From a David Weber post to Baen's Bar Snerker's Only dated August 13, 2009:

Costs of the Prolong Process

    I didn't have any significant problem with the way Eric dealt with this in the book, for a couple of reasons.

    First, prolong is in fact extremely expensive, in absolute terms. There's a reason why only the very wealthy, outside what you might think of as "first world" star nations, are able to afford it. Second, Anton is guaranteeing this treatment for someone who is not (at this time, at least) a citizen of Beowulf.

    The individual prolong therapy treatment is not especially expensive if the infrastructure to supply it is in place. The infrastructure is hideously expensive; once it's up and running, it's far less expensive, although it still ain't what I think of as cheap. The reason something like an MRI costs as much as it costs is primarily the expense of the equipment involved and the resulting scarcity/availability of the systems. If there were literally one MRI scanner (and trained operators for same) available for every couple of dozen potential patients, costs would drop like a rock. At the very worst, this "extremely expensive" procedure would become no more expensive than, say, a standard x-ray.

    I'm not saying that the infrastructure for prolong is represented by a single source chokepoint like an MRI scanner. What I'm saying is that the investment required to create the infrastructure in the first place is extremely expensive and that the guarantee of prolong provision to the citizens of a star nation is based on the view that the investment in question is being prorated across two or three centuries of potential productive contributions to society by the individuals who receive it.

    Let's assume that the cost of the procedure (including capital investment in the infrastructure) comes to $500,000 per recipient. Let's assume that the recipient is going to pay taxes for 250 years. His average tax burden for those 250 years to "repay" the cost of the procedure is going to be only $2,000, and that completely ignores any secondary contributions to his society as a whole. In other words, if you have the resources of a government entity, then this is a totally reasonable investment to make, even allowing for inevitable attrition through accidental death, military casualties, or simple emigration from your original pool of recipients.

    I'm not saying that the cost is $500,000 (or its equivalent in 40th century buying power). I have never specifically quantified it, so I'm not prepared to hand you a fixed figure at this point. What I am saying is that (1) absent a fully established system to provide the therapies (over a period of time), the treatments aren't possible at all, and (2) creating, establishing and maintaining that system in the first place is extremely expensive and requires an advanced medical tech base (generally not available to depressed economies in the Verge and certainly not available to seccies on Mesa).

    The second point I made in my second paragraph -- that Anton is talking about providing this treatment to a noncitizen -- is also significant. Star nations like Beowulf, the Star Empire, even the People's Republic of Haven, routinely make this treatment available to their own citizens -- native-born and naturalized -- as part of their basic public health medical system. In some cases, it's made available as a fully subsidized treatment. That is, there is no out-of-pocket for the recipient or the recipient's family. In others, the cost is partially subsidized, or subsidized on a sliding scale, with the recipient or the recipient's family expected to pay at least a portion of the total costs. If you are not a citizen of the star nation in question, however, you may or may not, depending on the star nation in question, be eligible for subsidized treatments. When I read Eric's original passage, it didn't really bother me at all because I have this information rattling around in the back of my brain. What I haven't really considered in enormous detail, one way or the other, at this point is how universal Beowulf's provision of this therapy would be, and on what basis.

    One thing people should bear in mind is that Beowulf should not necessarily be confused with, or considered identical to, any currently existing society here on planet Earth. Beowulf is what one might think of as a meritocracy on steroids. Obviously, it has its own homegrown elite -- its equivalent of an aristocracy -- but over all, as a society, it is powerfully dedicated to TANSTAAFL and to the notion that anyone can (and should be encouraged to) rise to and perform at the highest level of his own capability. The combination of these two concepts leads to a society in which individuals are "incentivized" to achieve and extremely well rewarded if they do. The converse of that, however, is that those who do not achieve are not rewarded. And a corollary of both is that access to citizenship is hedged about with protective safeguards.

