Exasperation with U.S. health care
Author Lionel Shriver talks with Kai Ryssdal about her book, "So Much for That," in which the protagonist's plans for early retirement change when his wife gets cancer. She talks with Kai Ryssdal about the American way of health care, and putting a dollar value on human life.
Lionel Shriver (Jerry Bauer / harpercollins.com)
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TEXT OF INTERVIEW
Kai Ryssdal: The thing about the national conversation we've all been having about the cost of health care the past year or so is that for a lot of Americans it's been kind of abstract. Off in the background. Unless you or someone close to you has been sick.
Lionel Shriver takes on the American way of health care in her new novel "So Much for That." Her protagonist, a reliable guy named Shep Knacker, has worked hard. He's planned his whole life for an early retirement on some faraway island. He's put his life savings aside for just that. And then his wife gets cancer. As the title says, so much for that.
Lionel Shriver reads excerpt: Shep shook his head. Glynis and I have always kept to a tight budget, trying to build that nest egg for the afterlife. We've waited for the two for one offer on shampoo. Bought toilet paper in the economy size of 12 rolls, single ply. Got the special on turkey burgers, even if we were more in the mood for steak. Now it's $500 for this, $5,000 for that. And they never tell you in advance what it costs. It's like going on a spree, piling all this s*** on the counter, and none of it has any price tags. We only pick up 20 percent in co-insurance, but that's after the 5K deductible. One single lab bill, that's a hell of a lot of toilet paper.
Ryssdal: Is your timing just exquisite, or were you going to write a novel about health care, anyway? I mean it has sort of plopped in the middle of a huge national debate.
SHRIVER: It looks almost calculated, it was anything but. When I started this novel, Obama was not even a credible candidate for president.
Ryssdal: So what prompted it then?
SHRIVER: Well, a long-term exasperation with the American health care system for one thing. But more immediately I had a very close friend of 25 years die of mesothelioma, which is a particularly vicious cancer, and it cost in the range of $2 million.
Ryssdal: That range of emotion that you went through clearly shows up in the book, and you weave that through all the four major characters. I mean you go up and everything's fine, and oh I've got health insurance, but oh, it doesn't pay for this and 40 percent out of network. I mean, it all wraps up in this discovery that the health care system in this country is troubled.
SHRIVER: Well, you start at the beginning of the book, you get a read out at the top of the first chapter, of how much money is in my protagonists' Merrill Lynch account.
Ryssdal: And it's a lot of money.
SHRIVER: It's a lot of money, it's almost three-quarters of a million dollars.
Ryssdal: And then you use those chapter headings. You use those account summaries to track how much Shep Knacker is spending in the course of treating his wife's illness, and it drops precipitously in a really short period of time.
SHRIVER: Yes, the Merrill Lynch account is in some ways another character in this book. And watching it drop, as Glynis gets sicker and spends more money, because they use out-of-network physicians, is part of the drama of the book.
Ryssdal: You know one of the beauties of fiction is that you can write conversations that people don't usually have. And one of the conversations we don't usually have about health care in this country is whether the amount of money we spend, both nationally and on an individual basis, is worth the huge dollar amounts.
SHRIVER: Of course, it's an American cliche that you can't put a dollar value on human life. But the truth is we do put a dollar value on human life everyday, we just put different dollar values on different human lives. This is a problem worldwide now, this is not just an American problem. And different countries have different ways of dealing with it. In Britain they've got an institution called "NICE," it's not a very nice organization that has a fixed amount that they will spend per week of your life, and if a drug costs more than that they won't pay for it.
Ryssdal: See this is where all the listener e-mails are going to come flowing into this program, because that's a tricky conversation to have.
SHRIVER: Well, NIE has a very bad reputation in the U.K. On the other hand there are countries all over the world that are starting to imitate this system. It's what I would call a necessary evil. I mean these are brutal decisions. But the bottom line is you can't expect people themselves to say "Oh, I'm not worth $2 million, I'm going to cut out early."
Ryssdal: But you have a character in this book actually saying exactly saying that. A 16, 17-year-old girl, her name is Flicka, with a horrible degenerative disease called, if I'm pronouncing it correctly, familial dysautonomia. It does horrible things and leads to a very difficult quality of life. And she says outright it's just not worth it to keep me alive.
SHRIVER: But that's a very rare submission, isn't it? And what's especially difficult, or I would say impossible, is to expect people to say, not just, oh my life is not worth $2 million, but my spouse's life is not worth $2 million. You're never going to get people to say that.
Ryssdal: Do you want when readers finish this book, because I have to tell you, when I finished this book I kind of sat there for a little while and shook my head. There are things in here that are jarring. It makes you angry. What is your intent that we leave with?
