March 22, 2010



Mark ... Paul Krugman wrote that. His picture is right there. If it were Tom Friedman there would be an interview w/ an Indian whiz-kid doctor who also drives a taxi cab.

Ward Jones

Mr. Friedman, by saying he's on the side of the better angles, paints the health care debate as a battle between good versus evil. The palette seen by some of us is a thicket of brambles, thorny issues that will scratch even the thickest hide. The doctors who will see fewer Medicare patients, the employers who will insure fewer employees, the investors who have less to invest, the insurance companies who with more to insure at smaller premiums with raise premiums higher than they already are, the drug makers, biotechs, and all those other companies doing research investing time, money, and effort into finding cures, fighting diseases, like the specialists who after years of training and paying for costly equipment will see before long their number of patients reduced to the baseline of minimal health care provided for the general population, a worthy goal until you need intensive, the near miraculous care we all want when critically ill. So it's not all devils versus angels, it's bad versus not so bad, and we might, were we to look down through the cloud of rhetoric, see that we have gone in the opposite direction.


Ward -

I share some of your misgivings, but it's important to note that, for example, in the Netherlands they offer incentives to insurance companies to take on riskier clients. This is, oddly enough, created a real marketing fight to attract these people.

As for "all those companies do research" - most drug companies leach off government research, and then turn around and sell the drug at a profit. This is what happened with AZT, for example. So you may be vastly overestimating the amount of actual research these companies do themselves.

Ward Jones

First let me apologize for attacking Mr. Friedman, when it was Paul Krugman, plainly shown by the preceding comment, who made that narrow minded analogy between opposition to Civil Rights and opposition to what many people believe is a deeply flawed health care bill---my own mind was pretty narrow to miss that. As to your point, if there's government research it's not getting much publicity, not down here in Houston where there's a lot of it at M D Anderson, at Baylor, at TIRR, which treats strokes and paralysis from other causes. Stem cell research has been largely, if not totally private. Money is a powerful incentive. That's why funding for new medicines, diagnostic equipment, and cures for diseases comes in big bets from the private sector. How much is taken, or if you prefer "leeched," from government, I can't say. But we may, in the years to come, find out how proficient the public sector is or is not in filling the void.


Ward -

I'm still not sure why you think healthcare reform is going to hurt the insurance companies. The bill will funnel millions of new customers their way, while at the same time creating no new competition for private insurance.

Investors don't seem to feel your concerns, ans insurance company stocks are way up today on the news of the passage of the reform bill in the house.


Well, I got a good laugh out of your correction re Krugman/Friedman--and agree with both you and your commenter Richard on that! As to the issue at issue, so to speak: it is such a great relief to see something pass, but of course, what we should have is Medicare for all. As Krugman has also noted, the insurance companies provide no value added to the system. I know at least one of your commenters feels otherwise, but, having worked in various parts of what passes for a U.S. health care system for more years than I can care to count (including on the insurance side), this is the conclusion to which I have come.

Thank you for taking time out from your wonderful literary commentary to celebrate this small step toward health care reform in the US.


I do not like this corporate health insurance bill at all as has ruthless divide and conquer politics. Yes, we need Medicare for all, but this bill will only insures 30 million of the 44 million without health insurance. The bill is a major setback for women making it much harder for poor women to get legal, safe abortions, so more poor women in their desperation will turn to back alley butchers. The bill also with its mandates assaults the already assaulted middle class. The Republicans already have court challenges against the mandates. I hope that the courts throw out the mandates.

Martha Southgate

I'm with you, Mark. Flawed. Yes. But to even get something through that begins to reshape our currently ridiculous system is a major, major victory. Do I worry about the fragmentation that literally has the governments of some states arguing against the need for people to buy insurance (!). Yes. Am I disheartened by the abortion thing? Of course. But that doesn't make this a bad thing. In a country where the notion of a single-payer system is a total non-starter (something I'll never understand but there it is), this is an exciting beginning that we can all work to support and improve. Let's do what we can to help Obama sell it to the parts of the country that aren't so sure about it.

Raining Acorns

Mark, I hope you don't regret having started this!

To Julia: your concerns are appropriate, certainly, but I do think Martha, in responding, has analyzed this correctly (though I fervently hope that, longer term, single payer will not be a non-starter). Take heart from what Paul Krugman says and has said over time. We really must support this and view it as a breakthrough on which we can build.

To all: I want just to say that, whatever each person's position, this is one of the most thoughtful, civilized discussions of the issue I have read. It is a tribute to Mark's site and the readers it attracts. I look forward to the next literary post!

Ward Jones

Me too, Raining Acorns. I'm starved for something literary, something to take my mind off of health, my own, for example, which at 66 isn't what it used to be.


Mark, you renew my faith in the wisdom of the truly talented artist. Thank you for so elequently noting the significance of Obama's call to service.

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  • The Elegant Variation is "Fowler’s (1926, 1965) term for the inept writer’s overstrained efforts at freshness or vividness of expression. Prose guilty of elegant variation calls attention to itself and doesn’t permit its ideas to seem naturally clear. It typically seeks fancy new words for familiar things, and it scrambles for synonyms in order to avoid at all costs repeating a word, even though repetition might be the natural, normal thing to do: The audience had a certain bovine placidity, instead of The audience was as placid as cows. Elegant variation is often the rock, and a stereotype, a cliché, or a tired metaphor the hard place between which inexperienced or foolish writers come to grief. The familiar middle ground in treating these homely topics is almost always the safest. In untrained or unrestrained hands, a thesaurus can be dangerous."


  • The Bookshop by Penelope Fitzgerald


    Penelope Fitzgerald's second novel is the tale of Florence Green, a widow who seeks, in the late 1950s, to bring a bookstore to an isolated British town, encountering all manner of obstacles, including incompetent builders, vindictive gentry, small minded bankers, an irritable poltergeist, but, above all, a town that might not, in fact, want a bookshop. Fitzgerald's prose is spare but evocative – there's no wasted effort and her work reminds one of Hemingway's dictum that every word should fight for its right to be on the page. Florence is an engaging creation, stubbornly committed to her plan even as uncertainty regarding the wisdom of the enterprise gnaws at her. But The Bookshop concerns itself, finally, with the astonishing vindictiveness of which provincials are capable, and, as so much English fiction must, it grapples with the inevitabilities of class. It's a dense marvel at 123 pages, a book you won't want to – or be able to – rush through.
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    Tim Krabbé's superb 1978 memoir-cum-novel is the single best book we've read about cycling, a book that will come closer to bringing you inside a grueling road race than anything else out there. A kilometer-by-kilometer look at just what is required to endure some of the most grueling terrain in the world, Krabbé explains the tactics, the choices and – above all – the grinding, endless, excruciating pain that every cyclist faces and makes it heart-pounding rather than expository or tedious. No writer has better captured both the agony and the determination to ride through the agony. He's an elegant stylist (ably served by Sam Garrett's fine translation) and The Rider manages to be that rarest hybrid – an authentic, accurate book about cycling that's a pleasure to read. "Non-racers," he writes. "The emptiness of those lives shocks me."