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Exasperation with U.S. health care

Lionel Shriver

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.

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