How soon can we come up with a health-care policy that makes sense?

The U.S. Supreme Court

Maybe the Affordable Care Act is constitutional and maybe it's not. If it turns out to be constitutional, maybe it's good legislation and maybe it's not. In any case, it's looking increasingly likely that the Supreme Court, come June, will strike down at least the requirement that everyone buy health insurance. And if the mandate goes, two other requirements will most likely go with it: Once again insurers will be able to reject or refuse to renew applicants. And once again Americans with pre-existing conditions will be uninsurable.*

Let me tell you four short stories about friends of mine. These are true stories, not hypothetical examples. I have changed nothing but the names of the people involved. I am not arguing on behalf of the constitutionality of the Affordable Care Act. I'm just saying that all of these people had serious problems before it was passed, and some of them are doing much better now because of it.

1. John, a pastor, was married to Jane, who worked in publishing. They were well insured - until John came down with a debilitating disease. They would have to rely on Jane's insurance, even though her job was over an hour's drive from their home and John's health-care provider. Changing jobs was out of the question; no new insurer would consider adding John to their policy. So for some 10 years, Jane worked full time, commuted over two hours a day, and worked evenings and weekends as her husband's primary caregiver. When he died, she quit her job and applied for insurance on her own. Every insurer turned her down.

2. Bill and Betty have a child with a learning disorder. When he finished high school, he went to work, but the only jobs he qualifies for are low-paying, without benefits. In addition, the nature of his disorder makes it hard for him to keep a job. He has persisted, however, and he is gradually learning how to be employable. Thanks to the Affordable Care Act, his parents' insurance pays for the medications that allow him to work. They wonder what he will do if his insurance is taken away.

3. Dan and DeAnn have a similar story. Their daughter, in her early 20s, had a life-threatening physical problem that was correctable by expensive surgery. Until it was corrected, she was unable to work and earn her own insurance. Before the Affordable Care Act, she would have been too old to benefit from her parents' insurance, but once the act went into effect, they were able to put her on their policy. This story has a happy ending: she has had the surgery and is doing well.

4. Martin was a truck driver and Melissa was a secretary until a series of illnesses - heart disease, strokes,  ulcers, dementia - forced Martin to quit work and go on disability. Fortunately for him, he is a veteran with excellent health benefits at a nearby veterans' hospital. Melissa took over the full-time home care he now requires. Unfortunately for Melissa, she had no insurance and was too young for Medicare. A strong believer in self-sufficiency, she tried to ignore her arthritis and diabetes. After ten years of giving her husband excellent care, she finally turned 65 and was able to sign up for Medicare.

My stories are all about hard-working, responsible people who would eagerly buy health insurance if they possibly could. Before the Affordable Care Act, sadly, they could not. People on the left and on the right agree - the Act is flawed. But if it is thrown out, what will happen to people like my friends? What will we put in its place? And how soon can we come up with a health-care policy that makes sense?
___________________________

*If the mandate to buy insurance is struck down but these two requirements are allowed to stand, you can be sure that insurance premiums will skyrocket and the number of uninsured Americans will reach new highs.

Grammar sins: a case study

From Nicolas Poussin,
 Le Christ et la femme adultère

You know the story. A woman was caught in the act. The religious leaders grabbed her and brought her to Jesus. Are you a biblical literalist? they asked. Because if you are, shouldn't we stone her? What would Moses do?

Quick, now. What did Jesus say?

About.com's French Language website quotes his words thus: "Let he who is without sin cast the first stone."

My inner grammarian wincing, I dashed off an email to the website's author: "That should be 'Let him who is without sin ... ' (i.e., 'Let him ... cast the first stone'; I don't think you'd be tempted to write 'Let he ... cast the first stone').

Of course she knew the difference - she herself is a grammarian. But, she said, she was just quoting the Bible, which says "Let he ...."

Actually it doesn't, at least not in the King James Version, the Revised Standard Version, the New International Version, the New American Bible, the Common English Bible, the Douay-Reims Version, or presumably any other version that uses copyeditors. Lacking a Bible at hand, she explained, she had found the verse online. Just Google it, she told me.