SHRIVER: I want you to be exasperated. I want you to think that something has to change in the United States in relation to health care. But I also want you to have had a wonderful time reading this book, and I want you to be happy on Shep's account on the last page.
Ryssdal: Lionel Shriver. Her most recent book is called "So Much for That." It's about health care. Lionel, thanks so much for your time.
SHRIVER: My pleasure.
Comments
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03/11/2010
I suppose if someone with a horrible debilitating disease WANTS to put themselves through the equivalent of Nazi torture in order to eke out a few more days or months of living, we ought to make money available for it. But a bigger question is: what about all the people who DON'T want to be kept alive in such situations? All the people who think quality of life is important?
As the Terri Schiavo case illustrated, a far greater problem in this country is being allowed to pull the plug. This author reminds me of Sarah Palin who immediately started crying "Death Panels!" when the topic of death with dignity arose.
My one hope for being able to die with dignity is the realization that the system will soon be so bankrupt that no one will be able to afford to keep me alive like that poor woman was.
From Milan, MI, 03/10/2010
Health care may be expensive in the U.S., but at least you can generally get it in a timely manner. Unlike, say, Canada or Britain.
From Seattle, WA, 03/10/2010
I guess I am in the "minority" but my philosophy is to live life as well as possible and do what I can to maintain my health (workout, eat right, meditate, etc...) and when the day comes recognize it is time. Don't misunderstand me, I am not looking forward to the day when my time is up but it is a simple fact of life - we all die so why deny it and act as if we can avoid it? Do what you can, live life, and celebrate each day. Oh, and to those who say "Americans don't want health care reform." I don't know who they are talking about. This system needs to be made more like the Canadian one as soon as possible. It is a right not a privalege and should not cost us an arm, a leg, and our retirement.
From San Diego, CA, 03/10/2010
After listening to this story, I wanted to go home to my wife and say "Let's buy that place in Mexico." Not because health care is good there. But, because it is no use saving my money so that the health care companies can take it later. Either I (we) stay healthy or we go broke. That's not much of an option is it? If all the money is going to go to the health-care-industrial-complex as I age then, let's spend it now. I may be indigent sooner, but so what? Indigence is indigence. At least I'll have something my kids can keep.
From PA, 03/10/2010
I had a classic NPR driveway moment listening to your show last night. Lionel Shriver hit the idea right on the head - no one thinks about healthcare and its costs until someone in their life is sick. Almost three years ago, my seemingly healthy 31 year old husband was suddenly diagnosed with a rare form of cancer. We had good health insurance, and all of his treatments were covered, but I seriously had to ask myself at one point, "What if we have to try experiemental treatments? How will we afford it?" I was really stressed about the possiblility of losing my husband to cancer and losing the house, and our savings to the disease as well. Luckily for us, his great team of doctors has rid him of this disease, but every 3 months we go for a checkup, and there was the two week period when we thought we would have to pay $12,000 for a PET scan that we were told would be covered. Again - thanks to doctors and hospitals that lobbied on our behalf (and absorbed some of the cost) we did not have to pay. This system is broken - everyone knows it - and is in immediate need to resucitating! Thanks for a real and honest (although they story is fiction) look at health care and the cost. I would like to say I will read this book, but since I have been living it, it may hit too close to home.
From Sacramento, CA, 03/10/2010
I work in an ICU, and if a patient was to say..."just let me die, it will be too costly to keep me alive", they would get a psych consult as they are "depressed". The patient gets treated as if something is wrong with them for making thaat decision.
From CA, 03/09/2010
I don't know if my husband and I are typical boomers or not, but we've discussed the cost of health care a lot. We would be happy to give up heroics to keep us alive in exchange for not having to worry our whole lives about affording decent health care. We are now paying for so much more than just decent health care, we can't afford to keep it up, especially if we're never ready to let go. (And we've never been without insurance, even when the price was usurious.)
From valparaiso, IN, 03/09/2010
Mr Rissdal and Ms. Shriver
Re:NICE-the point is that if Big Pharma and the like know that their product will not be paid with an open checkbook then they"(Big Pharma et al)are more likely to demand less(more reasonable) money for their product.
Is this not about market forces after all?
Thank you
B Pithadia md mph
From Newton, NJ, 03/09/2010
Hopefully this will become the Uncle Tom's Cabin of the healthcare debate.
From Rollinsford, NH, 03/09/2010
Sad but true, we are not in Utopia. Lionel Shriver's distaste that a dollar limit is set is on health care skirts the common sense part. Health care reforms could never change that because spendable money is finite. Health care is not free now and will never be free. Even if we forced doctors and hospitals to provide free service, they still must pay for goods and services, even in socialist and communist country's, somebody pays and there are limits. Who gets the big money spent on them will never be an easy decision and I wouldn't want that job for myself.
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