Kicking the Can (16 page)

“My thumb drive is missing,” Gupta announced. “Did anybody come across it? Last time I saw it, it was plugged into my computer in the Satwa conference room. It’s a backup copy of our work. I swear I left it in the USB port when I stepped out for lunch…It’s strange. If you picked it up by mistake, please return it.

“Health care is the perfect industry for smart cards—what I’m calling ‘I-HealthCards.’ USB compatible, credit card-sized storage devices, I-HealthCards will be the medium to collect and store all personal health information.
The data will be collected utilizing a transaction model. Let me give you a concrete example.”

Gupta held up a plastic membership card of some sort as a prop. “Casinos use ‘Total Rewards Cards,’ ‘Wampum Cards’—they go by different names—to track gaming habits; a way to profile guests so the casino can profit by improving guests’ experiences. Card usage is expanding to include shopping, meals, and entertainment.”

Gupta passed the card around so the others could feel it—bitty and lightweight.

“Health care is a late adopter of information technology. There are dozens of electronic health record systems and vendors. One hundred percent system compatibility is necessary for health care information to be ubiquitous. The infrastructure build will be resource intensive; less than ten companies in the world have the capability. The government should award long-term contracts via a request for proposal process to a few vendors who can develop, implement, and administer a Cloud-based system. The data will be collected by utilizing electronic kiosks—a swipe of the card.

“Analyzing and parsing data is not our problem. We aggregate data in a common file structure, like SQL Server. The consumer collects his or her health care information via the I-HealthCard. We use electronic exchanges for consumers to transmit their health information and browse between different benefit plans to find a deal they like and can purchase—eBay for health insurance. The exchange sets the price to be paid to the ACO via a common paymaster (PayPal) by pooling the individual’s health status within a framework for aggregating
risk across a patient population. The specifications can be written into the regulations.” Gupta looked around the room; jaws were dropping…

“I realize it’s a draft, but I’ve identified the key technologies and applications we’d need, and these exist today in stable business models. Unlike the systems for claims processing, which take weeks in the current health care scheme, this system would be real time—like banking services. Differentiating data aggregation from data analysis is critical, the latter being the market’s responsibility.”

60

C
hris Drummond was euphoric. Gupta had exceeded all expectations. It was 4:40 p.m., and he had time to run before dinner—an opportunity to burn off the optimism. It was too early to be celebrating. He retrieved his key to unlock the door, but as he approached, he saw the door ajar. From day one he had locked it every time he left the room—the confidential dossiers were inside. He pushed gingerly, enough for the heavy door to gape open. The room was deserted. A plain white envelope lay on the floor. He chuckled, wondering if this was another Gupta stunt—being invoiced for his lodging. He sat down on the cushion and draped a leg over the arm of the wicker chair and opened the envelope. The letter consisted of six words printed by a laser printer:
the wages of sin is death.
There was no signature. Instead, in the lower left-hand corner, a gay pride sticker had been affixed to the single sheet. Drummond visualized the man’s face he had met at the airport—the evil curl—taking pleasure from knowing how unsettling the letter would be. Drummond’s defiance toward him and everything the man stood for morphed into discomfort—the feeling of vulnerability Dain expressed the first time they
met. This was no coincidence. And neither was Duncan’s random violence.

Drummond located Mohammad at the concierge’s desk watching a soccer game.

“Good afternoon, sir. What can I do for you?”

Mohammad clicked off the television with his remote as he spoke.

“I found an envelope on the floor in my suite. Did you leave it?”

“No.”

“When did you find it?”

“Ten minutes ago.”

“Was your room made up? Perhaps housekeeping left it.”

“No. Housekeeping came yesterday.”

“Did you speak with Cala? Maybe she left it for you. Should I follow up with her?”

“No thanks. I’ll mention it at dinner.”

Dain’s verbalization of his concerns created an awareness of physical harm, but his message hadn’t registered with Drummond. His gut was telling him to share the news with Dain…but how? He felt compelled to test Dain’s trustworthiness first. Drummond was at a distinct disadvantage. He was dealing with a professional interrogator, probably a waterboarding expert. Drummond found Dain relaxed, reading a Navy SEALS-Six book in camo shorts, slapping his flip flop against his foot by cocking his ankle then pointing his toe. Each time he extended his foot, his calf swelled, forming two lobes of muscle definition. Dain looked up and closed his book.

“You have a look of trepidation, Mr. Drummond. Believe me, I know. Fear is my companion. I can smell it. Professional soldiers learn to compartmentalize it, but fear knows no boundaries, even among the savage.”

“I need to talk to you. I found this letter in my suite when I came back from this morning’s session.”

Drummond handed the note to Dain.

“The wages of sin is death,” he read it aloud. “What does it mean?”

“It was a passage quoted by a man I met at the airport in New York City. He planned the encounter…sought me out. He forbade me from participating in the contest—offered financial security if I declined. Said I’d be a distraction to the super committee.”

“Why didn’t you accept his offer?”

“The bookend to his generous offer was blackmail.”

“We are not alone,” Dain said. “Fahad, Cala’s husband, has been touring me around. This place has high-end security with closed-circuit video monitoring and surveillance capability. I have a couple more days of reconfiguring, but I’m working to set up a system to secure our perimeter. I’ve activated closed-circuit video—it’s tripped by sensors—but the cameras don’t have night-imaging functionality.”

Dain was studying Drummond’s body language to interpret his reaction.

“Cala speaks Arabic. I’ve been establishing a rapport with her. Boats are arriving in the middle of the night. Cala either doesn’t know the schedule or isn’t telling me. She claims she doesn’t recognize the men.