So I did. I am pleased to report that when I compared "Let him who is without sin" to "Let he who is without sin," correct grammar won, 3.8 million to 1.3 million.

I also learned that "Let He Who Is Without Sin" is the name of a Star Trek episode.

It's a good thing modern English tends to use only three pronoun cases (such as he, him, his). We'd never learn to speak Hungarian - it has at least 18 cases.

But hey, if you use the wrong case, I won't stone you. I'm not without sin: I refuse to say "It is I."

THE LAST DETECTIVE ... and others by Peter Lovesey

Several weeks ago one of my favorite magazine editors asked if I'd be interested in reviewing Peter Lovesey's forthcoming novel, Cop to Corpse. Yes, I said, provided I could do so from a position of ignorance--I had read none of the 11 other books in the series. OK, said the editor, but bear in mind that your readers will want to know "whether you felt motivated, by the time you’d finished this book, to go back to number 1 in the series."

Dear Reader, I'm having a hard time finding time to write the review. Not only did I feel motivated to go back to number 1, I've now also read numbers 2, 3, 4, 5, 6, and 8; number 9 is on my nightstand; and numbers 7, 10, and 11 are on hold at the library.

If you haven't yet met Detective Superintendent Peter Diamond of the Avon and Somerset CID, you have a lot to look forward to. Overweight ("burly," he'd rather phrase it), abrasive, sexist, impatient with standard procedures, he does not play well with others. But he is not a climber, is willing to admit his mistakes, and doggedly pursues the truth at whatever cost. Sort of like Michael Connelly's Harry Bosch, but not as noir.

Not noir at all, actually. These books are about 3/4 police procedural, 1/4 comic novel. For instance, here's how Lovesey introduces his famous sleuth in book 1, The Last Detective:

In the Bristol city mortuary a body lay on a steel trolley. In profile the swell of the stomach suggested nothing less than a mountainous landscape. Or to an imaginative eye it might have been evocative of a dinosaur lurking in a primeval swamp, except that a brown trilby hat of the sort seen in 1940s films rested on the hump. The body was clothed in a double-breasted suit much creased at the points of stress, gray in color, with a broad check design--well known in the Avon & Somerset Police as the working attire of Detective Superintendent Peter Diamond. His silver-fringed bald head was propped on a rubber sheet he had found folded on a shelf. He was breathing evenly.

I'll have more to say about the detective superintendent when I write the magazine review. Meanwhile, here's a chronological list of the dozen books in this series to date. You can begin with any of them, but book 1 is not a bad place to start.

Bath, U.K., where much of the action takes place

The Last Detective, 1991
Diamond Solitaire, 1992
The Summons, 1995
Bloodhounds, 1996
Upon a Dark Night, 1997
The Vault, 1999
Diamond Dust, 2002
The House Sitter, 2003
The Secret Hangman, 2007
Skeleton Hill, 2009
Stagestruck, 2011
Cop to Corpse, June 2012

Apostrophes are easy: a three-minute lesson

You wouldn't know it from reading blog comments or grocery store signs, but you know what? Using apostrophes correctly is really, really easy. Here's a three-minute lesson that will turn you into an apostrophe expert for life.

Rule 1. Never use an apostrophe to make a word plural. Never! No exceptions. Not even if the word ends in a vowel. The plural of apostrophe is apostrophes. The plural of 1920 is 1920s. The plural of LCD is LCDs. The plural of do is dos. Really.
   Corollary: Do use an apostrophe to make a single letter of the alphabet plural. Example: There are two p's, four i's, and four s's in Mississippi.
  No to words, yes to letters.

Rule 2. Use an apostrophe to replace the missing letter(s) in contractions. Most of us don't have too much trouble with this one. We know how to spell words like I'll, he'd, can't, shouldn't, it's (meaning it is).
   Put Rule 1 with Rule 2, and you become one of the few people in the United States who know how to spell dos and don'ts.

