(Edited for total incoherence -- apparently I was more tired than I realized!)
I just spent the past two days in various walk-in clinics, the Wal-Mart Pharmacy (because the pharmacy we use, where Everybody Knows Our Name, is closed Sundays), dental clinics and dental surgeries, all to deal with an abscess that suddenly ballooned up on Herr Dr. Delagar's jaw Saturday night -- Friday he was fine, Saturday it started hurting, Saturday night he was in agony.
In the Kafkaesque labyrinth that is America's useless modern medical system, I had plenty of time to speculate what medical systems might look like in the future.
I would love it if these future worlds and their health care systems were as pretty as they appeared in some of the SF books I read in my adolescence: where bright children asked their daddies what cavities were, and it is revealed that cavities were things children used to get before the vaccine was invented against them.
Or Octavia Butler's Xenogensis series -- just don't create kids that will have problems; and then if anything happens to go wrong afterwards, the Ooloi fix it!
Or her other series, the Patternist series, where those who have the talent can reach in and teach the body to heal itself. Very cool.
Or on Star Trek: McCoy and his tricorder, just a few passes of the remote control, and ipso facto, Dr. McCoy knew what was wrong. (Unless for plot reasons he did not. Actually, I never did figure out how medicine worked on Star Trek. There was that episode where Whorf had a spinal cord injury, which apparently no one could fix. But WTF? Aren't we like hundreds of years in the future? I guess that ban on stem-cell research really worked.)
Or Iain Banks' Culture Worlds, which are post-scarcity, and also have the ability to manipulate human biology so completely that -- so far as I can tell -- almost nothing is fatal. (A mixed blessing, surely, given what happens to some characters because they can be kept alive so endlessly.)
Or John Varley's early novels, where no surgeon need her hands before cutting into people, because no harmful bacteria made it off earth -- and also where surgery is so simple any ten year old can replace his own liver with a kit, and people pop in for cancer cures like we pop in to have our oil changed. Full-body sex changes take longer! And are also so common everyone has them dozens of times throughout their lives. But the point is, medical care is available to everyone, very high quality, and very low cost.
But even if none of these bright futures await us, surely we can dream of a nice future like Sweden or Denmark, where medical needs are met sensibly, rather than being a for-profit industry -- where those without a six figure income aren't forced to decide between staying alive and having a life.
True story: as I'm waiting in line at my friendly neighborhood pharmacy last year, the one where Everybody Knows My Name, where sometimes when my insurance company is being a Butt, as it often is, my pharmacist will work with me: on this one spring day, this guy in front of me, his kid has some horrible bacterial infection, apparently, resistant to most antibiotics. So he needs an uncommon antibiotic. Only his insurance company won't cover it, because, get this, it costs $3000 for ten pills. Luckily, dude is from Fianna Hills, the rich bit of Pork Smith, and he just whips out his debit card and pays $3000.
In my broody dark days I suspect future medicine will be like that: drugs and life for those who can whip out a debit card and pay. Suffering and misery for those who cannot.
Kind of like now, yes.
That's the future I speculate about when I write SF, for obvious reasons (obvious, because, as I frequently tell my students, no one actually is writing about the future when they write science fiction).
When I write about medicine or medical situations in my SF stories, almost invariably I find myself writing about that two tier system -- or, well, really, as I know, it's actually more complicated than that. (Everything always is!) The two tier system is really four or five or more tiers.
The topmost tier, which we never see. They own hospitals, in the sense that they are major donors, major lobbyists, have funded chairs, so on. Do they make appointments, wait in line, fetch scripts from pharmacies? Sit in waiting rooms outside MRI machines?
The upper tier, the really rich (but not that 1% who own the country): rich enough to jet across the country to get to the best doctor. They'll never do without an abortion or a specialist. Plus they have the money to buy the treatment.
The middle tier. We can treat abscessed teeth, and broken legs, but we better hope nothing really serious goes wrong.
The lower middle tier. They drive five or six hours to get to free clinics. These are my students, some of them. I keep tablets of cold medicine in my desk drawer to hand out to them, winters, and Tylenol. They're mortified, but they take it.
The lowest tier. They never see doctors. Like the upper tier, they're invisible. They look twenty years older than they are, usually, and are usually dead before they're sixty.
One of the clinics I visited was filled with the middle tier. The other was filled with the lower middle tier. And here's the thing: I want to believe in a bright future. It's why I do what I do, why I teach and keep teaching. Why I write science fiction. I want to believe the world can change. But watching the receptionist haranguing the suffering poor of Fort Smith, Arkansas -- people clutching their aching jaws -- demanding 1/3 of the price of having their teeth removed up front before the surgeon would even think about relieving their pain, and these were people with insurance, well, yikes.
Did I mention Christian music was playing in the background?
What other future could I write, living in this land?