‘Look at them. Well, it’s a shameful spectacle. To my eyes.’
‘It’s our system,’ he said. ‘Anything else would be unAmerican.’
Which was a tautology, as any truthful answer on this matter is bound to be.
It was not the highly individualised boho Updike who talked to me about healthcare in Mass. General; it was the lumpen bohunk Updike, the Rabbit Angstrom side of Updike – which is certainly there and is also the reason the Rabbit novels (particularly volumes three and four) are so good and so inner. But Rabbit was saying what almost all Americans say, or whisper: the more you earn, the longer you deserve to live.*4 For-profit healthcare is such an obvious moral and economic fiasco that only ideology – in the form of inherited and unexamined beliefs – could possibly explain its survival.
Rabbitism is especially strident on the healthcare question because the basic aversion is to spending money on the poor – who, it is felt, got that way through moral unregeneracy. This was the prevalent view in mid-nineteenth-century England, and clarifies the meaning of Bumble the Beadle’s repeated references (in Oliver Twist) to ‘them wicious paupers’. Bumble, one of the vilest characters in all Dickens, hates and fears the poor – because he can so vividly see himself among them. But in America everyone hates and fears the poor, even the very rich.
An individualist, a libertarian, and a credulous believer in the underlying wisdom of the market, Uncle Sam, don’t forget, is also a Puritan. Good, rich, clean-living Americans want to punish the unregenerate – as they would want to punish their own vulnerabilities, temptations, and nostalgias. The violent hypocrisy of them wicious paupers is of course an extreme manifestation of the urge. And perhaps Dickens, in creating Bumble, had in mind an even more savage exemplar.
This is from Lear – from one of the mad hero’s great visionary fits of perception in Act 4:
Thou rascal beadle, hold thy bloody hand.
Why dost thou lash that whore? Strip thine own back.
Thou hotly lust’st to use her in that kind
For which thou whipp’st her.
Then Lear continues, penetrating yet further:
Through tattered clothes great vices do appear;
Robes and furred gowns hide all. Plate sin with gold
And the strong lance of justice hurtless breaks.
Arm it in rags, a pigmy’s straw doth pierce it.
—————
With a groan he threw down his pen and sat back sharply…
‘All agree’, said Christopher, ‘that paperwork is the bane of Tumortown.’
‘Yes, and everywhere else in America that has a hospital. Or a doctor. In New York I went to get my ears sluiced and they handed me a ten-page questionnaire.’
‘They’re just covering their asses,’ he said, opening another bill. ‘I wonder when I’ll run out of money…’
Christopher Hitchens was a bestselling author and a highly paid columnist, with the unqualified support of a thriving magazine (and its famously bountiful editor, Graydon Carter); he also had full insurance. Yet there he was at his desk (in a gap between radio and chemo) with a stack of mail and a chequebook, wondering when he’d run out of money.*5
I said, ‘You’re an American, Hitch.’ True, as of 2007. ‘And for now you’re a sick American. So you’re not just a patient. You’re a customer. But you won’t run out of money.’ True again; the synchrotron treatment, whose starting price (I’d learnt) was close to $200,000, would be duly covered. ‘You’ll just worry about it. Money.’
It wasn’t the time to elaborate on this, but I wanted to say, American healthcare feels like an assault. Hasn’t anyone here realised that money worries are bad for you? Bad for your health? Doesn’t this partly explain why Americans don’t live that long? Shelling it out while not bringing it in – the doublesqueeze of US healthcare…
‘What’s bothering you’, I said, ‘is the enforced inactivity. It’s the work ethic of the Hitch. You’re not producing your thousand words per day, and you feel – what’s that Larkin line? – you feel you’ve been pushed to the side of your own life.’
There was a lull; shadows moved. And I found myself telling Christopher everything about the Larkin complication and Phoebe Phelps.
Brent: life goes on
‘Hi.’
‘Hi. Who the hell are you? I’m sorry.’
‘Grant. I’m sorry too, but who the hell are you?’
‘Cadence. Grant, do you know what happened with Brent?’
‘I’m just filling in here, Cadence. Who’s Brent?’
‘Jesus. Well where’s Trent?’
Now about to take my leave, I realised I was at home in Houston; I knew how it went here. Grant was probably all right, and Trent and Brent were probably all right. And Cadence was apparently all right, for now. But her husband was not all right: a day or two ago, in the forecourt, I saw him being stretchered out of a hearselike limousine while Cadence looked fearfully on…Everyone in the bar was probably sick, or was at least the spouse or child or parent or sibling of someone who was sick. It was a developed local fact – like the staggering array of wheelchairs waiting like city bikes in Arrivals at Miami Airport.
‘Trent’s on at nine.’
‘Nine? What’s it now?’
‘Six. Five after.’
‘…I won’t make it. I’ll have a ministroke at the very least…’
—————
In the Houston Center, with over thirty restaurants to choose from, Christopher chose the Hong Kong Cookery; and its ambience of neon lights and paper hats and party tooters suffused in us a mood that was no doubt quite common in Tumortown (and other warzones): the eerie euphoria of adversity.
That night Christopher wore the expression that his loved ones loved best. Blue called it ‘his foxy face’, crafty, greedy; to me it spoke of witty insubordination; and our friend Ian was not alone in maintaining that this particular smile went all the way back to his schooldays. ‘Hitchens,’ the masters kept telling him, ‘take that look off your face!’ From his memoir:
‘Hitchens, report yourself at once to the study!’
‘Report myself for what, sir?’
‘Don’t make it worse
