Remember Wilde: Every life ends in a tragic death

The healthcare debate in this country seems obsessed with who should pay for healthcare, and the fear of rationed healthcare, as though it isn't already rationed.

There are the right wingers largely trying to impede any progress by scaring the chickens with the threat of 'death committees', a version of the UK's NICE committee that decides when a drug is too expensive to approve. They have established a value of life cash amount of around $30K/yr, and if a drug costs more than that and doesn't significantly improve the patient's life, it is not approved and is available only to those who don't need insurance. Our 'death committees' would presumably follow suit, putting dollar amounts to quality of life and letting Granny die because Coumadin costs too much.

Then there are the left wingers, and this is often younger folks, who don't want to pay into a health insurance program knowing they are subsidizing the cardiac care of old people who eat the classic 'western diet' (i.e. fatty foods). Interestingly, I've read that insurance companies seem comfy insuring these elderly cardiac cases (they usually avoid those with 'preexisting conditions') so long as the youngsters are required to sign up - so the left wingers have a salient if selfish point. Needing very little care, they will be paying the same as the elderly cardiac patients...

So, healthcare rationing and who pays for this rationed healthcare? It seems clear that nobody under thirty wants to pay for anyone but themselves, and most everyone wants to believe we don't ration it. John Mackey of Whole Foods recently wrote an op-ed (and is being cross-nailed for it) proposing eight steps to better healthcare. I mistrust the advice of any millionaire on this issue, but Step 6 I like: make costs transparent so consumers understand what treatments cost. My current carrier, BCBS, does send FYI notes to us, detailing our claims and what was paid. It is enlightening - one sees the dynamic tension between what a physician wants to make and what the policy pays and there's usually a gap. I don't know how common this practice is, but if we all knew exactly what payments are made on our behalf, maybe that would smarten the debate, one way or the other.

As for rationing healthcare: a simple search of your favorite engine (yeah, probably Google) using terms like 'insurance denies claims' will net you much reading material, largely protests from angry Americans with denied claims for expensive medical treatment. It's easy to find human interest reporting on fund-raisers to pay for the treamtent or medical device an under or un-insured soul otherwise can't get? Our insurance carriers already have their version of the NICE committee/Death Committees. Wouldn't you like to make that process more transparent?

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The horror story has been rolling along quickly. Not having to fact-check historical detail really frees up the imagination.

I recently finished reading Coal Black Horse by Robert Olmstead. I had a workshop with him eleven years ago at the now-defunct Rappahannock Fiction Writers Workshop. It was my first writing workshop and he had a ton of advice, some of it very hands-on and some a little more abstract. I soaked up as much as I could, but I suspect he was a little disappointed in us because by the third day he was, in effect, lecturing us that he was trying to help us. Coal Black Horse is set primarily in Gettysburg, and it's vintage Olmstead in that it has a very moral tone and minimal dialogue. It may be classified as 'guy lit' as one reviewer compares it to Cormac MacCarthy. Having read some of MacCarthy's work, Olmstead does write in the same vein - horses, arduous travel, dangerous adventures.

In contrast, just before Coal Black Horse I read Clint McOwn's War Memorials. Clint currently teaches at the Vermont PostGraduate Writing Conference, which I've attended three times. I bought his book after hearing him read one evening, in part because his work sounded funny. What I very much liked about War Memorials is that it's a novel composed of short stories, and most of the chapters could stand on their own as short stories. That's how I believe most novels should be ideally structured. My own don't work that way, which explains my admiration for his technical skill.

What disappointed me in WM was a climactic scene between the main character and the bad guy who has been sleeping with his wife and has probably impregnated her. Now, the POV is first person through the main character and he considers himself a loser and non-violent. The scene where these two guys should be having it out, the villain reveals he's dying from an aggressive cancer, and a minute later blows himself up, making any thrashing superfluous. I expected something a little less gimmicky, less deus ex machina. I did enjoy reading the book, and most of the characters were quaint Southern stereotypes, and the book was a gentle, nonviolent tale, so too much violence would have given the story a darker end than the writing justified... but it was a let-down.

Motivation...

