Friday, June 26, 2009

Dear Mr. President: How to save millions on health care

Mr. President, Members of Congress, members of the press, and fellow bloggers---

There's a way to save millions of dollars on health care that nobody is talking about. It's a simple concept, and the start-up costs would not be enormous. It would be ideologically satisfactory to Democrats and Republicans. It would satisfy the President's call for "uniquely American" solutions, because it is based on free enterprise. Though it would not solve the current health-care crisis, it would help to contain costs while a solution is found.

Our current health-care system resembles free enterprise like a mugging resembles a trip to the mall. When we go to the doctor, the pharmacist, or the hospital, it's "your money or your life." We consumers usually have no idea how much any health-care service or product will cost until the bill arrives--we only know that we need help, and so we pay whatever is asked. Comparison shopping, an essential feature of budget management, is impossible.

So what if we figured out a way to make comparison shopping not only possible, but easy?

What if doctors' offices were required to post a list of their most common procedures, with prices for each? What if they also had to list all their prices on a central online data bank that consumers could access? What if pharmacists, laboratories, scan centers, hospitals, clinics--all providers of health care--had to do the same?

Imagine going online and checking to see how much your local family-practice physicians charge for a 15-minute office visit before making the appointment.

Imagine being given, along with your prescription, a computer print-out showing where your medication can be purchased, how much it costs from each pharmacy, and what other, cheaper options might be equally satisfactory.

Imagine being able to refuse your doctor's offer to use the CT scanner across the hall, which he owns, and instead driving three miles to a different CT scanner that costs half as much. Or confidently using the doctor's scanner, knowing that his prices beat out the competition's.

How hard would this be?

Posting the prices of usual procedures would take, what, an hour?

Listing all prices on the internet could take anywhere from ten minutes to a day, depending on how many services are offered.

Setting up an internet portal for providers and consumers would be the most expensive and time-consuming part. Google might be happy to help. Or Bill Gates.

Price-fixing could be a potential problem ("Let's all get together and charge the same outrageous amount ..."), though it is already illegal. Undoubtedly there will soon be caps on medical malpractice lawsuits. Perhaps underemployed ambulance chasers could move into antitrust law, which would certainly increase their popularity.

Some providers might object that they themselves don't know what their prices are, because so much depends on insurance company payments. Well then, imitate hotels and publish your maximum rack rate. Or imitate airlines and change your rates hourly (this would be time-consuming, and I really wish airlines didn't do it--but still, it's a lot easier to comparison-shop for a plane ticket than for a mammogram). Or keep your prices low and reasonable for everyone, and stop asking the uninsured to subsidize the insurance companies' discounts.

Any health-care system acceptable to Americans will contain some element of free trade. To the extent that we want the free market to play a role in our health care, let's insist that normal market forces operate. We live in an information society. Why not information for consumers on what our health care is going to cost?

Wednesday, June 24, 2009

Why I am a liberal

Liberal means favoring freedom.

In 17th and early 18th-century Europe, liberals brought down the Ancien Régime—a totalitarian alliance of church and state—and (with many false starts and not a little bloodshed) developed their current democratic systems of government. In America, liberals wrote (and fought for) the Declaration of Independence, the Constitution, and the Bill of Rights.

In England and America, especially, liberals favored free markets and strong businesses. Commerce, they believed, was a safer ruler than king or pope, because commerce was based on “enlightened self-interest.” Economic liberalism led to exploration, the industrial revolution, and an increased standard of living for Europeans and Americans.

However, 19th century captains of industry began rivaling 18th-century despots in their opulent lifestyle, and in turning a blind eye to the miserable living conditions of the workers who supported it. Liberals—that is, lovers of freedom—began arguing that freedom is possible only when everyone has access to education, decent housing, adequate food, reasonable working hours, and a safe working environment.

Today, some Americans think that liberals are anti-business and pro-government. Perhaps some who wear the liberal label are, but this is not true liberalism. I repeat: liberalism means favoring freedom. But this does not mean freedom without limits.

As a Christian, I believe in original sin: we all fall short of God’s ideal. I also believe in community: we are individually members of one another, and our enlightened interests must extend to others as well as ourselves. (That is why I am a liberal and not a libertarian.)

Alas, communities of sinful people are rarely better than the individuals who form them, and often—because of the increased power of the group—they are considerably worse. Think of the powerful medieval church, for example. Christ instituted the church for the good of humankind, but “power tends to corrupt, and absolute power corrupts absolutely.” Lord Acton, a devout Catholic, wrote that in a letter about the power of the pope.

If power corrupts the church, it also corrupts secular governments and multinational corporations. America’s founding fathers limited religious power by including the first amendment to the Constitution in the Bill of Rights. They limited the government’s power by dividing it into three branches: executive, legislative, and judicial. They did not limit the power of multinational corporations, because even though the Dutch East India Company had been founded in 1602, multinationals were not a huge concern in colonial and frontier America.