Rule 3. Use an apostrophe to make a noun possessive. Put it immediately after the noun that tells who is doing the possessing. (If you're not sure, just turn the phrase around and you'll instantly see where the apostrophe goes.) Examples:

• the boy's dog = the dog that belongs to the boy
• the boys' dog = the dog that belongs to the boys
• the Smiths' house = the house that belongs to the Smiths
• the smith's house = the house that belongs to the smith (would he be a blacksmith, perhaps?)
• the woman's room = the room belonging to the woman
• the women's room = the room intended for women (since the word womens doesn't exist, there is no reason to put the apostrophe anywhere else)
• the newspaper's reputation = the reputation of the newspaper
• the newspapers' reputation = the reputation of the newspapers

   Corollary: Never use an apostrophe to make a pronoun possessive. Not even if the pronoun is it. Examples:

• his dog = the dog that belongs to him
• their house = the house that belongs to them
• her room = the room that belongs to her
• its reputation = the reputation that belongs to it

OK, you're an apostrophe expert now. How hard was that?

________________________________

If you want to debate the fine points, you can always discuss what to do with words that end in s or z. Is it Jesus' name or Jesus's name? Thomas' car or Thomas's car? Style books differ. But notice that the apostrophe still follows Rule 3 above: it still comes immediately after the noun that describes who owns the name (Jesus) or the car (Thomas).

THE LEFTOVERS by Tom Perrotta

The first time she'd heard about the Rapture, she was a freshman in college, taking a class called Intro to World Religions. The phenomenon the professor described seemed like a joke to her, hordes of Christians floating out of their clothes, rising up through the roofs of their houses and cars to meet Jesus in the sky, everyone else standing around with their mouths hanging open, wondering where all the good people had gone... It felt like religious kitsch, as tacky as a black velvet painting, the kind of fantasy that appealed to people who ate too much fried food, spanked their kids, and had no problem with the theory that their loving God invented AIDS to punish the gays.

--from the Prologue to The Leftovers

And then, without warning, millions of people simultaneously disappeared, not just from Mapleton but from the whole world. Was it the Rapture? A lot of folks thought so, though Christians disagreed since so many of the vanished "hadn't accepted Jesus Christ as their personal savior." Whatever it was, the mass exodus left the remaining people with a whole new set of problems and a myriad of unhelpful ways of solving them.

In The Leftovers, Tom Perrotta - author of Little Children and The Abstinence Teacher, among others - goes way beyond the mildly comic suburban realism of his previous novels. In this comic dystopian novel (if such a genre is possible) he weaves together stories about Laurie, who joins a bizarre cult called the Guilty Remnant; her son Tom, who drops out of college to follow a guru who calls himself Holy Wayne; Aimee and Jill, whose attempts to combine high school with sex and drugs don't work out so well; Christine and Meg, sadly unhinged young women you just want to protect; Kevin, the stodgy mayor who keeps putting one foot in front of the other; and Nora - well, I'm not going to say anything about Nora, because she becomes especially interesting at the book's very end, and I don't want to be a spoiler.

I enjoy reading Perrotta because of the way he uses language. I appreciate the comic touches, continually giving hope that something good may come out of the tragic event and its aftermath. And maybe it does, depending on how you interpret the last couple of pages. Or maybe it doesn't.

I suspect that if Perrotta wrote a sequel, it would not be cheering. And that's why I'm not going to add to the praise this book has already gotten. It's a New York Times Notable Book, a Washington Post Notable Fiction Book, a USA Today "10 Books We Loved Reading in 2011," and one of NPR’s 10 Best Novels of 2011, and you might like it too.

For me, however, brilliant writing and wry observations aren't enough. I confess: I enjoy well-written genre fiction more than literary fiction (I loved Dominique Browning's delightful New York Times essay, "Learning to Love Airport Lit"). I like fiction with a plot that goes somewhere and characters who grow. I want eventual resolution or redemption or illumination - or comedy that is more than a thin veneer over massive tragedy. The Leftovers held my attention from start to finish, but in the end, it left me empty.

And perhaps that's exactly what Tom Perrotta meant it to do. It's not easy being a leftover.

HEART 411 by Marc Gillinov and Steven Nissen

Many of our colleagues claim that there are two types of people in the world: people who have coronary heart disease and people who are going to get it.... Our goal is to create two new classifications of people: those who have been successfully treated for coronary heart disease, and those who have avoided it altogether. 

