CATASTROPHIC CARE: HOW AMERICAN HEALTH CARE KILLED MY FATHER--AND HOW WE CAN FIX IT by David Goldhill

This week the company my husband works for unveiled the health-insurance plans available to us beginning July 1. If we chose the plan closest to our current plan, our premium would nearly double and our office visit co-pays would increase 25-50%.

I am so glad we are going on Medicare in August.

Medicare isn't perfect, by any means. It isn't even cheap. Just the insurance (Medicare medical, Medicare supplement, prescription) is going to cost us more than $500 a month, and that doesn't include the deductible or the prescription co-pays. And that's for this year. Who knows what it will cost 10 years from now?

I was so ready to read a book that would solve America's health-care crisis.

Besides, David Goldhill's title is irresistible: Catastrophic Care: How American Health Care Killed My Father - And How We Can Fix It.

First the bad news. Goldhill, who is president and CEO of the Game Show Network, got interested in health care when his physician father "died from a hospital-borne infection he acquired in the intensive care unit of a well-regarded New York hospital." In his early chapters, he piles up statistics about how truly dreadful our health-care system is. Wherever you are on the political spectrum, you need to read his "eleven strange things we all believe about health care." (Goldhill is a Democrat who thinks Obamacare will not work.)

After the bad news, Goldhill gives all kinds of wonky explanations about why our approach to health care doesn't work. This section will probably appeal most to free-market-loving Republicans. Despite being a lefty who distrusts the market, I found it very helpful.

Finally what we're all waiting for: Goldhill's solution. My daughter Molly should have written this book: she recommended an almost identical solution to me a couple of months ago when we had a long discussion about health care. (Molly and I do not agree about a lot of political issues, but we have respectful and helpful discussions. We don't see the point in today's political polarization: differing opinions can increase clarity and come up with better solutions than either side could do on its own.)

In a nutshell: Insurance should be reserved for catastrophes - unforeseen big-ticket expenses like major surgery or cancer treatment. Anticipated health-care expenses should come from health-care savings accounts. And there needs to be some kind of safety net.

What Republicans will like: Consumers need to have control of their own health-care dollars. There's no reason to siphon off 20% or more to insurance companies. Besides, when we pay for things ourselves, we tend to be a lot more careful about what we buy. We comparison shop. We avoid unnecessary expenses. And to get our money, providers compete with one another to provide good care at low prices.

What Democrats will like: Everyone must have a health-care savings account - no exceptions. Most people will build up a good-sized balance when they are young. As they age, they will start to draw from it. People whose emergencies cost more than their savings can borrow to cover the additional expenses. At a predetermined level, they need borrow no more: the government will make up the difference. Nobody will be left without health care: the government will provide the safety net (though not by running the program).

What everyone except certain industries and lobbyists will like: Prices must be completely transparent and equal for everybody. The market isn't free if people don't have the information they need to make smart decisions.

What nobody will like: There will be limits. Just because something sounds good in the TV ads doesn't mean everyone should have access to it. Some treatments (especially those that have little proven worth in lengthening lives) will not be available. Some will be too expensive and most people will choose to forgo them. Some will be available, but only to people who have lots of money to spend.

My favorite health-care book is still T.R Reid's The Healing of America. (See my review on this blog or in Christian Century, if you subscribe.) The fact is that a lot of other developed nations have much better health-care programs than America's. They get better results. People live longer. And they do this for about half our cost. Before we do anything else about health care, we need to lay aside our prejudices and study what these other countries are doing.

But if Reid should be required reading for legislators, Goldhill should be too. As Goldhill points out, America's politicians are unlikely to accept a lot of features that make perfect sense in other countries. We need a program that fits with our own weird beliefs and behaviors--one that combines vigorous free-market competition with a safety net for everybody.

Someday we may actually come up with such a program. But probably not until we understand, as Goldhill says, that "at some point, we will have to decide whether our attachment to the idea of helping people is more important than actually helping them--a decision that will require a rethinking of our assumptions."

MIDNIGHT AT MARBLE ARCH by Anne Perry

Some 20 years ago a friend lent me a stack of Anne Perry novels--all in the Charlotte and Thomas Pitt series, as I recall--which I eagerly devoured.

At the time I had no idea that Perry at age 15 conspired with a friend to murder the friend's mother, or that she at age 30 became a Mormon because of her commitment to morality. Until today I didn't know that since 1979 she has published more than 60 novels and novellas--almost two a year. No wonder, as her biographer points out, Perry's books deal with the themes of "miscarriages of justice, family secrets exposed, punishment, redemption and forgiveness."