Paradoxically, excess power, wherever it occurs, needs to be limited in order to allow freedom to flourish. Another name for freedom without limitations is anarchy, and a frequent result of anarchy is totalitarianism. Untrammeled freedom can destroy liberty.

Given humanity’s power-hungry sinfulness, the best way of limiting one power is often by keeping it in balance with other powers. In the Western world today, our princes are not kings or presidents or bishops, but CEOs and financiers. Tomorrow our princes may come from some other sector, requiring different kinds of limits. The important thing for a liberal is not to be anti-business or anti-government or anti-church, but rather to be pro-liberty, and to seek to limit any power that is dangerous to basic human rights.

One thing is certain: as original sinners, we are powerfully attracted to the god Mammon. Whoever has the power also has the money, and whenever power goes out of control, it enriches itself at the expense of others. If you want to know who needs restraining at any given moment, follow the money.

Tuesday, June 23, 2009

Review: A Plague on Both Your Houses

Knowing of my fascination with medieval sleuths, a friend recommended the Chronicles of Matthew Bartholomew by Susanna Gregory.

I began with A Plague on Both Your Houses, listed all over the internet as #1 in the series that is now up to 15 books, even though the book jacket unaccountably calls it the third chronicle. I suspect this book was the third written though the first chronologically, just as The Magician's Nephew is the 6th chronicle of Narnia though the first chronologically. Which makes me wonder how you can have an unchronological chronicle, but perhaps I'm being too logical.

The story takes place in 1348, some two centuries after Brother Cadfael flourished in Shrewsbury and nearly a century before Dame Frevisse roamed Oxfordshire, but only 15 years before Owen Archer will unravel his first mystery in York. Cadfael and Frevisse are monastics; Archer is an retired soldier and apothecary who works closely with a monastery; and Matthew Bartholomew is a physician who lives with monks and friars in a Cambridge college.

Gregory, a police officer before earning a PhD at Cambridge, has skillfully created the richly detailed historical ambience that medieval mystery readers crave. She includes not only descriptions of 14th-century university life, but also gruesome portrayals of what bubonic plague did to the human body, how it destroyed entire villages, and what the young doctor did to try to alleviate his patients' suffering. You can almost smell the piles of rotting corpses waiting to be tipped into the communal pit.

Of course--since this is a mystery--there is moral putrefaction as well: plots, conspiracies, greed, betrayal, all connected to a series of bizarre murders. Unlike many of his confrères, Bartholomew is naïve and very, very good. Like his biblical namesake (aka Nathanael), he is a man "in whom is no guile" (John 1.47). His innocence gets him into all sorts of trouble.

Bartholomew's character is well drawn, and his companions are believable. Conversation, however, is often stilted and professorial ("'There have been other signs, too,' Michael continued after a moment. 'In France, a great pillar of fire was seen over the Palace of the Popes in Avignon. A ball of fire hung over Paris. In Italy, when the plague arrived, it came with a terrible earthquake that sent noxious fumes all over the surrounding country and killed all the crops. Many died from famine as well as the plague.'" To the author's credit, Bartholomew nearly falls asleep listening to Brother Michael drone on.)

Occasionally Gregory seems guilty of anachronism. Though she depicts the general ignorance and superstition underlying 14th-century medical practices, and though she acknowledges that Bartholomew is ahead of his time, his ideas about the causes and treatment of disease sometimes seem unbelievably advanced. The plague is not a punishment from God; leeches are harmful; there is no reason to waste time with horoscopes ... will we discover in a later installment that a time machine has flung Bartholomew back from the Renaissance into the Middle Ages?

This is a complex, tightly plotted book. Trying to get my bearings, I kept returning to page 7, where the eight Fellows of Michaelhouse are briefly described. Eventually I knew everybody well enough to read in a more linear fashion, but then the bodies started to pile up. Gregory helped me out by having Bartholomew stop every now and then to take stock, usually by asking himself a paragraph or two full of questions ("Was it Abigny? Had he come back from wherever he was hiding when he had heard that Bartholomew knew about the [spoiler deleted]? Could it have been Swynford, back from his plague-free haven? Was it Michael, who had reacted so oddly at Augustus's death? Was it William, who had prompted him to look at the bodies in the first place, or Alcote, skulking in his room?" Is it tedious to read so many questions?).

The author also helped by neatly tying off all the loose ends in the final chapter and epilogue, which seemed just a little like cheating--but then if she had followed the novelist's adage Show, don't tell, the book might have become too heavy to lift.

Whether this is the first or the third chronicle, it is an early book in a series that has a lot of devoted fans. A reader who thinks the Matthew Bartholomew books "are simply the best out on the market" (and he's read them all) wrote this in an Amazon customer review: "Admittedly it has taken Ms Gregory 4 novels to really get going and you can almost see the development in the writing skills as you read each one." That's how I felt about the Dame Frevisse novels, with which I eventually fell hopelessly in love. So perhaps, several books from now, I'll be in love with the Bartholomew chronicles too.

