Friday, December 16, 2011


I had this idea of combining my two great enthusiasmsone is for [Jane Austen's] novels, and the other is for writing crime fiction, detective stories—and try and do them together, and I enjoyed it immensely. I think she’d probably forgive me, because I have kept very closely to her characters, and I think I've made a sort of picture of life at Pemberley which she would have approved of…

Six years have gone by since the end of Pride and Prejudice when three of the five Bennet girls got married: Elizabeth to the stubborn Mr Darcy, Jane to the affable Mr Bingley, and Lydia to the odious Lieutenant Wickham. Now even Mary, the studious sister with limited people skills, is happily settled as a vicar's wife, and Kitty lives contentedly at home with the elder Bennets. What more could Jane Austen possibly do with this group? No one is desperately looking for a wealthy spouse or falling in love with an unsuitable person; thus no one can gossip, compete, despair, fall from grace, or wildly rejoice.

P.D. James has come to Derbyshire at just the right time.

Baroness James, as I'm sure you know, is one of the best crime writers alive. Her detective fiction bursts out of the genre: most of her books are well-crafted novels with fully developed characters and intricate plots. Her usual detective, Adam Dalgleish, is not only a brilliant investigator but also a poet and a heartthrob. She of all people would know that beneath the apparently smooth surface of life at Pemberley,  disaster lurks.

I'm not going to tell you about the murder or the suspicions or the trial, and I'm certainly not going to drop hints about the surprising dénouement. I'll just point out that Death Comes to Pemberley is a fun read, though not as much fun as Pride and Prejudice or, for that matter, the Dalgleish books (but then what is?). It begins in full Jane Austen mode—
It was generally agreed by the female residents of Meryton that Mr. and Mrs. Bennet of Longbourn had been fortunate in the disposal in marriage of four of their five daughters
—and continues with the occasional hat tip to Charlotte Brontë:
From time to time the wind howled in the chimney, the fire hissed and spluttered like a living thing and occasionally a burning log would break free, bursting into spectacular flames and casting a momentary red flush over the faces of the diners so that they looked as if they were in a fever.
Much of the story, however, concerns neither ladies' relationships nor nature's staging but rather the public lives and utterances of various men: Messrs Darcy, Bingley, Alveston, and Wickham; Colonel Fitzwilliam and Captain Denny; Sir Selwyn Hardcastle, Mr. Justice Moberley, Mr. Mickledore, Mr. Cartwright ... The comedy of manners quickly turns into a courtroom drama, and Elizabeth quietly leaves the stage.

In her author's note James says, "I owe an apology to the shade of Jane Austen for involving her beloved Elizabeth in the trauma of a murder investigation." If an apology is needed, it is for quite the opposite reason: Elizabeth should have been more present, more involved, more significant to the story. Fortunately she returns to prominence in the final chapters, not—alas—with her original maidenly wit and cheek, but sweetly affirming her husband as he drones on and on, waiting for just the right moment to spring a surprise on him.

And yes, everyone lives happily ever after, which shouldn't be a spoiler. What, after all, would you expect when justice is served and romance flourishes?

P.S. If Jane Austen would lend some of her superfluous commas to P.D. James, both authors would be easier to read.

Saturday, December 3, 2011

Yesterday in U.S. health care policy - a step in the right direction

Yesterday a provision in the Affordable Care Act went into effect: health insurers' profits must now be limited.

In response, Rick Ungar, a journalist specializing in health-care policy, posted a feisty column on Forbes's Policy Page. Provocatively titled "The Bomb Buried in Obamacare Explodes Today - Hallelujah!," the article looks at "the provision of the law, called the medical loss ratio, that requires health insurance companies to spend 80% of the consumers’ premium dollars they collect—85% for large group insurers—on actual medical care rather than overhead, marketing expenses and profit."

Knowing how much Steve Forbes hates the Affordable Care Act (see, for example, my November 10 post), I started reading Ungar's post with trepidation. Was his "Hallelujah" sarcastic? Was he wincing when he wrote that the medical loss ratio provision would lead to "the death of large parts of the private, for-profit health insurance industry"?

Evidently not. Insurance companies can't possibly make a profit once this provision is enforced, Ungar writes, and their parent companies are "fleeing into other types of investments. They know what we should all know – we are now on an inescapable path to a single-payer system for most Americans and thank goodness for it." Ungar thinks the results will be good for the rich, who will still be able to buy expensive insurance for luxurious care; and good for the poor, who will finally be able to "get their families the medical care that they need." His Hallelujah is genuine.