“And there’s the thumb drive issue,” Dain said.

“Were you going to tell me these things?”

“You’ve had enough on your plate as it is. Let’s keep this conversation between us; there’s no sense alarming the others until we know more.”

Shit…this was not good.
Drummond turned to leave and stopped.

“Dain, what happened after you testified…in front of Congress?”

“I pissed off the wrong people, so I left the CIA to become a linguist.”

61

N
atalya Baturina walked around the suite, stooping to pick up after Pan Jiang. She smiled thinking of her daughter—like Jiang, not a gifted housekeeper. Jiang’s dirty clothes lay on the floor and were strung over various furniture pieces. The couch, unmade. And dirty towels were piled in the corner of the bathroom. She picked up the clothes and started a load of laundry but left the towels for housekeeping.

Baturina sat on the coach to finish reading an article discussing the psychology of Chinese women that she abstracted from the Internet. What she explained to Drummond regarding Jiang’s behavior was accurate. As a woman, Baturina may be able to reach Jiang. It would be impossible for Jiang to tear down the protective screen built up over a lifetime of Chinese culture without professional help.

Baturina heard the jingle on the dryer signifying the load of clothes had finished drying. She gathered up the dark-colored clothing in her arms and dropped it on the bed. The clothes were still warm, and the scent of laundry soap was fresh. She sorted the clothes—T-shirts, socks, and underwear. When Jiang entered the room, she saw her clothes laundered and folded.

“Why are you kind to me?”

“Small acts of kindness make this world tolerable. I can’t tell you how may loads of laundry I’ve done for my daughter. I knew she would visit, even when away at college. It was assumed her mother would always do her laundry. I planned it.

“Cup of hot tea?”

Jiang nodded, and Baturina poured two cups. She carried both cups to the couch, and the two sat on either end clutching warm cups and sipping tea.

“There was never a feminist movement in Russia,” Baturina said. “Women have always been equals. I was raised in an environment where both my parents and society confirmed my worth as a human being. It’s normal for a young woman, irrespective of race and ethnicity, to have a healthy sense of self-worth. To love, one must first love self. I’ve read Chinese women have emotional struggles,” Baturina continued. “Why should a son be more desirable than a daughter?”

Baturina’s statements—validating feelings of self-worth—were dangerous words…thoughts that challenged the sanctity of a culture whose underpinnings were conforming to collective interests. Baturina had no idea what the Chinese government was capable of doing. Neither did Jiang, until her attempted suicide. They had monitored her Internet usage. They were waiting for her at the subway station. When she jumped, an undercover officer
had tackled her, knocking her to the ground before she cleared the rail.

Jiang was hoping to save face with the Chinese government by assenting to participate in the contest. They led her to believe the release of her mom and dad was possible.

Still, Baturina is a gift,
Jiang thought.
She makes me want to live.

62

C
hris Drummond’s oversized suite had a sitting area with sweeping views of the south shore. It was comfortable, with stuffed leather chairs and a carved wood table.

“I’m jealous…The views from up here are fantastic,” Lowsley said. “The views from the third floor are obstructed by palm fronds.” Lowsley set up the cribbage board. It was made of exotic dark wood with gold inlay. The pegs were carved elephant ivory.

Drummond poured Coke into two glasses filled with ice and placed the beverages on stone coasters.

“This first hand won’t count. I’ll walk you through the mechanics and scoring. I’ll deal.”

Lowsley shuffled and dealt six cards to each player. Drummond placed two cards, turned over, next to the cribbage board, and Lowsley added two cards to form the
crib
. Drummond cut the cards. The card turned over was a jack of hearts. Drummond scored two points. He moved his peg.

“Twenty-five percent of Medicare’s expenditures are incurred in the last year of a patient’s life, according to the medical literature.

“The law of diminishing returns—greater quantities of health care consumption yield lesser incremental benefit,” Lowsley said.

Drummond played an eight of spades. Lowsley followed with a seven of diamonds, announcing a running total of fifteen, and moved his peg two spots. Drummond played a seven of clubs for a pair worth two points. Lowsley played a seven of spades for three-of-a-kind worth three points. The running total was twenty-nine. Drummond couldn’t play, so he said, “Go.”

Lowsley played a two of clubs. “Thirty-one for two,” Lowsley said.

“It’s a societal issue—expensive treatments to prolong life, often with marginal benefit, come at a great hidden cost. Patients who desire miraculous care should not be denied, but the financial cost ought to be borne by the patient.

“Our country needs to have a prophylactic conversation to establish reasonable boundaries and expectations. Citizens have been frightened into thinking they’ll be denied care by ruthless death panels—but these care decisions shouldn’t be made entirely by the patient’s provider of care.”

Drummond played a five of spades, and Lowsley followed with a king of diamonds.

“It’s an education issue. Human beings expect and deserve compassion at end of life. Many patients would choose a pathway of comfortableness, surrounded by loved ones in their final days. For them, it’s a better quality of life than being hospitalized.”

Drummond played a queen. Lowsley played a three of spades.

“What are your recommendations?” Drummond asked.

“We advise HHS to issue a white paper to raise awareness of the issue—twenty-five percent of Medicare costs are incurred in the last months of life. This is not understood by mainstream society. The white paper should list alternatives, including palliative care—an approach using a team of interdisciplinary professionals to guide the final days, weeks, and months of a person’s life, emphasizing quality of life, keeping patients comfortable through pain management, and choosing an appropriate setting, which for many patients is home care. Second, we require all legal documents be in place to obtain insurance. Advanced health care directive (living will) and durable power of attorney are necessary documents, so when a medical emergency arises, the care team understands the patient’s wishes.”