Bestsellers, 2008

I've been looking at Publishers Weekly's list of bestselling books 2008 (which they inexplicably title "Bestselling Books 2009," but publishers must think ahead), and I confess I have read very few of them.

The list includes books that were published in 2007 or 2008 and that sold (in the United States, in 2008) more than 100,000 copies each. Of these, 156 were fiction and 119 were nonfiction. I have read eight of the novels and one and a half of the nonfiction books (although I spent a long time at Barnes & Noble leafing through another nonfiction book on the list, How Not to Look Old.)

PW's fiction list is predictably heavy on brand names: Grisham, Patterson, Cornwell, Baldacci. My own brand preferences run more to PD James and Alexander McCall Smith, both of whom also made the list. Here are the eight bestselling novels I read, with comments:
  • The Story of Edgar Sawtelle. David Wroblewski. Ecco (9/08) 1,320,000 (Well, it’s about dogs and families, and it’s well written, but why did everyone like it so much?)
  • The Guernsey Literary and Potato Peel Pie Society. Mary Ann Shaffer and Annie Barrows. Dial (368,288) (Yes! By far the best of the lot. A book for booklovers, and also a beach book.)
  • Remember Me? Sophie Kinsella. Dial (336,870) (Forgettable fluff, but fun)
  • One Fifth Avenue. Candace Bushnell. Voice/Hyperion (290,004) (Also FF but F)
  • The Private Patient. P.D. James. Knopf (235,000) (Excellent. PD James is still wonderful at age 88.)
  • People of the Book. Geraldine Brooks. Viking (212,498) (Good, but I liked Year of Wonders more.)
  • The Miracle at Speedy Motors. Alexander McCall Smith. Pantheon (150,000) (Mma Ramotswe is my favorite serotonin enhancer.)
  • Liberty. Garrison Keillor. Viking (101,000) (Ranges from annoying to infuriating, with occasional spots of comedy.)


The nonfiction list was crowded with “how to fill your life, which currently sucks, with wealth, meaning, and beauty” books, which I have avoided ever since it occurred to me that if any of these books actually worked, no more would need to be published.

Since 2008 was an election year, political and issues books were also popular. I read half of
  • Hot, Flat and Crowded. Thomas L. Friedman. Farrar, Straus & Giroux (9/08) 625,363
a book with an excellent premise that is easily understood in the first chapter or two, so that eventually the remaining chapters seemed superfluous.

I also read
  • Things I've Been Silent About. Azar Nafisi. Random (100,305)
perhaps not as compelling as her earlier Reading Lolita in Tehran, but still a fine memoir that has increased my understanding of the frequent scary headlines from Iran.

Religion books
Interestingly--at least to me, since I've worked for some 30 years in religion publishing--21 of the 119 nonfiction bestsellers were religion books. Each of the 21 either was by an already well-known author or else profited from a recent sensational news story. I can't comment on their content, since I haven't read any of them. One of two looked worth reading (if you wrote one, no doubt I am referring to yours).

Of the fiction books, only one was published by a religious house: Dead Heat by Joel C. Rosenberg (Tyndale). Alas, it's a right-wing political thriller.

Marilynne Robinson's Home didn't make the bestseller list, though perhaps it will in 2010. Meanwhile, it is accumulating awards. Christianity Today chose it as the best religious novel of 2008, it won Britain's Orange Prize, it appeared on the New York Times "100 Notable Books of 2008" list, and it was a finalist for the 2008 National Book Award.

Which just goes to show . . . bestseller lists are interesting sociological and business phenomena, but they're not a great guide to good reading.

You knew that all along. Now you have the data.

Saturday, June 20, 2009

Summer reading: nonfiction reviews

Over the last 15 months I've reviewed or commented on some 40 books on this blog. Here's the nonfiction list--with links to my reviews--of books about sex and marriage, worship and coffee, anxiety and happiness, food and animals ...

OK, so there isn't much of a theme, which must mean I'm a hedgehog and not a fox. If that metaphor is unfamiliar, check out the first review on the fiction list here.

Brown, The Body and Society
Butcher, A Little Daily Wisdom
Coontz, Marriage: A History
Galli, Beyond Smells and Bells
Gill, How Starbucks Saved My Life
Grandin, Animals Make Us Human
Hathaway, The Year of the Goat
Jones, The Tenth Muse: My Life in Food
Kolodiejchuk /Mother Teresa, Come Be My Light
Madigan & Levenson, Resurrection: The Power of God for Christians and Jews
McMahon, Happiness: A History
Paulsell, Honoring the Body
Pearson, A Brief History of Anxiety
Pollan, The Omnivore’s Dilemma
Squire, I Don’t: A Contrarian History of Marriage
Stark, The Rise of Christianity
Sweeney, Almost Catholic
Wright, Days of Deepening Friendship

3 more lists
2008 Books: The 10 Mosts
Books and films that break your heart
Fiction reviews through June 2009

Summer reading: fiction reviews

Over the last 15 months I've reviewed or commented on some 40 books on this blog. Here's the fiction list--with links to my reviews--of mysterious, grisly, heartbreaking, heartwarming, thought provoking, or silly books, most of which I enjoyed.

