The beginning of this book sounded really interesting. A woman disappears from her car while waiting for her husband's train. However, I became weary quickly when the next few chapters seemed to focus on the pros/cons of a national health plan. Somehow then the mystery seemed to be less interesting to me, as I felt there was a deeper agenda. If you're interested in that sort of thing, you might enjoy this book. But, it just wasn't for me and I stopped reading.

President Dale Durham is months into her 2nd term as President. The feature accomplishment of her first term was getting a nationalized health system in place. Her 2nd term begins the implementation. She was an interesting candidate four years earlier. She and her husband were childless, but she became pregnant just after being nominated by her party. They withheld news of her pregnancy and revealed it at her inauguration. Early in her first term, she gave birth to a son.

Upon enrollment into this new system, each patient must give a blood (for blood banking and compatibility testing) and tissue sample (for DNA). Implementation of the nationalized health system is not without some expected snags. Chief of which is that government payouts to physicians and hospitals far exceeds expectations. The program’s head and its regional directors are forced to cap payments and order reductions in clinic hours. Operating Room times are slashed. Small to medium size hospital ERs are closed on weekends and also have to close their doors for 4-8hr/day, usually overnight.

But perhaps the biggest realization is that when patient needs far exceeds the capability of the medical system to provide, prioritization and rationing has to be imposed. And that means what was once a theoretical argument must be put in place.

A Tier system defines priority categories for each citizen: Tier 1 includes ‘high ranking government officials’, industry moguls, scientists, and celebrities (entertainment, sports, media). Families of those are also included. Tier 2 is made up of military officers, federal employees, health care professionals, attorneys, land law enforcement. Again, families are included. Tier 3 is anyone else. (but after initial implementation, the regional head from California convinces the other regional heads that a Tier 4 needs to be added. This would be any non-citizen).

Then, each person will have a Treatment Eligibility Score (TES) determined. Start with a Tier score (T1=0, T2=100, T3=300, T4=400). Now add 10 points for each decade over 50. Then more points for various chronic conditions in their medical history, with more points for ‘lifestyle’ diseases like obesity, smoking, substance abuse, and more. The resulting TES is then used to rank patients when requesting further diagnostic testing, elective surgery, and costly treatments. The lower your score, the quicker one gets service or treatment. The underlying philosophy is that healthcare is prioritized for those who can give the most to society. Old and infirm are at the end of the queue.

A scientist responsible for groundbreaking discoveries in the treatment of emphysema needs a lung transplant. A Senator needs a new kidney. And most heartbreaking for the nation, the President’s son has developed a cardiomyopathy that requires a heart transplant.

The health system database ha been set up to mine the genetic and molecular information to find potential donors - a national donor list. But when transplant demand exceeds supply, it’s now possible to mine the database and find someone with a high TES (meaning last to get treatment for anything). A very small group under the control of the program’s chief medical officer finds an eligible person with little or no family ties, snatches them, sedates them, and tests them for compatibility. If not compatible, they are dropped off at an ER as the sedation wears off. But if they are compatible . . .

The scientist get his lungs and the Senator gets his kidney. The President’s son? Still looking.

That’s where a parallel story comes into play. Dr. Sand, an internist (Tier 2), his wife and daughter, fed up with DC life, move to rural Pennsylvania into a German Baptist community. Much like the Amish, but they do drive and use electricity. Dr. Sand’s sister is a database administrator for the new nationalized health system. His brother is a DC detective who investigates missing persons (and he’s getting the hots for a local widow). The strange kidnappings around the country eat at the detective and the details of the TES formula raise ethical issues with the sister.

Ergo, the intersection of the two stories. Shouldn’t take you long to figure out the basic details of how these two stories intersect.

Set Apart was first published in 2010 and I can only guess that it didn’t sell well with reviews saying It was overly long with excessively drawn out descriptive text. The 2nd edition’s forward says that McCall took those comments to heart, shortened the book to tighten up the story and his publisher is re-releasing it in 2019.

This is really two stories in parallel. One is a medical mystery and the other a coming-to-grips-with-life story. For some, this will be an interesting set of parallel circumstances intersecting late in the book. For some.

Not so much for me. The medical mystery is a cautionary tale of an abuse of a nationalized health system. Could it happen? Theoretically, I guess it could. Practically, I doubt it because I suspect that a nationalized system would have multiple safeguard layers and firewalls to allow such an egregious misuse of what most everyone accepts is the highest level of personal privacy. Then again, I could just be naïve. The coming-to-grips story seemed just too easy of a change in life for the Sand family. A well-to-do family from DC up and moving to a near-Amish setting and becoming as close to the locals as an outsider can? I just didn’t buy it. Maybe this German-Baptist enclave isn’t as cloistered as the Amish. I found myself skipping long segments from Pennsylvania because, to me, they were presented simply to set a stage for Dr. Sand’s family to be caught in the system’s database net. Might have been more interesting if there were more examples of overreach of the for the police, appalled doctors, and computer hackers to detect. It came down to this: Are the nuances on one family’s life enough to carry the story or would it be more interesting for multiple instances of transplants for The Privileged (Tier 1s) at the expense of the Tier 3/4s make for a more compelling tale?

Set Apart
by K.J. McCall

JJ Publishers, LLC

Mystery & Thrillers , Romance

Pub Date 14 Mar 2019

I am reviewing a copy of Set Apart through JJ Publishers, LLC and Netgalley:

Just as the president marks the first anniversary of a federally run health care which includes speeches and a parade a D.C detective investigates the disappearance of a woman who went missing from a parking lot.

Only a few city blocks away the D.C detectives sister works, his sister works as a health care databank administrator. As such she is able to learn the goings on of the mighty health care board and the potent behind-the-scenes data that rank people by level of importance. Just Ninety minutes to the north, in sleepy Dorsey Pennsylvania, his physician brother witnesses the steady decline of his patients’ health services. Each of them are seeing evidence of the same collision through different vantage points.

I give Set Apart four out of five stars!

Happy Reading!

A good solid mystery with a story line about healthcare that is very relevant to today's climate. The characters are well-developed but the book just didn't hold my interest. I did finish the book but I don't think I'll read anything else by this author.