BookBrowse Reviews So Much for That by Lionel Shriver

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A timely novel that explores the human costs of American health care

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Lionel Shriver has never shied away from tackling topical issues in her fiction; a previous novel, We Need to Talk about Kevin, was heralded as a provocative fictional examination of school shooters and their potential genesis from within "good" but sterile families. In So Much for That, her tenth novel, Shriver addresses the all important topic of the state of health care and health insurance in America.

At the center of Shriver's novel are the Knackers, whose investment accounts are being consumed at a truly frightening rate, as Glynis's terminal cancer and Shep's father's relocation to a private nursing home insatiably devour the family's finances. The Knackers are not the only characters for whom a drastic diagnosis requires a radically different view of the future. Their best friends, Carol and Jackson Burdina, have long felt the burden of being tied to a stifling job - or jobs - just to find comprehensive health care coverage for their chronically ill daughter, Flicka. Meanwhile, Jackson's attempts to bring a little spice to their marriage through a procedure that is decidedly not covered by health insurance backfires miserably, painfully, and shamefully, and may have long-lasting effects on their marriage and family life.

What's clear from Shriver's narrative is that the issues surrounding health care and health insurance are far bigger than any single family or set of circumstances. Given the weight and currency of the topics she's exploring, it's little wonder that, at times, characters can seem like mouthpieces for some of the most high-profile discussions happening in Washington and elsewhere. Shriver largely avoids having her novel read like one huge policy debate, however, by putting some of the more extreme notions in the mouths of characters like Jackson, whose bombastic "Mugs and Mooches" theories seem pulled from talk radio but carry their own brand of internal logic, and Glynis, whose pragmatic, even prickly approach to dying challenges conventional perceptions about the nobility of the terminally ill.

So Much for That continually circles back to the question of whether - and how - we can set a price tag on human life. Shepherd repeatedly and guiltily reflects that if his wife would only die sooner rather than later, he might still have a financial shot at his escapist "Afterlife." Set against the backdrop of the Terry Schiavo right-to-die case and the squalor and suffering of Hurricane Katrina, the novel also raises provocative questions about what, if anything, taxpaying citizens can and should expect their government to provide them in exchange for a share of their hard-earned dollars.

Shriver's novel is hardly apolitical - at one point, she cleverly addresses head-on the common argument that simply having health insurance - no matter how minimal - is even close to sufficient in the face of catastrophic illness. But in the end, her case is more a moral one than a political one, a commentary on the values Americans profess to share. We know how to create capital, to build businesses, to invent things, Shriver notes. But, when it comes to caring for human beings at their most vulnerable times, we are paralyzed, not knowing what to say or how - on a personal or political scale - to act in a moral or compassionate way.

Given the acrid tone and complex implications of the current debates on health care, it's clear that these issues will remain with us for a long time to come; by melding the political with the personal, Shriver's novel, in the way of the very best topical fiction, will bring the matter home, to people's dining room tables and living room sofas, as families and book clubs and friends debate - using the tools of fiction - the issue that will define our times.

This review was originally published in The BookBrowse Review in April 2010, and has been updated for the April 2011 edition. Click here to go to this issue.