Clearly my reading is not thematic. It does, however, promote happiness, and if you'd like to read more on that topic, check out McMahon's book on the nonfiction list here.

Barbery, The Elegance of the Hedgehog
Cornwell, Blow Fly
Frazer, The Apostate’s Tale
Genova, Still Alice
Harvey, The Wilderness
Keillor, Liberty
McCall Smith, Tea Time for the Traditionally Built
Minot, Evening
Mohsin, The Reluctant Fundamentalist
Munro, The Complete Saki
Perrotta, The Abstinence Teacher
Robb, The Apothecary Rose
Robinson, Home
Sansom, Dark Fire
Sansom, Dissolution

3 more lists
2008 Books: The 10 Mosts
Books and films that break your heart
Nonfiction reviews through June 2009

Friday, June 19, 2009

Two elegant hedgehogs

As a former French teacher who lives with an elegant little terrier named Mrs Tiggy-Winkle, how could I not like Muriel Barbery's The Elegance of the Hedgehog?

A runaway best-seller in Europe--over a million copies sold in its native France since its 2006 publication, translation rights sold to 31 countries--the book is #14 on the most recent New York Times paperback trade fiction best seller list.

Last September when the U.S. edition was published, Caryn James characterized it as belonging "to a distinct subgenre: the accessible book that flatters readers with its intellectual veneer." I love being flattered, I am pining for France, I'm a sucker for best sellers, and there's the hedgehog thing. I put a hold on it at the public library.

In James's New York Times review, she offers this interesting insight into the book's title:
The sharp-eyed Paloma guesses that Renée has “the same simple refinement as the hedgehog,” quills on the outside but “fiercely solitary — and terribly elegant” within. Yet there is no mention of “The Hedgehog and the Fox,” Isaiah Berlin’s essay on Renée’s beloved Tolstoy, which may make this the sliest allusion of all. (What are the odds that a philosophy professor with a working knowledge of hedgehogs and Tolstoy would not have known it?) In Berlin’s famous definition of two kinds of thinkers — foxes gather multiple unrelated ideas, while hedgehogs subsume everything into a controlling vision — Renée, intellectually eclectic yet determined to cram her thoughts into a self-abnegating theory of life, resembles Berlin’s description of Tolstoy, who was “by nature a fox, but believed in being a hedgehog.”

Well, actually, Ms. James, the hedgehog idea wasn't Berlin's. The ancient Greek poet Archilocus said it succinctly 27 centuries ago: πόλλ' οἶδ' ἀλώπηξ, ἐχῖνος δ'ἓν μέγα; and Erasmus of Rotterdam ran with the idea some 21 centuries later: Multa novit vulpes, verum echinus unum magnum. You can read all about it here, if you happen to be a fox.

But enough intellectual veneer. Now that I've read The Elegance of the Hedgehog, I'll suggest another important literary reference buried within it--an allusion to Beatrix Potter's The Tale of Mrs Tiggy-Winkle. Consider Potter's story: Depressed little girl meets "a very stout short person" with bad hair. The prickly person works for many people of higher status than herself, including the sad child. A garment gets lost in the washing. Eventually the old woman serves the girl a cup of tea, and the two look "sideways at one another." An improbable friendship forms.

And then there's the whole thing about laundry and dry cleaning, about which I will say no more to avoid spoiling Barbery's plot.

OK, I've been playing with you. What I just did is exactly what Renée, the concierge/ hedgehog/ protagonist of Barbery's book, despises. "If you want to make a career" in academia, she muses,
take a marginal, exotic text ... that is relatively unexplored, abuse its literal meaning by ascribing to it an intention that the author himself had not been aware of (because, as we all know, the unknown in conceptual matters is far more powerful than any conscious design), distort that meaning to the point where it resembles an original thesis, ... devote a year of your life to this unworthy little game ... , and send a courier to your research director.

That kind of reflection permeates this strangely absorbing little book, which--after a great deal of philosophy and French spleen--ends up affirming art, music, friendship, beauty, goodness, and the wonder of daily life.

I'll say no more. For a really fine introduction to and review of The Elegance of the Hedgehog--far better than I could provide--read Michael Dirda in the Washington Post.

Tuesday, June 16, 2009

If France can do it, why can't we?

I just sent an e-mail about health care to my congressman, Peter Roskam (R Illinois, 6th district), through his website. If you have ever gone uninsured, struggled to pay insurance premiums, been given unnecessary and expensive tests, lost your insurance because of changing jobs, lost your insurance because of a pre-existing condition, gone bankrupt because of medical bills, or feared any of the above, please write your member of Congress too. You can find his or her contact info here.

