anything like the math and science I was used to. The kids weren’t learning how to run programs to solve mathematical problems, or watching computer simulations of experiments—no, they were actually solving the problems and doing the experiments themselves. I watched a room full of sixth-graders work their way through a geometrical proof, and a class of eighth-graders hard at work setting up some kind of complicated apparatus with mirrors and prisms that ran out to all four corners of the classroom.

“The Michaelson-Morley experiment,” the teacher explained to me as we stood on one side of the classroom and watched the students and a couple of teacher’s apprentices get everything lined up. He was an old guy with flyaway white hair and disconcertingly blue eyes.  “I don’t know if they teach that outside, but it’s one of the classic experiments in physics.”

“I don’t think I heard of it,” I admitted. “I’m curious why you have them repeat it, rather than just telling them how it came out.”

That got me the classic Lakeland you-don’t-get-it look. “We actually have them replicate a whole series of classic scientific experiments,” he said. “That way, they learn that science isn’t some kind of revelation handed down from on high—it’s a living, growing thing, and it lives and grows when people get their hands dirty running experiments, and replicating them.” He gestured at the hardware. “And by making mistakes. Michaelson-Morley’s a finicky one; the first time they do it, the kids almost always get a different result than Michaelson and Morley got, and once that happens they get to go back over what they did and figure out what happened.”

Right then he got called over by one of the apprentices to help sort out some detail of setting up the apparatus, and my guide and I watched for a few more minutes and then headed for another class. All in all, it was an interesting morning; one thing I noticed is that the kids were never just sitting there being bored and restless, the way they were in every school I’d ever seen back home. I wondered how much that had to do with the fact that the students here were actually doing something active in every class I saw, instead of sitting there staring at screens by the hour.

I left when the students went to lunch. While I’d been inside, a rainstorm had come rolling in off the lake, and though it wasn’t much more than five minutes before a streetcar came to the stop out front, I was pretty wet by the time I climbed on board. I had lunch at the hotel; by then the rain had stopped, and I dodged puddles up to the Capitol and then a block and a half past it, to the office building that housed the Lakeland Republic’s Department of Commerce. I spent all afternoon there with Jaya Patel and half a dozen other Commerce staffers, looking into possible trade deals and sorting out how those would be affected by their tax and tariff policies. It was a productive session but a tiring one, and then we headed off to an Indian place for dinner; by the time I got back to my hotel room I was feeling pretty run down.

It wasn’t until the next morning that I realized that there was more going on than simple tiredness. I felt awful, and the face that confronted me in the mirror looked even worse. I sat down on the side of the hotel bed and tried to figure out what to do. Back home, I’d simply have canceled everything for a week, taken some over-the-counter meds, and waited it out.  You don’t go to a doctor or a hospital in the Atlantic Republic if you can possibly help it—a checkup plus lab work and a simple prescription will cost you the better part of a month’s income even after health insurance pays its cut, and you really don’t want to know how many people end up sick or dead every year because somebody screwed up a diagnosis, or because trade treaties won’t allow the government to pull medicines off the market even if they’re ineffective or worse. I’ve seen the numbers and they’re pretty grim.

Still, I wasn’t at home, and I couldn’t afford to spend the next week doing nothing. After a bit I went over to the packet I’d gotten on arrival, and paged through the paper on getting by in the Lakeland Republic. There was one short paragraph on medical emergencies and another on ordinary health care; this didn’t feel like an emergency, so I read the second one. It told me to call the concierge’s desk, and so as soon as I’d called Melissa Berger and cancelled the day’s meetings, that’s what I did.

“No problem, sir,” said the voice on the other end of the line. “I’ll call Dr. Hammond, find out how soon he can get here, and call you right back. It’ll be just a moment.”

About the time I’d begun to wonder how long “just a moment” was—it probably wasn’t more than five minutes, to be fair—the phone rang. “Mr. Carr? Dr. Hammond’s on his way. He’ll be up to see you in twenty minutes or so.”

Up to see me? I wondered about that. Something I’d read on the metanet once mentioned that a long time ago, doctors used to actually go to people’s homes—I think they called it “making house calls” or something like that. The idea sounded pretty far-fetched to me, but then plenty of things about the Lakeland Republic were pretty far-fetched by the standards I knew. Sure enough, right about twenty minutes after I’d gotten off the phone with the concierge, a crisp knock sounded on the door, and I went to open it.

Dr. Paul Hammond turned out to be a youngish African-American guy dressed like an ordinary Toledo businessman, with a big brown leather case in one hand. We did the usual, and then he sat me down, pulled over a chair, pulled a pen and a notebook out of the big leather case and started asking me questions about my health and the symptoms I’d noticed. After he’d finished with that, he got a thin glass thing that seemed to be some kind of thermometer in my mouth, checked my pulse, used some kind of rig with tubes that went from his ears to an odd-shaped disk to listen to my breathing, and then took the thermometer out, had me stick my tongue out and shone a flashlight down my throat.

“Pretty much what I expected, Mr. Carr,” he said then. “There’s a nasty little 24-hour flu going around, and I’m sorry to say you’ve got it. The good news is that you’ll be over it sometime tomorrow if you take it easy and let your body deal with it. You’ve got a mild fever, but that and the muscle aches are normal for this bug—all we have to do is keep any kind of secondary infection from getting going in your upper respiratory tract or your chest, and you’ll be fine.”

