Book Review: Samaritans by Jonathan Lynn

Political satire has changed over the last 10 to 20 years thanks to programs like The Daily Show, The Colbert Report, Last Week Tonight with John Oliver and Full Frontal with Samantha Bee. Shows such as these go beyond amusing entertainment. They’ve become sources of news and information, vehicles that actually increase political knowledge. Jonathan Lynn’s book Samaritans does the same with America’s healthcare debate

The book is a biting takeoff on healthcare in America. More important, it conveys many of the ideas at the heart of the ongoing spectacle of the current farcical debate over the Affordable Care Act. In so doing, Lynn also weaves in plenty of real life facts and statistics that say much about the state of America’s healthcare system.

Lynn is perhaps best known as a television writer and film director (including one of my all-time favorites, My Cousin Vinny. Satire becomes a scalpel in his story of Max Green, head of hotel operations at a Las Vegas casino, who sees being CEO of a large hospital as the path to wealth. And few elements of the healthcare system are spared.

Green becomes head of Samaritans Medical Center in the Columbia Heights area of the nation’s capital. Obsessed with the bottom line, Green insists his contract include him getting “a fair slice of the profits” when he turns the hospital’s the red ink into black. The hospital board, chaired by the billionaire owner of a company that makes electronic components for weapons systems sold worldwide, decides to give Green a chance.

Green’s efforts include fairly common strategies — trying to build high profile practices by hiring renowned doctors, eliminating costly elements (even nurses, here many are replaced by janitors) to create profit centers, and buying outside service providers, such as temporary nursing and billing and collection agencies. These aren’t enough for Green. He implements numerous “innovations,” including cutting a deal with a celebrity lawyer who frequently sues Samaritans, that bring profit but also have dire ramifications for both he and the hospital.

It’s what motivates Green and his data-driven deputy, Blanche Nunn, that sharpens the book’s focus. They expound the free market and evangelical ideologies underlying much of today’s healthcare debate. Green tends to make Paul Ryan-like pronouncements, such as, “People can’t have what they can’t afford. That’s what got America into this economic mess — everybody wanting something for nothing.” If someone can’t afford health care, Green says it’s “TP,” their problem.

Green’s philosophy also lays out the Catch-22 in leaving people uninsured. “Prevention’s not profitable,” he observes. It’s better to shutter a diabetes center because treating the consequences of the disease is far more profitable. And when Andrew Sharp, the star cardiothoracic surgeon Green hired, suggests not everything can be decided by the marketplace, the CEO says that “sounds like communism.”

Blanche’s devotion to the free market is rooted in what she’s learned from her evangelical ministers, Pastors Spittle and Wallow. (The hospital’s Roman Catholic chaplain doesn’t express opinions he “can safely leave my theological thinking to my superiors.”) “Capitalism is God’s ordained economic system,” Blanche maintains, and because the free market is “divinely inspired,” government should not interfere. When it comes to medical needs, Spittle taught her that “God had prescribed the answer: unregulated, free-market corporate health care.” Thus, Medicare’s problem, she says, is that it was “set up to help patients, not profits.”

In lampooning these ideas, Samaritans shows how they are at work in the politics of healthcare. Dr. Sharp and other Samaritans physicians and employees provide the counterpoint, observing and experiencing the impact of Green’s and Nunn’s machinations. Ultimately, Green goes a step (or three) too far, resulting in inventive denouement. Lynn’s one page epilogue contains some of the book’s best humor but it would require an inexcusable spoiler to show why.

Samaritans is more insightful farce than laugh-out-loud funny and generally succinct and well written. It does, though, have its flaws. A couple characters seem unnecessary to advancing the story and feel more like walk-on extras. More disquieting is a tendency for some of the female characters to use sex as a tactic to achieve success. While Lynn uses this to further distinguish between the good guy and the bad guy, the frequency with which it appears collapses toward hackneyed trope.

Still, these blemishes are comparatively negligible compared to the book’s truth telling. In looking at America’s healthcare system, Samaritans both entertains and educates.

