He slept. After a while I smoothed him and kissed him and, as instructed, left behind me on the bedside table a skeleton staff of cigarettes.
All the medical facilities in Houston have their own cab ranks, waiting for the next malignancy to come staggering out of the shadows. The lead driver inched forward and gave a conspiratorial wink of his lights. I held up a hand with fingers splayed. Five minutes would be needed – for a smoke, naturally, and also for the assimilation of pity, or sorrow, or sheer emptiness, which was how it took me, comparable, perhaps, to the sudden loss of faith in God or in Utopia, leaving you on a hopelessly soiled planet in a hopelessly soiled cosmos. My body remembered the times when late at night I used to leave my younger boy in the Peter Pan Ward of St Mary’s in West London, fighting his breathlessness, when he was three.
I stepped towards the taxi while behind my back, behind the closed curtain, Christopher, like Gus, dreamed and drowsed. Lay your sleeping head, my love.
Rabbitism
The day before, on that placid Sunday afternoon, I sat reading in the Hitchenses’ suite while Christopher applied himself to his desktop and his scattered mail. I wonder, he said, leaning back, I wonder when I’ll run out of money…
You are, let us say, a citizen of the United Kingdom. And in your late forties you notice, with some sourness, how much of your social time is spent listening – or remaining silent – while your elders talk about health and its maintenance, about diet advisories and exercise regimes, about diagnoses and prognoses, about treatments, about surgical interventions, et cetera, et cetera. All this goes on for year after year after year until at a certain point – in your mid-fifties – you find that the health chat no longer sounds like a snore in another room. Is this mere habituation? No. The ugly truth is that you’ve started to find it all rather interesting. Mortality, when it’s close enough to reveal its lineaments, turns out to be rather interesting…
Then, aged sixty-two (let us say), you emigrate from the United Kingdom to the United States. The conversation continues, but its terms have changed, and not subtly. Act V is what they’re talking about in Great Britain (attitudes to it, mental strategies for it). In America they’re talking about income-pegged tax credits, prefunded savings accounts, variable caps and ceilings for employer-provided ‘plans’, co-pay options, higher or lower deductibles, and out-of-pocket additionals…In the old country they seldom talk about the healthcare system – because it is free; in the new country they talk incessantly about the healthcare system – because it plays a part in about two-thirds of all individual bankruptcies.
While we were moving from Camden Town, London, to Cobble Hill, Brooklyn, there was much to do:*2 and Elena did almost all of it. At the outset she made it clear that by far the greatest obstacle we would face – the most time-consuming and labour-intensive, the most tediously labyrinthine, and the most extortionate – had to do with American healthcare. One afternoon I gingerly looked into it; and after an hour or two I thought, Well at least there’ll be no ambiguity in our case: if any Amis gets so much as a headache or a nosebleed, it will be far simpler and thriftier for the four of us to fly first class to London, take a limousine each to the Savoy, and then, the next day, wander into one or another outlet of the NHS.
Stateside – and you learn all this by anecdote, atmosphere, and osmosis – adults of all ages imagine and anticipate illness or injury with a two-tier queasiness wholly unknown in Britain (and in all the other developed democracies except South Africa). On the question of healthcare, as on the question of guns, facts and figures lose their normal powers of suasion. It is no cause for embarrassment when the World Health Organization ranks America thirty-seventh in quality of service; and it may even be a point of pride that America comes a clear first, besting all rivals, in cost per capita.*3 On this question America will go on failing to put two and two together, and for a little clutch of very American reasons.
In the days leading up to the passage of Obamacare (the Affordable Care Act of 2010), I listened on the radio to ‘a town hall’. ‘I happen to be an American,’ said a woman in the audience, her voice yodelling and hiccuping with emotion, ‘and I don’t want to live in a country like the Soviet Union!’ Or, she might have said, a country (at last) beginning (at least) to emulate Canada, Australia, and all the constituent states of the EU. But in the US saying ‘like Europe’, or ‘like England’, or ‘like France’, or ‘like Switzerland’, is the rough equivalent of saying ‘like the Soviet Union’ – which disappeared for ever in 1991.
A marginally better-phrased version of the same distaste was put to me by John Updike, in the panoramic setting of Mass. Gen., or Massachusetts General Hospital, in Boston (the year was 1987). In the pre-interview chat I was absorbing the sight of hundreds of Updike’s compatriots (and rough contemporaries) milling about
