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There are two fundamental propositions that give rise to works of science fiction. One is What if? as in: what if something new comes along that completely revises the paradigm of our existence? What if we discover life out there? What if it discovers us?

The other is If this goes on... as in: suppose we logically extrapolate a trend in our current situation, where will it take us and our posterity? If we continue to sacrifice liberty in exchange for supposed security from terrorism, do we end up in a police state? If we continue to define ourselves by the brands we use, are we handing over our very sense of identity to the amoral forces of marketing?

Back in the 50s, a thirty-something science fiction writer named James Gunn decided to pose one each of those basic premises: what if genetic mutation produced a human being who didn't age? and where will we end up if market-based medical care continues to be a commodity made increasingly scarce by rising costs?

The answers came in a series of linked short stories published in pulp magazines and republished in 1962 as an episodic novel, The Immortals. This reissue by Pocket Books includes a new story interpolated into the series to deepen the development of one of the continuing characters in the 150-year scope of the novel: Dr. Russell Pearce, the young geriatricist who unknowingly transfuses Leroy Weaver, a senescent billionaire dying of old age, with blood from Marshall Cartwright, a drifter who sold a pint for the price of a cheap hotel room. But Cartwright is the world's first immortal and Weaver suddenly regains his youth, then just as suddenly sinks back into decrepitude because the effect wears off after twelve weeks. And so the hunt for Cartwright -- and in time, his descendants -- is on.

Gunn's answer to the What if? question of an immortality mutation is logical, though depressing: the rich and powerful will seize control of the precious commodity hidden in Cartwright blood and keep it for themselves. Even after the elixir is synthesized, knowledge of its existence will be buried so that only a tiny few can enjoy its benefits, in a re-emergence of feudalism.

His answer to the question of whither health care? is more interesting, perhaps because we now live in the future that must have seemed so far off when he was pecking out those stories almost fifty years ago. And some of what he foresaw has come to pass: doctors can cure more of the ills that flesh is heir to, but the cost of machines and drugs has risen exponentially; more people are living into their eighties and nineties and beyond, but their survival means that a greater share of resources are diverted to their needs; and health care has become a scarce commodity, especially in the US, where the market determines who gets treated and who doesn't.

In Gunn's future Kansas, more than fifty per cent of US gross domestic product is devoted to health care. Medical precincts have grown into square miles of self-contained hospitals and medical schools, fenced and fortified against the rotted cities that surround them, where "citizens" struggle in a stew of carcinogens and germs, dependent on unlicensed "leeches" and stepped-on antibiotics from street corner "shovers," while the "squires" who fled to suburban villas are desperate to avoid falling into the untreated underclass.

As a vision of an If this goes on... future, The Immortals is not that far from what has now emerged. As more and more Americans find themselves unable to afford health care, it may require only another generation or two before it becomes clear that young Jim Gunn nailed it back in the 50s. Oddly enough, though, the What if? part of the story doesn't lead to much. Immortality never gets very far beyond the grasp of the powerful and affects only a small circle of the rich and their retainers.

Finally, a word on the style: The Immortals is old-fashioned genre fiction of the 50s, straightforward storytelling, with characters whose inner lives are less important than their need to meet the external challenges of the world they find themselves in. No artsy pretensions or stylistic innovations here. We move forward with an economy of verbiage and a strong storyline. As someone has called it, the good old stuff.

Matthew Hughes writes science fantasy. His stories have appeared in Asimov's, F&SF, Postscripts and Interzone. His novels are Fools Errant, Fool Me Twice, Black Brillion, and Majestrum. The first chapter of his new novel, The Spiral Labyrinth: A Tale of Henghis Hapthorn (Night Shade Books, September 2007), is on his web page is at http://www.archonate.com/spiral-labyrinth.