    Note that in Torch, Hugh specifically discusses with Berry what's involved, normally, in obtaining Beowulfan citizenship. That's because Beowulf's immigration and citizenship policies have always been built around that meritocracy concept, on the one hand, and because Beowulf's wealth (and medical services) make it one of the primary targets for immigration in the explored galaxy. The stringent immigration and naturalization procedures, and the deliberate, conscious selection for ability to contribute to the system which Beowulf has adopted represent the Beowulf's defense against being overwhelmed by a flood of immigrants. (Part of the reason for Hugh's discussion of this is to underline the fact that Beowulf's "fast track" to citizenship for liberated genetic slaves represents a major concession which results from the hatred for Mesa and genetic slavery which is pretty much (and you should pardon the expression) genetically impressed upon all Beowulfan governments.) In many ways, Beowulf has a degree of tough-mindedness -- almost harshness -- where citizenship and the availability of medical services are involved which is considerably at odds with our own current discussion of universal medical care. (And, no, this isn't an aspect of Beowulfan society which emerged on my own radar screen in the last couple of years; it's always been there, people.) No matter who you are on Beowulf, you're going to get good basic medical care. Where something as expensive/resource intensive as prolong is concerned, however, citizens get first consideration and noncitizens are going to end up paying at least some (and possibly quite a lot of "some") of the expenses. And if you can't pay it, then you don't get it.

    As I say, I hadn't really considered the universality of Beowulf's prolong provision for immigrants (as opposed to citizens) prior to Torch. I had always assumed, however, that there would be a fairly steep differential between the way in which Beowulf considered the provision of services for those two classes of potential recipients, and so it was clear to me that what Anton was saying was "I will pay the cost differential to get Nancy her prolong treatments on Beowulf <or, for that matter, possibly Manticore> while there's still time for the earliest possible generation to be effective." In other words, he's promising to take the Beowulf citizenship issue out of the equation and to get someone who is already in mid-adolescence access to the latest generation of prolong while there's still time for it to be effective. If you assume that Nancy is 14 (I haven't gone back to the book and checked the age) and that first-generation prolong can be effective through about age 25, then she's got 11 years to get through the citizenship process to qualify for the full subsidy treatments. Even with Beowulf's citizenship procedures, she'll probably make it by then, but its very likely that in the normal process she would be too old for anything but first-generation prolong by the time she got her citizenship. But that's the least effective version, and Anton is promising to get her top of the tree's quality treatment. (Please note that it's extremely probable that Nancy and her mother would find themselves being fast tracked for citizenship on Beowulf -- even if the official reasons for that fast tracking were never made public -- because of the [part] they've played in the events of Torch. There is, however, no guarantee of that. In addition, Anton is making this promise to someone who's never been to Beowulf, knows nothing about Beowulf, and has just seen a life she does know about torn apart. He's giving Steph his personal, Highlander guarantee where her child is concerned, and as I see this scene that guarantee, while completely serious, is also intended largely to comfort someone who is totally adrift and on her way into a world and a life she had never imagined might happen to her.)

    It's possible that the passage really ought to be revisited or expanded upon. I think that working in a background discussion of all the factors involved in Anton's offer would tend to gum up the emotional works a bit, however. And, in addition, there is simply the time pressure involved. Eric and I are going to have one shot at correcting/changing things in this book, when we see the page proofs, and if we get into trying to put patches into the process at this point, it's going to engender confusion and additional typos and continuity errors. Trust me, this is something I've had entirely too much experience with. We'll be doing some tweaking in the final editing/proofreading stage, but we're not going to have time for the kind of copy edit and detailed consideration that is normally part of the production process. So unless there is a truly serious glitch in the works, we're probably going to be inclined to let little stuff go lest we create a significantly more severe problem trying to fix it. Since the scene Eric has structured works for me in an emotional sense, and is also generally compatible with what I know from my own tech bible and in the back of my own brain about the prolong therapies and how they are administered, "fixing" this particular scene does not loom enormously high on my list of priorities.