The room was still dark when she felt the sheepskin–lined cuffs fitted around her wrists and ankles. When she was secured, he lights came on without warning, stabbing through her frightened pupils. She issued a low moan as ice-cold but expert hands slipped a needle into the pale flesh of her elbow pit.
The room slowly resolved. She realized she was in a surgical theater. She was naked. Windows lined the round room along the ceiling. She could see faces, hazy and indistinct, yet somehow familiar. Scraps of a well-worn nightmare, perhaps. And then he stepped into view. Naked except for surgical gloves, he loomed over her before turned to address the audience.
"Please don't put your faith in market forces. It's a popular idea: that Adam Smith's invisible hand would do a better job of designing care than leaders with plans can." The audience brayed and clapped.
She blinked in confusion and tried to scream. Only a hoarse cry came out. “I’ve paralyzed your vocal cords, dear,” turning to look at her, “so please be quiet and let your betters talk.” His deranged eyes worked at cross-purposes to stare at her before he turned away.
"And it's important also to make health a human right because the main health determinants are not health care but sanitation, nutrition, housing, social justice, employment, and the like." He crossed to the foot of the gurney she was strapped to. He selected a scalpel from the cart nearby and deftly cut a deep circle at the base of her right big toe. Her cry came out as only a gurgle.
“If we can't standardize appropriate parts of our processes to absolute reliability, we cannot approach perfection." He grunted to work latexed fingernails under the skin of her toe. With a sigh of pleasure he de-gloved the skin of her toe and tossed it on her belly.
"Young doctors and nurses should emerge from training understanding the values of standardization and the risks of too great an emphasis on individual autonomy." He flourished with the scalpel as he spoke. When he turned, she saw that he had a full-on erection.
He ran the scalpel along her legs as he grew quiet, cutting the faintest of lines into her skin. She looked away, desperate to dissociate herself from the pain. The hooting faces behind the glass were finally clear as they pressed ever closer and jostled for a better view. The tightly drawn face on one, perpetually surprised at her own pustulence; the sagging bitch-tits and rape whistle of another; and, finally, the pinched face of Vinegar Joe attempting to leer and distain simultaneously.
He picked up her toe skin and toyed with it. “"Health care is a common good—,” he droned, “single payer, speaking and buying for the common good." She watched, gagging, as he tugged her toe skin down over the turgid tip of his penis.
With a series of quick slashes, he cut a deep slit into her side, between her ribs and hip. Still in shock from that pain, she could barely react when he stabbed his toe-skinned penis into the wound.
Thrusting with every word, he jabbed frantically into her. "The unaided human mind,” he laughed out as she began to weep, “and the acts of the individual,” he snarled, “cannot assure excellence.” Blood smeared them both. “Health care is a system,” he growled and then spat into her tear-filled eyes, “and its performance is… A. Systemic . Property!" He finished and turned to the windows, gore and semen dripping from his dwindling member. He bowed to the hooting and gibbering legislature.
The confirmation process was complete.