Reviewed date: 2018 Oct 4
It's 2012, and the Health Control Laws have been in effect for nearly two decades. Health care is free, but only to those who agree to permanent sterilization, as per the eugenics laws. Health care outside of an official Health Control facility is illegal. Most doctors rebel against this, so there is a vast marketplace of underground medicine: doctors making clandestine house calls, dispensing medication in homes, even performing table-top surgery in kitchens. Tying this underground system together are the bladerunners: men who supply contraband medical equipment like medicine, gauze, bandages, masks, and even scalpels and other surgical tools. Whenever a doctor makes an illegal house call, he calls his bladerunner for supplies.
Billy Gimp, bladrunner
The hero of this story is Billy Gimp. He's a seventeen-year-old bladerunner who works for Doc, a licensed doctor and surgeon at Health Control Hospital Number Seven. Billy wants to work in the healthcare field, but because of his club foot, the best he can do is participate illegally in underground medicine. Billy isn't doing this purely for altruism, though: Doc has promised to find a bone surgeon to fix Billy's foot.
Dr. John F. Long, MD. He hates the eugenics laws and the Health Control Laws. So he practices underground medicine after hours, and on the job he does his best to stymie the Health Control Board's new research project: robot surgery. Number-crunching computers and machine learning algorithms (Nourse is prescient here) have already been used to aid in diagnosis. Now, facing a shortage of doctors (surgeons in particular, but throughout the book Nourse seems to presume that doctor = surgeon), the Health Control Board has decided the solution is to hook a surgeon up to a neuropantograph, record his actions and brain activity while he performs surgery. Then that data is run through a machine learning algorithm and the results are used to program a surgery robot. Soon doctors will be obsolete! Long live the machines.
Doc is one of the surgeons tapped to participate in a pilot program, so he's hooked up to the neuropantograph every time he operates. But by feeding the computer misleading patient records before the surgery, and by abruptly changing the parameters of the procedure once he's begun, Doc so discombulates the computer that it's unable to make progress. It's unclear to me why Doc is so opposed to robotic surgery. I can understand why he's against the eugenics laws and the Health Control Board, but his objection to robotic surgery seems to be purely on the basis that anything which the Health Control Board wants is therefore bad.
Eventually we get to the real problem: there is an epidemic. Decades of over-immunization and over-medication have deprived the people of natural immunities, and helped to breed powerful superbugs. A mild virus, the Shanghai flu, is sweeping the nation. A few days of fever, somes minor aches, and that's all. Most people ride it out and don't even see their doctor. But about 30% of people develop a second phase of the disease: a deadly meningitis. Of those who develop meningitis, about 30% die within 48 hours. With about a third of the population contracting the Shanghai flu, this epidemic threatens to kill as much as a tenth of the population. A literal decimation.
The Health Control Board is aware of the problem, but can't announce it. If they announce that the mild Shanghai flu is actually a killer meningitis, and would everyone please come to a Health Control Hospital to get a vaccination (which by the way, means agreeing to permanent sterilization), nobody would believe them. The eugenics laws are already deeply unpopular and the Health Control Board is not trusted.
The Health Control Board could waive the sterilization requirements in this case, but that would undermine the eugenics laws and rob the Health Control Board of any real influence in the future. After all, people would know that if things got really bad, the eugenics laws would be suspended again.
So Dr. Mason Turnbull from the Health Control Board asks Doc for help: the Health Control Board will waive the sterilization requirements in this case, but only unofficially. There can be no official announcement. He needs Doc to reach out to his contacts and spread the word through the underground medicine network. Doc says he doesn't have the contacts necessary to spread the word quickly, but that Billy, his bladerunner, does. So they enlist Billy's help, and Billy runs around to his suppliers and fellow bladerunners. They get the word out, and within a day or two, masses of people show up to clinics for free vaccinations: no questions asked and no sterilization. The epidemic is halted, but the Health Control Board doesn't quite get what it wants. Public opinion shifts: the power of the eugenics laws are broken for good.
Also, Doc finally makes good on his promise to find a bone surgeon: Billy gets his club foot fixed.
There were some clumsy infodumps. Not quite as bad as "As you know, Bob," but pretty clear.