--Marc Gillinov and Steven Nissen in Heart 411 

I grabbed Heart 411 just as soon as I heard of it (it was published January 31). Less than six months ago, I had open heart surgery at Cleveland Clinic, America's top-ranked heart hospital, where Dr. Gillinov is a cardiac surgeon and Dr. Nissen is chair of the department of cardiovascular medicine. I'm doing well, thank you, but I still have lots of questions. I figured these doctors would be able to answer them.

It's a wonderful book, though as it turns out, Gillinov and Nissen didn't really write it just for me. They wrote it for people who have heart disease and don't know it (but could easily find out), and for people who are very likely to develop heart disease (but don't need to), and for people who have had surgery for heart disease at least once and will probably need to have it again ...  and again (but could put a stop to the pattern).

Perhaps as much as 90 percent of heart disease, they are convinced, is entirely preventable (the other 10 percent is hereditary or, like my problem, congenital: such problems can be fixed, but can't be prevented). Alas, they write,

we heart doctors tend to "fix" the plumbing problem of the moment and then move on rapidly to the next one. All too often, patients become "cases" ("Can you check on the 80 percent left main coronary artery obstruction in cath lab number 4?") rather than people in desperate need of advice and counseling.

Doctors Gillinov and Nissen want to fill the gap left when the last "kindly, unhurried, gray-haired gentleman with a white coat, a black bag, and a stethoscope" left our doorsteps and began practicing high-tech assembly-line medicine. They want to sit down and chat with us about our risk factors, our food and drink, how we exercise, our emotional life, the medicines we take, whether we need surgery or can avoid it ... and lots of other things (check out the table of contents by clicking here, then clicking "Search inside this book").

This could have been a dreary read, as serious as, well, a heart attack. Fortunately, it isn't. The book is designed for easy reading and reference, with lots of subheadings to help us find what we're looking for ("Questions to Ask Before You Have a Heart Test") and to interest us in information we might not have thought to ask about ("Good Vibrations: Do Positive Emotions Provide Cardiac Protection?"). Flipping pages, we'll find frequent sidebars with fascinating factoids ("Why We Put Salt in Our Food," "Three Simple Household Routines Help Prevent Obesity," "Cardiovascular Disease in Mummies").

Even better, the authors are good writers. I don't think they used a ghost; Gillinov mentions his love of writing, and the diction lacks the airy chirpiness that characterizes so much ghosted material. Their explanations are clear and simple, free of technical jargon so laypersons will not have to struggle to follow. They tell lots of stories, and tell them well. They even have a wry sense of humor. This book can be used for reference, of course, but it's so interesting that you might want to just sit down and read it straight through.

Ignore the subtitle. It isn't really The Only Guide to Heart Health You'll Ever Need (I'm sure the authors were surprised when the publishers came up with that one). As they write on page 196, "Medical researchers periodically uncover new evidence that results in profound changes in our approach to heart disease.... We must accept that today's wisdom may seem foolish tomorrow." That's why Chapter 9, "How to Tell Fact from Fiction: Sorting Through the Medical Evidence" is so important. If you're like me  (and 61 percent of other Americans), you go online to find answers to your medical questions. Unfortunately, a huge percentage of what we find there is purest junk, and even the reputable studies can be hard for a layperson to evaluate. A skeptic by nature, I thought I knew how to sift through internet information and come up with truth, or at least facts. I figured I didn't need this chapter, but I read it anyway - and I learned a lot that will come in handy even when this book is long out of date.

Throughout the book the authors do plenty of fact-checking themselves, advising us on which popular beliefs to keep and which to toss. Is fat bad? Not necessarily. Is wine good? Could be. Are generics and brand-name medications equally effective? Depends on the medication. Should you have a physical exam before beginning an exercise program? Maybe not: consider these factors.

I have just one bone to pick with the authors: their analysis of hormone replacement therapy is flawed. Yes, the Women's Health Initiative studies came up with damning evidence against Prempro, but Gillinov and Nissen use those studies to damn all long-term hormone replacement. What is true, however, of orally administered hormones made from equine estrogens is not necessarily true of transdermally administered hormones made from bioidentical plant sources. In fact, subsequent research reported in the British Medical Journal, a publication rated highly by Gillinov and Nissen, shows that there are indeed differences in HRT that need further exploration.

