Nourse’s 1974 novel follows three characters practicing underground medicine in the decades following the 1994 healthcare riots, Doctor John Long, Nurse Molly Barret, and their assistant Billy Gimp, a club-footed boy who scores contraband surgical supplies, the titular ‘blade runner’. 

It’s an enjoyable bit of speculative fiction about what happens when medicine in the US has to be rationed because modern science has so prolonged life spans that quality care became almost impossible to deliver. The solution: Health Control. Through legislation, care became free on delivery, as long as your genes were good. Otherwise free care came at the cost of sterilisation. Nourse himself turned to sci-fi to pay for  med school, so the medical details are all believable. (I was a medical secretary for several years, and can vouch for as much as that’s worth.)

He makes the scenario believable enough as well. Oddly, we probably should have had healthcare riots in 1994 when Clinton couldn’t get affordable care legislation past Congress, but that’s a different matter. 

When the crisis hits, an epidemic of a flu that has a deadly meningitis follow-up, Health Control, and the above-ground medical establishment, can’t cope and turn to the illegal practices to abate it. The action is mostly terse and the dialogue better than average. The only downside is several pages of almost-skippable exposition that Nourse could have handled with action.