Here is what I wrote to Mr Roskam. (Most of my statements are supported by data available at the World Health Organization website. The link will take you to a page where you can find an incredible array of data and build your own comparison charts. If you're a wonky nerd like me, you'll love it.)
Thank you for your phone message asking for our ideas about improving health care.

Having studied in France and worked in England, I am amazed at what some Americans, including yourself, are saying about single-payer systems. Clearly not enough study has been done on European countries whose health care is much better than ours--and at half the cost.

Contrary to popular beliefs, the French and Italians and Dutch (to name just three) do get to choose their own doctors. They have many more doctors and hospital beds available per 10,000 population. Their life expectancy is greater, and their infant and maternal mortality are lower. And yes, they do wait longer to see a specialist--but they are able to get in to see their primary physician much more quickly than most Americans can (and many doctors make house calls). Virtually everyone is covered, and when they go to the hospital they are admitted immediately without having to spend time in the business office first. Government doesn't interfere with their choices nearly as much as our own insurance companies do.

And what is most interesting is this--European government spending on health, per capita, is very similar to ours (France, $3050; U.S., $2862; Netherlands, $2311; Italy, $2061, 2005 statistics). Theoretically, we could improve our healthcare, cut the cost in half, and insure everybody, just like they do--unless, of course, we are more corrupt or less efficient than our European friends.

If you're really interested in learning about options, go to the WHO website and check the comparative data. It's very enlightening.

I agree that we can't just keep throwing money at our failed system. We need an entire restructuring, along the European model. Call it "socialism" if you like--I don't care what our system is called, as long as it delivers. And I've lived in Wheaton for 21 years.

I appreciate your willingness to listen.

Friday, June 12, 2009

How to live long and prosper

“What Makes Us Happy?”

It’s an eternal mystery, and it's also the title of a fascinating article by Joshua Wolf Shenk in the June Atlantic. Shenk was given access to archives of the Harvard Study of Adult Development, which has been following a group of men—Harvard College sophomores in the late 1930s—for over 70 years. About half of the original 268 are still living.

Reading their stories and talking with the study’s longtime director, psychiatrist George Vaillant, Shenk tried to find reasons for some men’s happiness and others’ dissatisfaction, failure, or ill health. The key to happiness proved elusive and complex, but one factor stood out. Shenk reports:
In an interview in the March 2008 newsletter to the Grant Study subjects, Vaillant was asked, “What have you learned from the Grant Study men?” Vaillant’s response: “That the only thing that really matters in life are your relationships to other people.”

Tony Woodlief, writing in today’s Wall Street Journal, comments on the Atlantic article and half a dozen other sources in “Ya Gotta Have (Real) Friends.” Woodlief links to Jeffrey Zaslow’s WSJ article “The Ties That Bind,” pointing out that women are more likely than men to cultivate lifelong friendships. Zaslow cites
a 14-year project at Flinders University in Australia that tracked 1,500 women as they aged. The study found that close friendships—even more than close family ties—help prolong women’s lives. Those with the most friends lived 22% longer than those with the fewest friends.

Woodlief points out that Facebook “friends” don’t really count. But how do we keep in contact with flesh-and-blood friends who live far away?

I’m still in touch with several childhood friends. Sharon and I met the summer we were 8; she has lived in Italy for the last 35 years. Kathleen and Molly and I met the summer we were 12; now we live in Maryland, Idaho, and Illinois. Thank goodness for Penny—we met at age 13—who lives only an hour away! And for airlines—Molly visited in May, and I’ll be seeing Sharon and Kathleen later this year.

Some of my post-college friends are amazed that we've all kept in touch. It helps that we all grew up in a well-networked subculture, and that we knew each other's parents and siblings and cousins. It also helps that, even though we didn't all go to the same college, we each spent a year in the same little school in Haute-Savoie, France. Not even the same year, but we sneaked out of the same dorm and bought Swiss chocolate in the same stores and knew the same shortcut up the hill to our school (turn right at the dog).

I wish we all lived in the same city now. Paris would do.

Wednesday, June 10, 2009

What North Korea doesn't want the world to know

On Monday, journalists Laura Ling and Euna Lee were sentenced to 12 years of hard labor in a North Korean prison. This morning, Blaine Harden in the Washington Post tells the probable reason: they were researching an article on the plight of women who, fleeing famine and poverty in North Korea, crossed the border into China. (You may have to create an account to read the Post article, but the account is free and takes only a minute to set up. It's worth the effort.)

Many of these refugee women ended up “being sold like livestock in China,” according to one refugee who was sold in marriage to three men, sent back to North Korea, permanently maimed from a police beating, and then sent to a labor camp which she characterized as “hell on earth.”

Actually, says a South Korean human-rights researcher, most of the women are much better off in China than they were in North Korea. If they stay with the men who buy them, they are given adequate food and housing. However, they and most of their children have no legal status. Without residency papers, the women can be deported at any moment—back to North Korea, where they will be treated as criminals. Their undocumented children, who will remain with their Chinese fathers, may not be able to go to school.