But bless Gillinov and Nissen, they never come across as know-it-all M.Deities. They know they are writing to intelligent, informed readers, and they treat us with respect - an amazing feat for people who spend most of their waking hours looking at people wearing hospital gowns.

David Brooks, Charles Murray, and the Reign of Mammon

Today's New York Times carried a thought-provoking op-ed by David Brooks called "The Materialist Fallacy." I recommend that you read it: it's only 764 words long. Brooks argues that "in the half-century between 1962 and the present, America has become more prosperous, peaceful and fair, but the social fabric has deteriorated." This is not just because of job loss (the liberal explanation) or government intrusiveness (the libertarian explanation) or "the abandonment of traditional bourgeois norms" (the neo-conservative explanation).

It has more to do with declining social context and social capital, says Brooks, who never met a financial capitalist he didn't like. He really likes Charles Murray's new book, however: Coming Apart: The State of White America, 1960-2010. (If you're not up for the 416-page book, you might want to read Brooks's January 30 column in praise of it.) Both authors worry about nefarious social forces that are driving a wedge between rich and poor, productive and non-productive, law-abiding and outlaws.

Brooks is partly right, and so are his critics. Yes, there's a rip in our social fabric. Yes, it is caused or made worse by job loss, ill-advised government programs, and shifting (or abandoned) values. Yes, it diminishes social capital and impoverishes social context. But also, Mr Brooks, and perhaps fundamentally, our decaying social fabric is the direct result of our enthusiastic worship of Mammon--the love of money that is the root of all evil (1 Timothy 6:10).

I don't need to remind anybody about rapacious financiers, bloated CEOs, unscrupulous lobbyists, and corrupt politicians. But there were plenty of those in the 1890s and the 1920s, and, as Brooks points out, the social fabric still stayed more or less intact back then. Even two World Wars and a Great Depression didn't unravel it. People still finished school, still got jobs, and still got married before having children, if not always before getting pregnant. Why did things start to break down in the 60s?

It's all the Boomers' fault, right? I mean, the first Boomers were getting their driver's licenses in 1962, the very year Brooks chooses as the beginning of the end. And once we had wheels, and cars with back seats, and, hey, the Pill!--it was all downhill from there.

Nope. Brooks doesn't think it's that simple. But I don't see him fretting about the sea change in the cult of Mammon that took place in the 1950s when we older Boomers were children. For the first time, kids--millions of us--became a market segment. With a brand-new television set planted in nearly every living room in America, we were sitting ducks for anyone who had a product to sell and money to buy air time. We were as plankton to whales, as baby seals to sharks.

The marketers told us we were fantastic, and we believed them. They told us we deserved whatever we wanted, and we agreed. They warned us, sometimes not so subtly ("often a bridesmaid, never a bride"), that if we didn't buy their product, we might face some diminution of our social capital, and we trembled. And they encouraged us to buy their product right now, whether or not we had cash on hand.

Believing them, we stopped thinking about tomorrow. Sha la la-la-la-la, live for today--never mind that what we did today might get us in debt, or destroy our brains, or produce babies. We were the "Now" generation, and proud of it.

But what do you get when people start wanting everything now, so much so that they stop making and carrying out long-range plans, that they defer commitment indefinitely, that they heedlessly risk future solvency in favor of present satisfaction? Well, at the front end, you get a great economy based on thriving businesses with ever-expanding sales volumes. Then, when the rush subsides, you get fatherless children, inadequate education, declining health, a hazardous environment, crumbling roads, and joblessness. You get a social fabric shot full of holes.

So whom shall we blame for the present sad state of so many Americans? Government? Big business? Mysterious social forces? Our own lack of moral fiber? Sure, why not. We've all sold out to Mammon. Our society's organizing principle is the love of money.

Alas, until we as individuals and as a nation stop worshiping at Mammon's altar, all attempts to fix the social fabric--be they Republican, Democratic, socialist, anarchist, moralist, religious, or academic--will be about as effective as sewing "a piece of new cloth on an old garment" (Mark 16:21). Still, a patched garment, if no new fabric exists, is better than no garment at all.