05/29/2010 05:12 am ET Updated May 25, 2011

Healthcare Reform: Fiction Goes Where Congress Fears to Tread

It's still early days in my US author's tour for my new novel So Much for That, but a host of realities have already emerged clearly: that fiction is uniquely equipped to put flesh on the otherwise dry, tedious debate about healthcare reform; that readers are not merely desperate for escapism, but hungry for novels that speak to their exasperating experiences with cancer and health insurance companies; and that the most potent fury surrounding this protracted debacle in Congress is not from "tea-partyists" who want government to keep its hands off their precious, wonderful private health insurance, but from a much larger population that has one way or another been burned or cheated by health insurance companies and wants the substantive "change" they thought they voted for in 2008. I detect a widespread rage at a healthcare system that is grotesquely complex, bogged down with paperwork, and designed to stick patients who are ostensibly insured with as large a proportion of the tab as possible. An indignation that our representatives are still just tinkering around the edges of dysfunctional medical provision whose failings are structural. A steaming anger that, though the only viable long-term answer is to scrap private coverage and build a national healthcare system from the ground up, this is the one reform that was taken off the table from the start. So much for that democracy.

Call me prescient or merely lucky, I started writing this novel back in the autumn of 2007. Though its release has landed eerily in the month that Obama has insisted Congress finally pass a healthcare reform package, the timing is coincidental, not opportunistic. When I began the book Obama was not a credible candidate for president, much less was he pushing healthcare reform to the top of his administration's agenda. Nevertheless, the novel has been driven by a political purpose from its incipience, and to whatever degree it can contribute to this heated ongoing debate, grand.

Briefly, So Much for That is about Shep Knacker, the kind of decent, responsible hero you don't often find in fiction these days (certainly not often in mine)--a modest, hard-working man who has supported his family with his own small business. He asks only one thing in return: to take his savings and decamp to the Third World, where he can escape the inert rush-hour queues of New York's West Side Highway for what he calls "The Afterlife"--a simpler, cheaper, more restful existence in an economy where his nest egg would last forever. But this ambition is thwarted when his wife is diagnosed with a deadly cancer. Despite the fact that he does have health insurance, deductibles, co-pays, and out-of-network co-insurance rapidly ravage his nest egg for The Afterlife.

The plot was inspired by both a close friend's death from mesothelioma and an article I tripped across explaining that the leading cause of bankruptcy in America is medical bills, and that the majority of these bankrupts have health insurance--which staggered me, and left me wondering: well, then what is private health insurance for?

I do think fiction is the only form that can animate the current healthcare debate, which otherwise gets lost in the dulling details of tax credits and Medicare fee structures. Fiction gets behind the statistics and reminds us that what's at stake is treatment for real sick people and the often cataclysmic erosion of Americans' hard-earned income. But now that the novel's out, I'm especially interested in the non-fiction story in Congress, and along with many of my readers utterly disgusted by our legislators' sorry excuse for "reform."

Though a fellow American, most of the year I live in Britain, whose National Health Service has been unjustly demonized in America. The NHS has its problems, as do all Western medical systems these days; with aging populations and finite resources, it's hard to pay for every exorbitant drug and treatment available. Nevertheless, I've always got good medical care from the NHS; its infamous waiting lists have drastically shortened under Labour, and it's a huge relief when you're injured or ill to be able to concentrate on getting well, and not divide your anxiety between your body and the bill.

The majority of Americans have polled as preferring a single-payer system. Yet we were informed at the outset that building an equivalent of the NHS would be too "disruptive." What, pray, is wrong with disrupting a system that doesn't work? What we're not allowed to disrupt, of course, is for-profit medical provision that lines so many pockets in this country. So watching the healthcare circus from an ocean away has made me deeply cynical about our much-vaunted "democracy." You'd think that in a so-called democracy when the majority of voters want something, they can have it.