Free The Oath by John Lescroart

instead of Parnassus losing twenty-five grand, which is covered by premiums, we lose a quarter mil. To cover that, we’d have to increase premiums and copays by a factor of ten, which nobody can afford. So the whole system falls apart, and no one gets any health care.”
    Elliot drank some water. “But let’s say out of the fifty guys who want their tests, ten in fact need them. Not five. What happens to them?”
    “They get identified, Mr. Elliot. Maybe a little late, which is regrettable. Nobody denies that. They’re tough choices, I admit. I personally wish nobody had to go through any pain ever, honest to God. That’s why I became a doctor to begin with. But it’s my job now to keep this ship afloat, and if we tested every patient for everything they wanted as opposed to everything they truly needed, we’d sink like a stone, and that’s the cold, hard truth. Then nobody would get any tests because nobody could afford them. You think that would be better?”
    “Let me ask you one,” Elliot replied. “I’ve heard a rumor you haven’t paid some of your doctors. Would you care to comment on that?”
    Ross kept on his poker face, but Elliot’s awareness of this fact startled and worried him. He also thought he knew the source of it—the always difficult Eric Kensing, who’d admitted Baby Emily and then, he suspected, been Elliot’s source on the breaking story. But he only said, “I don’t know where you would have heard that. It’s not accurate.”
    This evidently amused the reporter. “Is that the same as not true?”
    Ross sat back in an effort to appear casual. “What we did was ask our doctor group to loan a sum to the company, with interest, that would come out of the payroll reserve. It was entirely voluntary and we’ve paid back everyone who’s asked.”
     
     
     
    Jeff Elliot had been sitting listening to Malachi Ross’s apologies and explanations for over an hour. Now the chief medical director was talking, lecturing really, about the rationale for the Parnassus drug formulary, maybe hoping that Jeff would spin the self-serving chaff into gold in his column, get some PR points for the group in Ross’s coming war with the city.
    “Look,” Ross said, “let’s say the Genesis Corporation invented a cancer-curing drug called Nokance. The budget to research and develop the drug and then shepherd it through the zillions of clinical trials until it got FDA approval comes in at a billion dollars. But suddenly, it’s curing cancer and everybody wants it. Sufferers are willing to pay almost anything, and Genesis needs to recoup its investment if it’s going to stay in business and invent other miracle drugs, so it charges a hundred bucks per prescription. And for a couple of years, while it’s the only show in town, Nokance gets all the business.
    “But eventually the other drug companies come out with their versions of Nokance, perhaps with minute variations to avoid patent disputes—”
    “But some of which might cause side effects?”
    A pained expression brought Ross’s eyelids to half-mast. “Rarely, Mr. Elliot. Really. Very rarely. So look where we are. These drugs also cure cancer, but to get market share, they’re priced at ten bucks. In response, Nokance lowers its price to, say, fifty dollars.”
    “That’s a lot more than ten.”
    “Yes it is, and you’d think that once we educate people, tell them all the facts, everybody would stop using it and go for the cheap stuff, wouldn’t you?”
    “They don’t?”
    “Never. Or statistically never. Given the choice, the patients almost always choose Nokance. It’s the brand name people recognize. There’s confidence in the product.”
    “Like Bayer aspirin.”
    “Exactly!” Ross silently brought his hands together, as though he was applauding. “So—and here’s the point—although it costs us forty dollars more per scrip to supply the Nokance, if we approve it and keep it on the formulary, it costs the patients the