Tag Archives: United States

The book I have read: Lionel Shriver

When I went to the second hand book fair in  Nelson, I had no real hope of finding a book that would please  me (actually I found a dozen, for the modest sum of fifteen NZ dollars). When I go to such events, I do not take the trouble to read the back cover. My principal interest is in finding  authors I’ve heard of. Lionel Shriver is best known for her book (and  the film) We Need to Talk About Kevin, a book and a movie that I absolutely did not want to read or see because the subject (how to be a parent of a child  who commits a massacre) bothers me too much. But I found So much for that by  the same author and I thought  that if I was wrong, it would not be a dramatic mistake (I’ve also found a book by Richard Russo, recommended  by arlingwoman I look forward to reading) . Reading  the American book coincided with an interview she (yes, it  is a woman who changed her name at the age of fifteen) gave to the BBC during the famous Hay Festival, that takes place annually in Wales, one of the places in the world that I had long dreamed of visiting one day (books, books, books). The starting point of the book  is not particularly attractive: an American, Shepp, who has always dreamed of another life in a country where he could  live with just a few dollars a day, has finally managed, at age 50,  to raise the money he needs to realise his dream and is   ready to embark on the new adventure. The day he plans to tell his wife that he is about to  leave with or without her, she tells him that she just found out she has cancer (caused by asbestos). This is the beginning of a different type of  adventure called surgery and treatments, and for Shriver, it is  an excuse to thoroughly criticize the US healthcare system. Shepp, Glynis’s husband must give up his dream and keep doing a job he hates to qualify for the invaluable health insurance from his employer. However we discovered that the insurance is not as reliable as we think.  Shepp must constantly eat away their savings to top up what  insurances do not pay, or because they  pay only a part  of the costly treatments that Glynis has to  go through to “defeat” the disease. Shriver also deals with the complex problem of marital relations during  a difficult time in their life together, but also the relations of the sick woman  with “friends” and family.

While reading this book I remembered that when I’m with American friends, the conversation almost always ends up turning around health insurance and this probably indicates that this is a constant concern for those  living in the United States. Shriver could have been content to condemn the “health industry”, bad bosses and bad insurers but goes beyond and traces the origin of the system, which was born during World War Two. While workers were few and  wages were regulated, employers who wanted to attract employees, offered health insurance as a bonus. At that time, it did not mean much: treatments were minimal and people died young. The reader is certainly tempted to accuse the wicked employer of all evils. Shriver prevents us to do this  by serving us a small speech from Shepp’s employer  (also not friendly), which shows us that we can not expect a small business to be able to   support all medical expenses families of all employees through insurances, especially when some family members require special and expensive care: it can only lead to  the company’s bankruptcy. The employer also attracts Shepp’s attention of the fact that his wife’s  expensive treatments  have raised the insurance cost to the point that the employer now employs only contract workers, in order  to maintain his competitive edge  (we feel like saying  that this is not a  good reason, but  we ourselves have all  been guilty of trying to find the best deal, and often because we do not have afford to pay top dollars). There are several levels of discussion, including a  criticism of  insurers themselves, says Shriver, who have employees whose role is to find ways  to not pay for treatment, but also of medicine and doctors, who sometimes maintain the unrealistic expectations of desperate patients. Shriver also talks about money, which is refreshing, in a way, because we rarely talk aboutit  in novels (each chapter starts with the amount of money  Shepp has got in his saving account). Of course  we know that money is not important, but only  as far as one has  enough of it. When in need, that’s another story. Towards the end of the book (do not read if you want to read the book), Shepp asks  Glynis’ doctor, a year after having started the treatment that could  save Glynis (which cost almost two millions dollars),  how much time the doctor believes to have added to the life of his wife :  three months, he replies laconically (hence the title).

After finishing the book, one feels grateful for  living in a country where there is a health system run by the state, but  relief does not last very long.  I realised that if I had to make a long stay in the hospital, or if I had to undergo expensive surgery, I would be quickly ruined if I had to pay for it and it would probably the case of a large part of the population. It is ridiculous to believe that the state can afford  treatments that individuals cannot pay for (since we are the ones who pay taxes) and we increasingly live longer and run the risk of needing  expensive treatments sooner or later.

And then I suddenly remember the horror stories I see more and more regularly in newspapers, about this charming gentleman who worked all his life and has always paid his taxes, who needs a new hip and has been waiting  for three years, and has been  given morphine to ease his pain, although the case is not deemed  urgent enough to go at the top of the waiting list. Or a mention is made about a new drug, which could extend the life of x or y that has not been approved by the government, while  individuals in despair can not afford the treatment costing tens or hundreds of thousands of dollars.

Shriver makes us aware that medicine today is a time bomb that is just waiting to explode. A very interesting book that really made me think. Shriver is often accused  to expand on the results of her research in her books. For me it is not really the research as such that bothered  me because it was used in a very  efficient way (in fact,  I  often wondered, while reading the book, what  was fiction  and what was experienced and  this is probably a good sign), but the repetitive side of certain passages. Shriver is  philosophical in this regard and says  that readers can  skip the  passages they do not like (that’s what I did). As for me, I wish the editor had  intervened  further to amputate the  over five hundred pages book  (which reads nonetheless easily) of about one hundred and fifty pages. Shriver is not a great stylist, but her  dialogues are very skilled and reading is enjoyable. She likes  to focus on subjects that cause controversy.  Her most recent book is about   debt (collective and individual) and inheritance, which I will certainly read. She has convincing male characters, except when they discuss the way women dress, which seemed to me to be feminine. I thought extraordinary that Glynis hardly mentions her two children and not very often in Shepp’s mind either. The end is a little too Hollywoodian for me, but I am not sure what would have been a good ending*.

And until we find a solution to the problem of modern medicine, I  can only eat lots of  vegetables and exercise daily, hoping that it will do.

 *this was before obamacare, which has changed the situation to a certain extent.