He reached into his case, pulled out a brown glass dropper bottle and what looked for all the world like a package of tea bags. “Twenty drops of this in water every two hours,” he said, indicating the bottle, “and one of these in hot water whenever you feel like it—that’s to treat the muscle aches.”

I picked up the package, gave it a dubious look. Yes, they were tea bags, full of what looked like bits of leaves that I guessed came from a bunch of different plants.

Hammond watched me with an amused look on his face. “The concierge tells me that you’re from outside,” he said. “So you were expecting pills, right, rather than plants.”

“Well, yes.”

“Care to guess where a lot of the ingredients in those pills come from?” 

I gave him a quizzical look.

“Plants. Aspirin comes from willow bark, menthol from mint, and so on—there’s a long list. And here’s the thing—some of these plants have been bred for thousands of years to have the right mix of active compounds to treat this or that health problem. By and large, the kind of pharmaceuticals you’re used to taking pull just one compound out of the mix and use that, because somebody or other decided that it was the ‘active ingredient.’” He shook his head. “I can get you some pills if you really want them, but the tincture and the infusion will actually do you more good.”

That seemed improbable to me, but I was feeling too out of sorts to argue. He wrote down some notes about what to eat, told me what symptoms to watch for, and handed me his card so I could call him if anything out of the ordinary happened. Then he told me he’d check on me the next morning, said goodbye, and headed out the door.

I put twenty drops of the stuff from the dropper bottle into half a glass of water from the tap. It tasted so bad that I filled the glass the rest of the way before choking it down. By then I was feeling really tired, so I crawled back into bed and proceeded to sleep like a stone until past noon. I called room service and got some food, along with hot water for the tea-ish stuff—I figured, what the heck, might as well give it a try. It had an aromatic smell I didn’t recognize at all, but it went down easily enough and it seemed to make my muscles ache less.

That’s basically the way I spent the rest of that day. By sunset, rather to my surprise, I was starting to feel noticeably better, and by morning I felt—not well, exactly, but the sort of weak-but-better feeling that tells you that you’re going to be over an illness pretty soon.

Dr. Hammond showed up again at nine-thirty sharp. He had someone else with him, a wiry kid of eighteen or so—Hammond introduced him as his apprentice Larry Soames. “So how are we feeling?” he asked, as he settled on the same chair he’d used the morning before.

“A lot better,” I admitted. I fielded his questions and then got my temperature, pulse, and so on taken again, while the kid watched and listened and took notes in a little black notebook.

“Excellent,” Hammond said finally. “You ought to take the rest of today off, too, but if you do that you should be back on your feet again tomorrow.”

“Fair enough,” I said, “and thank you. Now how much do I owe you?”

“You don’t,” he said, with a broad smile. “I gather nobody’s told you how we do health care here.” When I shook my head:  “It’s pretty simple, really. Doctors like me—general practitioners—contract with businesses, churches, or citizen’s groups to provide basic health care.  That used to be common all over the old United States a century and a half ago.  My contract’s with the hotel; I get a flat monthly salary from them, and in return I provide all the primary health care for the employees and the guests.”

“What if somebody gets something a general practitioner can’t treat?”

“Well, of course, then I refer them to a specialist, and people have health insurance to cover that—but that’s not really that common, all things considered.”

That surprised me.  Back home, if you want to risk going to a doctor, you pretty much have to go to a specialist in whatever’s the matter, and if more than one part of your body is involved you’d better hope the specialists you get are willing to talk to each other or you’re going to land in a world of hurt.

“You don’t have a lot of general practitioners back home, I imagine,” he said then.

“I don’t think I’ve ever met one,” I admitted.

“Well, there you are. Here, probably ninety per cent of the physicians are GPs, and if you want to get into med school and become a specialist you pretty much have to go through an apprenticeship and then work as a GP for at least a few years first.  That way you remember that your job’s to treat patients, and not just a heart or an endocrine system or what have you.”

“Hold it,” I said. “You don’t go to med school to become a GP?”

“Not usually, no.” With another broad smile: “Back in the old Union, the universities got really good at inserting themselves into just about every job category you can think of as a job requirement. It was a big moneymaker for the academic industry but it didn’t work very well for anybody else—you’d go to college and learn a bunch of things dreamed up by people who didn’t actually work in the field, and then you’d graduate and have to unlearn most of it once you were on the job. We ditched all that after Partition; outside of a very few fields, most of them scholarly, it’s pretty much all apprenticeship.”

He nodded at Larry. “Six years from now, when he’s done with his apprenticeship, he’ll have years of hands-on experience to go with what he’s learning from the books, and once he passes his board exams he’ll be ready to start treating patients on his own right away. That’s the way it used to be done, you know—by apprenticeship, followed by state board exams. Doctors, lawyers, teachers, architects, all the skilled professions used to be that way, and it worked better, so we went back to it.”

He got up. “But that’s neither here nor there. Take it easy for the rest of the day, and if you feel worse—or if you get any of the symptoms I mentioned—give me a call right away. Okay? Excellent. Well, Mr. Carr, have a great day.”

They left, and I lay back down and eventually dozed off again.