Her newest book, Midnight at Marble Arch (number 28 in the Charlotte and Thomas Pitt series), is especially strong in the first two themes. The year is 1896. Thomas Pitt is now in charge of Special Branch, similar to the U.S. Department of Homeland Security. No longer a policeman, he does not normally get involved in assault cases, even when he learns that a prominent businessman's wife has died after being brutally raped.

But when it appears that the 16-year-old daughter of the Portuguese ambassador has been raped by a sociopathic but exceedingly rich young man, Pitt decides to act. His reason may be to satisfy his wife's sense of justice, but his excuse is that Britain's international relations will be endangered if foreign diplomats fear to bring their families to London--and whoever the rapist is, he is likely to strike again.

Meanwhile, the widowed businessman has asked Pitt's former superior, Lord Victor Narraway, to help him find the man who raped his wife. Narraway eagerly takes the case, partly to make himself feel useful in retirement, and partly because he is very fond of Charlotte Pitt's formidable great-aunt-by-marriage, Lady Vespasia Cumming-Gould.

And then a couple more women are raped, and Pitt and Narraway find themselves working together once again.

Perry adeptly portrays late 19th-century society with its fancy dress, incessant parties, and suffocating superficiality. She chillingly shows how most Victorians regarded rape, how it ruined women, and why it was rarely prosecuted. Somehow, however, the four sleuths at the center of the story--Thomas and Charlotte, Narramore and Vespasia--have escaped the attitudes of most of their contemporaries, which somewhat strains the story's credibility. But as long as you can handle 21st-century consciences in a few 19th-century people, you will likely enjoy this addition to the Charlotte and Thomas Pitt collection.

In fact, I think Midnight at Marble Arch might make a good movie.

Perry's plotting is full of surprises, and yet not too complex to follow easily. In a film, action and conversation would replace the book's incessant and sometimes tiresome inner questioning ("How many men feared for their sons?... What would Pitt do if Daniel ... should be wrongly accused of such a violent and repulsive crime?... How would Pitt know what Daniel thought of women who perhaps teased him, provoked him, with little or no idea of what tigers they were awakening?... How would he prevent Daniel from becoming a young man who treated women as something he had the right to use, to hurt, even to destroy? Where did such beliefs begin?... How would he ever make certain his son could lose an competition with the same grace as when he won?... Would it be Pitt's fault if Daniel grew up arrogant, brutal?"--and all of these questions come from just one page). With its faster pace and--minus the internal monologues--reduced opportunity for anachronism, the film might be even better than the book.

I haven't figured out who should play three of the four good guys, but Lady Vespasia Cumming-Gould, with her elegance, steel-trap mind, and late-life sexual allure, is Helen Mirren.

THE MOONLIGHT SONATA AT THE MAYO CLINIC by Nora Gallagher

Ten years ago Nora Gallagher wrote Practicing Resurrection, a memoir involving her brother's death, her Episcopal parish's response to their recently uncloseted gay priest, and her own process of deciding whether or not to prepare for priesthood. Publishers Weekly's anonymous reviewer loved it: "With a poet's ear for language and a novelist's eye for essential detail," she wrote, "Gallagher offers a compelling story of her journey toward 'a wholeness bought at the cost of suffering.'"

OK, I confess: I wrote that review. And I also loved Gallagher's earlier memoir, Things Seen and Unseen (1998), about her brother's cancer and her own coming to faith, all taking place within the framework of the church calendar with its major feasts and fasts.

So I was twice happy to learn from Gallagher's website that "Moonlight Sonata at the Mayo Clinic is part three of a quartet on modern faith as it is lived out"--once because this new memoir is about her journey into what she calls the Land of the Sick, or Oz (a land I know better than I'd like to), and twice because if this is part of a quartet, there's yet another book coming.

Let me say right up front that you should read Gallagher's other two memoirs first. They reach out to a broader audience. They are more finely crafted. They will allow you to befriend Nora before going with her on this darker journey where both physical and spiritual health are challenged.

The story begins in November 2009 when the vision in Gallagher's right eye goes blurry. She hasn't been feeling well anyway--headaches, queasiness, fatigue--so she schedules an appointment with her doctor. He doesn't like what he sees, and for the next two years Gallagher goes from specialist to specialist trying to find out, and hopefully to fix, whatever is wrong.

There's an element of medical mystery about her story, and I'm not going to spoil it by telling you the eventual diagnosis. Suffice it to say that it will not raise your opinion of American medicine in general: "Doctors were often baffled; the system of specialists who did not follow up on patients made it worse." The Mayo Clinic comes up smelling like roses, however. (Personal note: My experience at Cleveland Clinic, where I had open-heart surgery in 2011, was similar to Gallagher's at Mayo. Both have stellar reputations for the quality of their health care, and both have found ways to keep costs below the national average.)