(A disgression: if you Google “religion and women’s rights,” you’ll find plenty of evidence for serious shortcomings in this area on the part of all major religions. But note that North Korea and China are both officially atheistic countries, so apparently the absence of religion is not the answer. When I get impatient with the church’s slowness in treating women and men equally, I should probably remind myself of that.)

Let’s all pray, light a candle, march, or do whatever we do best on behalf of Ms. Ling and Ms. Lee.

Sunday, June 7, 2009

Sotomayor and Thomas--separated at birth?

"For Sotomayor and Thomas, paths diverge at race." This is the title and topic of a fascinating article by Jodi Kantor and David Gonzales in Saturday's New York Times. It begins:
If Judge Sonia Sotomayor joins Justice Clarence Thomas on the Supreme Court, they may find that they have far more than a job title in common.

Both come from the humblest of beginnings. Both were members of the first sizable generation of minority students at elite colleges and then Yale Law School. Both benefited from affirmative action policies.

But that is where their similarities end, and their disagreements begin.
Sotomayor, as we all know by now, is fiercely proud of her Latina heritage. Thomas, if not actually ashamed of being African-American, at least does not want his racial heritage to affect his life, or his decisions, in any way.

Yet their early lives ran on amazingly parallel tracks, right down to the intense language study each of them did in order to learn to speak standard American English.

Still, the young Thomas, isolated from family and peers, grew increasingly disaffected at college. Drawing on statements in his autobiography, Kantor and Gonzales write, "Mr. Thomas learned he could rely only on himself."

By contrast Sotomayor, who recalls the warmth of her "Nuyorican" childhood, plunged into Hispanic studies and social groups at Princeton, gaining strength from her community.

Apparently Sotomayor plays well with others, and Thomas does not.

Some might argue that this makes Thomas the more objective judge. Others might label him the more selfish of the two--in college Sotomayor worked tirelessly on behalf of her community, whereas Thomas worked equally tirelessly on behalf of himself.

And yet, as the article points out, "both judges are passionate about minority success, dedicating countless hours to mentorship."

I hope Sonia Sotomayor joins Clarence Thomas on the bench. I don't for a moment think that one will be more or less objective than the other. Both have been shaped by deeply felt personal experiences; both are dedicated to equal justice for all. As the Court grows toward resembling all of us, Justice--once focused on elderly white males--can readjust her blindfold.

Saturday, June 6, 2009

Obama, Mohsin, and the importance of listening

This post was inspired by President Obama's Cairo speech, and specifically by a wonderful analysis of it by Richard Engel. I thought I'd tell you this up front, since I take a while to mention the speech.

Thursday evening I joined the public library’s contemporary book discussion group to talk about The Reluctant Fundamentalist, Pakistani novelist Hamid Mohsin’s brilliantly unsettling little book about a Pakistani Princeton grad who gives up a promising business career in the U.S. and returns to his family in Lahore. Easy to read in one evening, the book raises uncomfortable questions about East-West relations. Some participants in the book group hated it. They thought it was anti-American.

I didn't agree. Being from another country, the narrator sees things Americans take for granted, and some of the things he sees are not good. He has strong opinions about aspects of American politics and business, and he is critical of certain military decisions. At the same time, however, he loves New York, enjoys his American friends, and appreciates his Ivy League education. This is a book about conflict--not only between East and West, but also within the narrator's soul.

It is difficult to straddle two or more cultures. As the late Senator Paul Simon pointed out in his 1980 book The Tongue-Tied American, literal translations may have unintended hilarious meanings (e.g., it was hard to market the Chevy Nova in Spanish-speaking countries where no va means "it doesn't run"), and unless business people are fluent in their clients' language and at ease with their cultural expectations, they are always at a disadvantage in negotiations.

Isolated from the rest of the world on our big island, we Americans need repeated reminders that other people may have expectations, views, habits, standards, and hopes that differ markedly from our own--and that are perfectly reasonable from their point of view.

I thought I had learned that lesson at age 16, living in France during the Vietnam war when Americans were decidedly unpopular. But I had to relearn it at age 40, working for a successful British publisher that didn't edit or market books the way an American publisher would have done (more than once someone quoted to me George Bernard Shaw's famous wisecrack that "England and America are two countries separated by a common language"). At 60, I'm still learning, mostly through reading books like Mr Mohsin's.

The gap between East and West, of course, is much wider than that between the United States and France (hey, it's D-Day, and today the French adore us!). It is almost inconceivable to most Westerners that a woman might freely choose to wear the hijab, or that a nation might democratically elect a dictator, or that a culture might not want religious freedom. Most of us simply wouldn't know how to speak to people who differ that much from us. Unless, of course, we make an effort to find out what's important to them.

