do with American health care.
Just before I left on this trip, I learned that my uncle was in Mercy Hospital in Des Moines. So I looked up the number in the phone book and under Mercy Hospital there were ninety-four telephone numbers listed. The phone numbers started with Admitting and proceeded alphabetically through Biofeedback, Cancer Hotline, Impotency Program, Infant Apnea Hotline, Osteoporosis Program, Public Relations, something called Share Care Ltd., Sleep Referral Services, Smoke Stoppers and on and on. Health care in America is now a monolithic industry and it is completely out of control.
The person I was visiting, my elderly uncle, had just suffered a severe heart attack. As a complication arising from this, he also had pneumonia. As you might imagine, he looked a trifle under the weather. While I was with him, a social worker came in and gently explained to him some of the costs involved in his treatment. My uncle could, for instance, have Medicine A, which would cost five dollars a dose, but which he would have to take four times a day, or he could have Medicine B, which would cost eighteen dollars a dose, but which he would have to take only once a day. That was the social worker's job, to act as a liaison between the doctor, the patient and the insurance company, and to try to see to it that the patient wasn't hit with a lot of bills that the insurance company wouldn't pay. My uncle would, of course, be billed for this service. It seemed so crazy, so unreal, to be watching him sucking air from an oxygen mask, all but dead, and giving weak yes-or-no nods to questions concerning the continuance of his own life based on his ability to pay.
Contrary to popular belief abroad, it is possible, indeed quite easy, to get free treatment in America by going to a county hospital. They aren't very cheery places, in fact they are generally pretty grim, but they are no worse than any National Health Service hospital. There has to be free treatment because there are 40 million people in America without hospital insurance. God help you, however, if you try to sneak into a county hospital for a little free health care if you've got money in the bank.
I worked for a year at the county hospital in Des Moines and I can tell you that they have batteries of lawyers and debt collectors whose sole job is to dig into the backgrounds of the people who use their facilities and make sure they really are as destitute as they claim to be.
Despite the manifest insanities of private health care in America, there is no denying that the quality of treatment is the best in the world. My uncle received superb and unstinting care (and, not incidentally, they restored his health). He had a private room with a private bath, a remote control television and video recorder, his own telephone. The whole hospital was carpeted and full of exotic palms and cheerful paintings. In government hospitals in Britain, the only piece of carpet or color TV you find is in the nursing officers' lounge. I worked in an NHS hospital years ago and once late at night I sneaked into the nursing officers' lounge just to see what it was like. Well, it was like the queen's sitting room. It was all velvety furniture and half-eaten boxes of Milk Tray chocolates.
The patients, in the meantime, slept beneath bare light bulbs in cold and echoing barrack halls, and spent their days working on jigsaw puzzles that had at least a fifth of the pieces missing, awaiting a fortnightly twenty-second visit by a swift-moving retinue of doctors and students. Those were, of course, the good old days of the NHS. Things aren't nearly so splendid now.
Forgive me. I seem to have gone off on a little tangent there. I was supposed to be guiding you across Wisconsin, telling you interesting facts about America's premier dairy state, and instead I go off and make unconstructive remarks about British and American health care. This was unwarranted.
Anyway, Wisconsin is America's premier dairy state, producing 17 percent of the nation's cheese and milk products, by golly, though as I drove across its rolling pleasantness I wasn't particularly struck by an abundance of dairy cows. I drove for long hours, south past Green Bay, Appleton and Oshkosh and then west towards Iowa. This was quintessential Midwestern farming country, a study in browns, a landscape of low wooded hills, bare trees, faded pastures, tumble-down corn. It all had a kind of muted beauty. The farms were large, scattered and prosperous looking. Every half-mile or so I would pass a snug-looking farmhouse, with a porch swing and a yard full of trees. Standing nearby would be a red barn with a rounded roof and a tall grain silo. Everywhere corncribs were packed to bursting. Migrating birds filled the pale sky. The corn in the fields looked dead and brittle, but often I passed large harvesters chewing up rows and spitting out bright yellow ears.
I drove through the thin light of afternoon along back highways. It seemed to take forever to cross the state, but I didn't mind because it was so fetching and restful. There was something uncommonly alluring about the day, about the season, the sense that winter was drawing in. By four o'clock the daylight was going. By five the sun had dropped out of the clouds and was slotting into the distant hills, like a coin going into a piggy bank. At a place called Ferryville, I came suddenly up against the Mississippi River. It fairly took my breath away, it was so broad and beautiful and graceful lying there all flat and calm. In the setting sun it looked like liquid stainless steel.
On the far bank, about a mile away, was Iowa. Home. I felt a strange squeeze of excitement that made me hunch up closer to the wheel. I drove for twenty miles down the eastern side of the river, gazing across to the high dark bluffs on the Iowa side. At Prairie du Chien I crossed the river on an iron bridge full of struts and crossbars. And then I was in Iowa. I actually felt my heart quicken. I was home. This was my state. My license plate matched everyone else's. No one would look at me as if to say, 'What are you doing here?' I belonged.
In the fading light, I drove almost randomly around northeast Iowa. Every couple of miles I would pass a farmer on a tractor juddering along the highway, heading home to dinner on one of the sprawling farms up in these sheltered hills above the Mississippi. It was Friday, one of the big days of the farmers week. He would wash his arms and neck and sit down with his family to a table covered with great bowls of food. They would say grace together. After dinner the family would drive into Hooterville and sit out in the cold October air and through their steamy breath watch the Hooterville High Blue Devils beat Kraut City 28-7 at football. The farmer's son, Merle, Jr., would score three of the touchdowns. Afterwards Merle senior would go to Ed's Tavern to celebrate (two beers, never more) and receive the admiration of the community for his son's prowess. Then it would be home to bed and up early in the frosty dawn to go out hunting for deer with his best friends, Ed and Art and Wally, trudging across the fallow fields, savoring the clean air and companionship. I was seized with a huge envy for these people and their unassuming lives. It must be wonderful to live in a safe and timeless place, where you know everyone and everyone knows you, and you can all count on each other. I envied them their sense of community, their football games, their bring-and-bake sales, their church socials. And I felt guilty for mocking them. They were good people.
I drove through the seamless blackness, past Millville, New Vienna, Cascade, Scotch Grove. Every once in a while I would pass a distant farmhouse whose windows were pools of yellow light, warm and inviting. Occasionally there would be a larger town, with a much larger pool of light scooped out of the darkness-the high-school football field, where the week's game was in progress. These football fields lit up the night; they were visible from miles off. As I drove through each town, it was clear that everybody was out at the game. There was nobody on the streets. Apart from one forlorn teenaged girl standing behind the counter in the local Dairy Queen, waiting for the postgame rush, everyone in town was at the football game. You could drive in with a fleet of trucks and strip the town during a high-school football game in Iowa. You could blow open the bank with explosives and take the money out in wheelbarrows and no one would be there to see it. But of course nobody would think of such a thing because crime doesn't exist in rural Iowa. Their idea of a crime in these places would be to miss the Friday football game. Anything worse than that only exists on television and in the newspapers, in a semimythic distant land called the Big City.