Gallagher is a spiritual writer, and a person facing a major health crisis tends to have major spiritual concerns. I'm not going to spoil the account of her spiritual journey by telling you how her illness affected her faith, either. I'll only say that she and I--two women of about the same age, both of us having spent years in the Episcopal Church, both of us living with scary health conditions--look for peace in somewhat different places.

You may not identify with this memoir if you are young, or if you have never faced a life-threatening illness, or if you are a conservative evangelical. You'll probably want to read it if you prefer questions to answers, if you've faced serious illness or are caring for people who do, or if you work in health care and wonder how it feels to be the one on the examining table.

I'll finish by quoting a few paragraphs, one of Gallagher's many asides, that I particularly enjoyed:

I once interviewed Jews who had recently emigrated from Russia in one of the openings in the Cold War in the 1980s. Many of them had survived the siege of Leningrad. They were living in a retirement home in Denver. One of them took me aside after I had been there for a few days and said, "Tell me, Nora. Is everyone in America always fine? I ask someone how they were doing and they reply, always, 'Fine.'"
     I explained to her that this was a commonplace; a custom, it meant nothing. Relief showed all over her face.
     "Ah," she said. "That's good. Because I am rarely fine." (Later, whenever they saw me, they would chorus: "How are you? We are fine!" and then laugh uproariously.)
     I missed them, I thought. These were people who understood not fine.

Money: The God of This World

This week Pope Francis spoke out against the cult of money. Here is how Catholic News Service's Carol Glatz summarized his remarks:

Pope Francis called for global financial reform that respects human dignity, helps the poor, promotes the common good and allows states to regulate markets.

"Money has to serve, not to rule," he said in his strongest remarks yet as pope concerning the world's economic and financial crises.

A major reason behind the increase in social and economic woes worldwide "is in our relationship with money and our acceptance of its power over ourselves and our society," he told a group of diplomats May 16.

"We have created new idols" where the "golden calf of old has found a new and heartless image in the cult of money and the dictatorship of an economy which is faceless and lacking any truly humane goal."

His words reminded me of one of the most significant books I've ever read, Protestant French philosopher Jacques Ellul's Money and Power.

First published nearly 60 years ago as L'Homme et l'argent ("Man and Money"), new French-language editions appeared in 1979 and 2007. I translated the English-language edition in 1984 and have been grateful ever since for the opportunity to immerse myself in this paradigm-bending book.

Money, Ellul argued, is not morally neutral. It is "Mammon, a demigod, a demon, an idol, a power from which we need liberation" (I'm quoting from David Neff's review of Money and Power in the February 15, 1985, issue of Christianity Today--and yes, he may have been biased, but damn, his review was good).

The problem isn't money, we say. The problem is that we don't have enough. Or that somebody else has too much.

No, says Ellul. Money is not neutral. "Jesus personifies money and considers it sort of a god. He does not get this idea from his cultural milieu. … This personification of money, this affirmation that we are talking about something that claims divinity . … reveals something exceptional about money, for Jesus did not usually use deifications and personifications" (p. 75).

Ellul explains that in Matthew 6:24 and Luke 16:13 Jesus shows that money is a power, a law unto itself that acts in the material world but with a spiritual orientation. In the Bible, power is never neutral. And it is often personal. Just as Scripture often portrays death as a personal force, so it also portrays money.

In the 60 years since Ellul wrote Money and Power (and even more in the 30 years since I translated it), the love of Money has taken root throughout the world in ways even Ellul might never have imagined. We fight wars to keep it, and to gain more of it. We damage the earth, deny social services to the poor, and pay ever smaller wages for ever longer hours, because to do otherwise would be bad for business. We don't enforce safety regulations or we outsource production to places with no regulations, so we can make higher profits on cheaper goods. And we have developed a theology of money in which the "free market" is the giver of every good and perfect gift - never mind the evidence.

Perhaps this is nothing new. It's been 2000 years since Jesus identified money with Mammon. But whether our love of Money is worse than ever before in the history of the world, or whether it is just business as usual, Pope Francis joins Jacques Ellul in reminding us that Money is a powerful false god.

If you like to get your reminders straight from Scripture, read Revelation 18, a gorgeously dark and dreadful poem about the fall of Babylon, surely Mammon's capital city, for she has deceived "all nations." As Babylon falls, so do the political leaders who "committed fornication with her" and the business tycoons who "have grown rich from the power of her luxury" and the multinational merchants whose ships "grew rich by her wealth."

The good news in Scripture is not that our stock portfolio has doubled or that our taxes have been cut or even that our nation's GDP is in recovery. The good news comes through an unmarried pregnant teenager: The Mighty One

has brought down the powerful from their thrones,

and lifted up the lowly;

he has filled the hungry with good things,

and sent the rich away empty.