And that brings me, finally, to President Obama's speech Thursday in Cairo. With a father from Kenya, a mother from Kansas, a stepfather from Indonesia, and grandparents in Hawaii, Obama has no illusions that the rest of the world either loves or envies Americans. He is painfully aware that much of the world--rightly or wrongly--sees Americans as arrogant, ignorant, irreligious, materialistic, and militaristic. Which is why, in Cairo, he spoke humbly, intelligently, and respectfully, focusing on our shared values and hope for peace.

"This is a huge break from the past," says Richard Engel, the NBC News chief foreign correspondent, who has lived in the Middle East for 12 years and speaks and reads Arabic fluently. In MSNBC's World Blog, he writes:
Former President George Bush was Al-Jazeera’s bête noire. Yesterday, one of the network’s guests remembered Bush as "a warmonger" who spoke "in a language of blood and killing." Another analyst compared the former president to Osama bin Laden.

"I don’t see much of a difference between Bush and Bin Laden," he said. "Both say, ‘You are either with us or against us.’"

In contrast, Al-Jazeera described Obama’s speech as "honest," "historic" and "deeply respectful."

I suspect a main reason Obama was so well received was that he – either by design or coincidence – successfully used the tools of Arabic rhetoric: flattery, history and religion. Simply put, Obama translated well into Arabic.

Engel notes Obama's knowledgeable use of Muslim religious terminology that communicates respect to a Muslim audience. He also mentions phrases Obama used--"the Holy Koran," "peace be upon them"--whose omission would have been perceived as socially incorrect or even blasphemy. His listeners, many of them, came skeptical but left singing his praises.

We Americans have plenty of catching up to do. More of us need to study the history and languages of non-Western countries. We need to encourage our young people to spend time living and working in other cultures. And indeed, we are making progress. Young-adult children of my friends are blogging from Vietnam, Uganda, and India; and I proudly report that my 14-year-old granddaughter just got a 90 in credit-by-exam for first-year high-school Chinese (her public school offers four years of Chinese language).

Americans don't have to be ugly. Most of us, in fact, aren't. The noisy, contentious ones draw a crowd--but the rest of us are quietly, respectfully observing and learning from our neighbors to the East. When we listen to them, we risk discovering that they don't like our country as much as we wish they would. But when enough of us really listen to them, some of them may begin to revise their opinion of us.

As a young Egyptian student said after the President's speech, "All we want as Muslims is for there to be a partnership. And he was seriously humble. Humility is important for us."

Monday, June 1, 2009

STILL ALICE by Lisa Genova and THE WILDERNESS by Samantha Harvey

This review was first published in Books and Culture online (June 2009) as "Into the Abyss with Alice and Jake: Two novels about Alzheimer's disease"

Early this year, two improbable first novels hit the market. Both feature a protagonist with Alzheimer's disease, and both tell the person's story from his or her point of view alone. As dementia mounts, no omniscient narrator intervenes to explain, correct, or fill in the widening gaps.

Still Alice, by Lisa Genova, a 38-year-old American actress and neuroscientist with a Harvard PhD, enjoyed a good run on the New York Times bestseller list. Alice Howland, 50 years old and a well-known Harvard professor, is troubled by occasional forgetfulness. Is it menopause? A brain tumor? The lapses increase in frequency. She gets lost on her usual jogging route. She blows off a speaking appointment in Chicago. She is diagnosed with early-onset Alzheimer's.

Genova tells Alice's story in familiar hen-lit style, focusing on Alice's relationships, especially with her husband and children, as well as on her sense of self. The story is straightforward and linear, covering three years in Alice's life. Though the point of view is third-person, it is always Alice's, growing more confused as her condition deteriorates. The book is emotionally gripping and a bit romantic: through it all, Alice, though greatly diminished, is still Alice.

By contrast, The Wilderness, by Samantha Harvey, a 34-year-old British woman with degrees in philosophy and creative writing, has received glowing reviews but few American sales. This is probably because Harvey tells Jake Jameson's story through the medium of literary fiction—a genre in which, as its detractors are keen to point out, nothing much happens, a great deal of thinking goes on, chronology is a puzzle rather than an anchor, and at the end of the book, the main character is even more miserable than at its beginning.

Most readers, myself among them, prefer likable characters, a page-turning plot, and manageable conflict that leads to some sort of satisfactory resolution. But Alzheimer's disease isn't like a romance or a mystery or even a fairly realistic piece of hen lit. It is, rather, very much like a literary novel, and Harvey's use of this genre gives her book a feeling of realism that Genova's more conventionally realistic novel can only approximate.

Four people I loved had Alzheimer's disease: my father, my mother, my mother-in-law, and my best friend's mother. I know the grief of a disease that wipes out memory, destroys knowledge, alters personality, stirs up emotions, impairs judgment, removes control of bodily functions, and finally turns its victims into little more than the skin and stuffing of their former selves. I have wondered how this disease, so devastating to the people who observe it, must feel to the person who has it.

Samantha Harvey knows.