I completely support the medical loss ratio provision, but I believe Ungar should have mentioned that the poor are unlikely to be able to get the medical care they need unless there is a federally enforced mechanism for limiting costs. As far as I know, there is no such mechanism in the Affordable Care Act - the providers' lobbies saw to that. So federal funds will continue to subsidize providers' profits (as long as the providers aren't insurance companies), and prices will continue to rise way beyond the means of poor and middle-income families.

I also believe he is mistaken when he suggests that "the death of large parts of the private, for-profit health insurance industry" will lead to the advent of a single-payer system. As T.R. Reid points out in his excellent 2009 book, The Healing of America, "the United States is the only developed country that relies on profit-making health insurance companies to pay for essential and elective care." Those other OECD countries, however, do not all have single-payer systems. Britain, Canada, Sweden, Denmark, Norway, and Spain do. France, Germany, Japan, Belgium, the Netherlands, and Switzerland do not. Like us, they finance health care through competing private (but not-for-profit) insurers. There is no reason we could not do the same.

The United States has taken an important step forward by limiting insurers' profits. We now need to do something about profiteering in other parts of the gargantuan health-care industry. If we truly want to improve our health-care outcomes, provide health care for all Americans, and still spend less money per capita on health care, we need to take lessons from other developed nations, all of whom are ahead of us in all categories (see, for example, this 2010 article on a Commonwealth Fund study, or check out the facts and figures yourself at the World Health Organization's detailed database search page).

Or we can continue down our present path of allowing lobbyists to finance elections and line the pockets of our elected representatives in hopes of reversing or indefinitely deferring any meaningful health-care reform.

Friday, December 2, 2011

NEVER SAY DIE by Susan Jacoby

"Susan Jacoby has long made it her project to uncover ill-formed, cynical 'junk thought' and administer a cold dose of reason and logic against it," wrote Ted C. Fishman in the New York Times ("It Gets Worse," 2/25/11). "But Jacoby is no Mr. Spock. Her rationalism is delivered in an angry barrage peppered with enthusiastically snide asides."

"In her book, Ms. Jacoby serves as a reality instructor. Bad news flows from her as profanity from a rap group," wrote Joseph Epstein in the Wall Street Journal ("Nobody Gets Out of Here Alive," 1/29/11). "Imagine a modern-day Cassandra but one ticked to the max."

OK, Never Say Die isn't for everybody. Sheeesh, if neither the NYT nor the WSJ liked it, perhaps it isn't for anybody. But don't quit reading yet (I promise to keep this short). Though I agree with Messrs Fishman (aged 52 at time of writing) and Epstein (aged 74) about Ms. Jacoby's style (she is now 66), I still think she offers some insights that we neglect at our great peril (I'm 63):

1. When AARP magazine and self-help books dispense relentlessly upbeat advice and unfailingly inspirational stories, they focus almost entirely on the "young old" - people in good health in their 60s and 70s. Rarely do they look at the "old old" - people in failing health and/or over age 85, when fully 50% have Alzheimer's disease. Boomers who believe that the optimistic sources are giving an accurate picture of old age are in for a big shock.

2. To the extent that we live in a dream world in which old folks are happy and healthy until they suddenly, painlessly drop dead (while parachuting out of an airplane, perhaps, or in the midst of wild sex), we will not as a society provide for the real-life needs of real-life old people and their exhausted caregivers.

3. If we want to continue providing adequate health care for seniors, we're going to have to provide adequate health care for everyone else too. People will not vote to pay Grandma's medical bills if they can't pay their own.

Check out Susan Jacoby's short Newsweek column, "The Myth of Aging Gracefully" (1/30/11), for a preview of her position. Here's a sample paragraph from chapter 7 in Never Say Die, "Greedy Geezers and Other Half-truths":
The myth of young old age, which simultaneously overestimates the earning potential and underestimates the needs of the dependent old old, also poses a major impediment to any serious, reality-based discussion of social justice for both old and young. Healthy old old age is costly, and unhealthy old old age is even costlier. If, as a society, we see longevity as a good thing, then we're going to have to pay for it. But all we are hearing from public officials, now that the brief period when conservatives could use the health care debate to prey on the fears of the elderly has passed, is how to pay less to support longer lives. If there really were such a thing as a radically new brand of old age in which everyone can take care of himself or herself, there would be no reason to worry. Society would be off the hook. The boomers - healthy beneficiaries of this wonderful new old age - would surely be able to tote that barge and lift that bale until the very end.