What gets me going? I can identify two powerful motivators. First, a really good idea gets me going. It may be good enough to power me through a complete draft. Second: jealousy. Someone else's success. When I was writing Stone House Diaries (that is, during that decade), the novel City of Light by Lauren Belfer was published. Now, Lauren appeared to get what I'd been dreaming of. She got a big publishing company behind her novel about Buffalo, she had an agent, she was feted locally (she's not from Buffalo, she just went to school there. She lives, doncha know, in NYC). Me? My book was published by an unknown indie publisher, I have no agent and I got minimal attention locally. So, as I said, jealousy is a motivator.

And I know this isn't just me, as a good friend of mine who writes just emailed me about her own jealousy over the success of someone half her (our) age. Yep, it cuts like a knife. Is it enough to make us abandon writing? I wish.

We may start out in this field acknowledging the dismal statistics against success, conceding as we devote our time to writing and rewriting that we won't have the commercial success we want. We think we've prepared ourselves. Then someone does just that - younger than you, wildly successful. And it never helps if you pick up their book and read a few pages and are left... unimpressed.

Ebooks...

I was surprised to read in a post on Publisher's Weekly that an industry study negates the popular assumption that ebook sales eat into the print market. Ebooks - particularly etextbooks - were heavily used, but didn't impact print sales. That's good news and bad news. For the promoters of the Kindle, saving trees is a big selling point. But the ebook reader won't necessarily save any trees... instead, there's the additional kilowatts (perhaps just watts) the readers will require. That technically adds to the electrical power we need to generate... so ebooks are hypothetically more convenient (how's the Kindle going to handle getting dropped in sand?), no improvement on saving trees, and another damn battery operated appliance.

So what's the upside? Another gadget, something else to buy. Hmm... do I sense another addition to the junkpile of history where now resides the 8-track tape player?

Literary history

I was thinking of great literary nonfiction I've read, which includes some of Orwell's work, and others like John McPhee. My favorites have been history titles: Son of the Morning Star and Custer and Sitting Bull, Nathan Philbrick's Mayflower the most recent. I'm currently working through Lepore's New York Burning. The latter is not going to make my list of great non-fiction. Lepore has fleshed out pre-Revolutionary New York City nicely, especially its slave population, but her writing bogs down in the way that academics sometimes do when trying to write for a popular crowd.

The lack of zombie novels...

Why, oh why, do I enjoy zombie flicks so? A good one is a real treat, as compared to the many very-low budget flicks one can find on Netflix. I have never read a good zombie novel (correction: I have never read any zombie novel). This may be because I don't read science fiction anymore. Or because there's no Mary Shelley of Zombies.



A quick search of Amazon (don't you freaking love the inter-web?) provides four zombie titles, but only one novel. I expect there must be more than one, but Amazon feeds my suspicion that there aren't many.

So I'm going to write one...

George Orwell

Or Eric Blair. As nonfiction writers go, Orwell is among my favorites. During and after earning my graduate degree in history I found myself reading almost everying he wrote. The one that endures among others is Down and Out in Paris and London. Orwell was a beacon of truth in a time of much bullshit. He favored socialism in postwar England, but he wasn't afraid to take on Socialism, both in the grand and petty forms. In The Road to Wigan Pier he has a famous piece where he's on a bus in the country that stops and picks up two riders dressed - unconventionally - in shorts, with sandals and other accoutrement that elicits the comment from other riders, under their breath, "socialists". Orwell confesses he had the same thought - these geeks are socialists. He goes on to discuss the practical impediments to bringing Socialism to England, but not fatalistically, rather in a way that would ease the transition.
What poverty truly felt like, that was where Orwell excelled as a reporter, in part by living poor. In both Wigan Pier and Down and Out he writes of being poor; in Down and Out he spends months living in flophouses and eating garbage, then returns to England where he discovers the promised job isn't there and once again he is poor. Now he does a tour of the poor houses in England, and one is living again in miserable conditions, living among the unwashed and dying.
Lesser titles: Keep the Aspidistra Flying, which he himself called his least favorite work; again, it focuses harshly on class and economics. Burmese Days covers his early years as a petty bureaucrat in India.
1984 is his best known title, and it is a tour de force, but as a work of ficition left me a little bored. Orwell was at his best writing in the first person, writing about the world he was living in.