Well, she can't really know, any more than anyone can really know what it feels like to be dead. Near-death is not the kind of death that stays dead, and no amount of experience with Alzheimer's patients can put us in their heads. Still, Harvey convincingly sees through Jake's eyes, even though she tells his story in the third person.

Jake, a 65-year-old architect, is driving to his office along familiar roads:
He looks around his car and tries to remember what make it is; he cannot. He opens the window to feel what month it is. It isn't a month. There aren't months. There are just happenings, a lack of signposts … . He pulls up at the side of the road, lifts his glasses, and rubs his eyes. He has been doing this journey to and from work every day for thirty-five years. He pores over the map.
He is about to retire, and none too soon. He has spent all day trying to figure out what to do with the architectural drawing that has been passed to him for approval. He can't recall his secretary's name or what exactly she does. But he is polite and articulate, and he can rise to the occasion. "I am going to spend my retirement seeking beauty," he announces at his going-away party. Instead, he spends it searching for himself.

His confusion would be intolerable were it not for his rich memories, most of them about women: his formidable Jewish mother, Sara; his devout wife, Helen; his beloved daughter, Alice; his childhood friend, Eleanor; the girl in the yellow dress, Joy. Through recalled events, scenes, stories, and conversations we piece together a picture of his life and that of his family.

Jake is a disappointed man. He was once a successful architect, but his modernist buildings fell out of favor. He loved his wife, but she died of a stroke and now he is suspecting she was unfaithful to him. He had two children that he adored, but Henry is in prison after an alcohol-fueled rampage, and Alice is dead.

Or not. The stories change in the telling and retelling, and the reader—like Jake himself—comes to doubt even the bare outline of his life. Themes, images, characters weave in and out. Who climbed the cherry tree, Helen or Alice? Did Alice die young—of an accident, or was it an illness?—or is she still alive, or was she never born at all? What happened to the money under the bed? Who is writing all the letters—the ones from Joy, the ones to Helen, the one from Eleanor? Who ran over the dog?

Is it possible for Jake, or the reader, to know anything for sure?
In his brain are countless cells—countless, but not infinite. To say infinite would be reckless. Inside each cell a little piece of him is packed, and every time a cell dies a piece of him dies. His past is just an electric impulse. Static flashes on a petticoat. Gradually he is being scattered and lost—hundreds of unread messages floating out across the sea.
Unlike Still Alice, The Wilderness is not a typical book-club selection, though I can imagine book-club participants avidly trying to sort out the factual from the invented, the real from the hallucinatory. Such an exercise would certainly elucidate Harvey's amazing art, and it might well lead to a good discussion on the importance of memory to personhood. Some readers would side with Jake's wife, talking about her war-injured father:
That man with only one foot was still my daddy. If he'd had no feet, no hands, no legs, he'd still be my daddy. So we can't be our bodies alone. And if we are not our bodies we must be something else."
"Our brains," he said.
"More than that, Jake.
"Why more than that?"
"His soul shone out through his eyes. I saw his soul."
Others, more pessimistic, would resonate with Jake's anguish:
There were times—there are still—when he would face the darkness of three a.m. and be terrified by the idea of entropy: nature dismantling every human object, and eventually every human being, until there was just an unfettered, cold chaos. Other people had God to protect them from such an outcome, but he had nothing—nothing except himself.
Who, then, is "himself" after his brain succumbs to chaos and all the messages have floated out to sea?
I used to think that a person with Alzheimer's was completely different from the rest of us. "Senile," we said of the old lady who shared the board-and-care home with my grandmother. She was clearly out to lunch—her words made no sense to any of us, and her behavior was bizarre. "I hope I never get like her," said Grandma. (She didn't.)

But when my parents developed Alzheimer's, I came to realize that the disease did not immediately destroy the persons they once were. Flashes of normality sometimes cut through the fog. Reasoning and logic persisted, even in the absence of accurate information. Imagination stepped in and filled in the blanks. My father, who loved to travel, told us of his travels to Israel and India—where he had never gone—which he now remembered happily, and in detail. Emotions continued to register, even after my mother lost the ability to talk.

Still Alice, as the title indicates, takes the popular sanguine view: despite the ravages of Alzheimer's, whatever makes Alice herself remains. Jake shares this view, at least while his disease is still only moderately severe:
When he looks in the mirror he does not see an old man, nor does he see a brain that lacks logic. He sees himself, greatly changed, but undeniably himself, and he is grateful to this self for persisting this long.
Eventually, ineluctably, the man in the mirror becomes unfamiliar. In one of the book's last scenes, Jake recognizes a man in a photograph but does not know he is looking at himself. Is he still Jake?

Harvey captures the mix of understanding and mystery that is Alzheimer's disease and that is also the human condition. She raises thought-provoking questions about memory and personhood and the soul. If you prefer a fast-paced, informative, easy-to-understand novel, read Still Alice first. But when you are ready to plunge into the abyss and experience Alzheimer's first-hand with all its confusion and tears and unanswerable questions, find a quiet place where you can ponder and weep, and read The Wilderness.