                                                  Luke 2:52-53

THE GOLDEN EGG by Donna Leon

If you're already a Donna Leon fan, all I need to tell you is that the 22nd Commissario Guido Brunetti mystery was published March 26.

If you're not already addicted to the Brunetti books, you can check out a complete, chronological, annotated list of each book in the series here.

Or you can read a perceptive short review of The Golden Egg in the New York Times's April 5 crime column by Marilyn Stasio. In fact, even if you are a fan, I recommend this review. Stasio highlights the important theme running through this book:

“If the Brunettis had a religion,” Leon tells us, “it was language.” And so this thoughtful policeman is also led to brood over the debasement of language by the politicians and bureaucrats who cynically confuse, misdirect and misinform the public.

In The Golden Egg, language

• is the basis for hilarious dinner-table games at the Brunetti household.
• obfuscates the police bribes Brunetti is asked to investigate.
• is oddly absent from everything connected with the life of the slain dry-cleaner assistant. 
• becomes an important tool in Brunetti's investigations (should he speak Italian or Veneziano? Will his Neopolitan assistant be able to relate, since she doesn't speak the local dialect?).

Language is also the subject of Brunetti's extended meditation in the closing chapter. Here's a sample:

He drank a glass of wine, left the second one unfinished, drunk with the words that crossed the table, their different meanings, the fact that they indicated time: future and past; that they indicated whether something had been done or was still to do; that they expressed people's feelings: anger was not a blow, regret was not tears. At one point, Paola expressed a wish and used the subjunctive, and Brunetti felt himself close to tears at the beauty of the intellectual complexity of it: she could speak about what was not, could invent an alternative reality.

Language is probably why so many of my friends - many of whom are writers, editors, or publishers, and most of whom love words - are hooked on Leon's mysteries. Language, and food. Brunetti's wife, Paola Falier, seems to have few responsibilities at the university where she teaches English literature; she is nearly always home in time to prepare magnificent meals. Fritto misto. Baked finocchio with rosemary. A salad of carpaccio of red beet, ruccola, and parmigiano. Involtini of chicken breast. Cake with fresh black currants and whipped cream. I can't imagine why Brunetti's Cookbook, aka A Taste of Venice, is no longer in print. Maybe it should have been called, more accurately, Paola Falier's Cookbook.

To be sure, readers of detective fiction don't always appreciate the Guido Brunetti series. Some of the books are police procedurals, while others, like this one, focus almost entirely on Brunetti's deductions. There may be violence, but it is usually offstage. It may take awhile to get to the murder - if indeed a murder has occurred. It's often not too hard to figure out whodunnit. Brunetti's wife and children are as important as his coworkers at the questura. And Leon keeps tossing in Italian words, as I just did, without translating them.

Those are all reasons that I love the series, but I don't want to take you there on false pretenses. If the subjunctive, used correctly over a bowl of risotto, never brings you close to tears, perhaps you should read a different series instead.

P.S. If you hate spoilers, don't pay any attention to this book's title.

THE TOOTH TATTOO by Peter Lovesey

It seemed appropriate last week, when my dentist was replacing five fillings, to show him the book I was reading: The Tooth Tattoo by British writer Peter Lovesey (published April 30).

Like Lovesey's Detective Chief Superintendent Peter Diamond, I had never heard of tooth tattoos, but my dentist told me he had done some. He then hauled out a handful of photos to show me the possibilities. My favorite showed a Canada goose on the upper molar and a bullet on the corresponding lower molar.

In Lovesey's latest novel - the thirteenth in the Peter Diamond series - an almost unidentifiable corpse is discovered in a canal. The one distinguishing feature, so faint that it was missed by the first medical examiner, is a tattoo on one of the corpse's teeth. It appears to be a quaver, or an eighth note. Diamond and his team spring into action.

But all is not well at the Bath CID. Diamond's coworkers fear that, due to the economic crisis and government cutbacks, their jobs may be on the line. Diamond's churlish behavior, even more extreme than usual, seems to confirm their fears: they have no way of knowing that he is in the midst of a crisis of his own.

When I read the first 12 Peter Diamond books last year (for a review in Books and Culture magazine, "A Rough Diamond"), I grew increasingly enamored of the burly Bath detective's exploits. The Tooth Tattoo, I think, is one of Lovesey's best. Like the others, it's a procedural puzzle, but here Lovesey pays more than usual attention to Diamond's personal life. In addition, much of the novel focuses on the relationships among the members of a world famous string quartet. (If you like music-themed mysteries too, see my reviews of Morag Joss's Sara Selkirk series and Donna Leon's The Jewels of Paradise.)

You don't need to have read the rest of the series to enjoy this book. After you've read it, though, you may want to go back and check out the others. Here's a list of all the titles.