When did they change the start of the Hippocratic Oath from “First, do no harm” to “First get the check”?

Jonathan Lynn, Samaritans

Weekend Edition: 7-22

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Book Review: Crowns in Conflict by Theo Aronson

While reading Theo Aronson’s Crowns in Conflict: The Triumph and Tragedy of European Monarchy 1910-1918, an essentially biographic approach to World War I’s effect on Europe’s monarchies, I often thought of another book I read years ago. The Fall of Eagles, C.L.Suzberger’s account of he fall of the Habsburg, Hohenzollern, and Romanov dynasties, was on my bookshelves for decades — until the Great Purge. I say decades because in checking I learned it was published exactly 40 years ago.

Aronson’s approach to this topic differs in two respects from Sulzberger’s. First, he takes a broader view, looking at roughly a dozen major and minor monarchs who sat on Europe’s thrones in the second decade of the 20th century. Second, as noted, Crowns in Conflict is biographic in nature, not surprising given that Aronson, who died in 2003, wrote nearly two dozen royal biographies. Rather than rehash how the Central and Entente Powers careened into war, the book looks at the history of each monarch and what the kings and queens did through the course of the war.

This approach works in large part because most of the royalty were related to each other. For example, Britain’s King George V, Tsar Nicholas II of Russia, Kaiser Wilhelm II of Germany and the crown princesses of Romania and Greece were all first cousins. The kings of Belgium and Bulgaria were also cousins of King George. Aronson uses these connections to not only explore the relationships among the monarchs but how each monarchy was led into the war and its ultimate effect on them.

Originally released in 1986 but with a new imprint two years ago, Crowns in Conflict also recognizes and explores the impact the advent of constitutional monarchy on each monarch’s power. The monarchs were no longer the only voice or decision-maker. “When set against the forces of nationalism and militarism, these dynastic relationships counted for nothing,” Aronson observes. Instead, the monarchs’ loyalty was now “country before caste.”

Britain, Germany (ruled by the Hohenzollerns), Austria-Hungary (the Habsburg empire) and Russia (the Romanovs) were the powerhouses and the last three bore the most responsibility for World War I. Thus, George V, Tsar Nicholas II, Kaiser Wilhelm II and Franz Joseph of Austria-Hungary are the main focus, Yet other monarchies, such as Belgium, Bulgaria, Greece, Italy and Serbia, also were buffeted by the war. Three such monarchs — King Albert of Belgium, Victor Emmanuel of Italy and Ferdinand of Bulgaria — also are looked at in detail.

Some may view Aronson’s approach as a bit superficial or perhaps even gossipy. I, though, found it an interesting version of an oft-told tale. Rather than simply being a diplomatic or military history, Crowns in Conflict uniquely personalizes World War I. It also helps place monarchies in a historic context.

In fact, the book may make the 1911 Encyclopædia Britannica somewhat prescient. Its entry for monarchy said that while “it survives as a political force, more or less strongly, in most European countries, ‘monarchists,’ in the strict sense of the word, are everywhere a small and dwindling minority.” What the encyclopedia couldn’t or didn’t predict was what would succeed these hereditary autocracies. “Dictatorships of one sort or another shortly were established in almost any country over which the monarchs had once reigned,” Aronson observes.

Monarchs should not lie — or at least, should not be caught lying — to each other.

Theo Aronson, Crowns in Conflict

Weekend Edition: 7-15

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No art says “I want to live” better or more forcefully than jazz.

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Book Review: Red Fire by Wei Yang Chao

While the American Revolution is central to the Fourth of July, America also seemed to encounter a revolutionary temperament in 1968. We weren’t alone; revolution also seemed to be in the air in Europe. Even the counterculture symbol The Beatles would record their first politically explicit song, “Revolution.” Yet you’ve got to wonder how much support there is for your revolution when John Lennon writes, “But if you go carrying pictures of Chairman Mao/You ain’t going to make it with anyone anyhow.”

Lennon’s attitude may have changed later but there’s little doubt the excesses of China’s then two-year-old Cultural Revolution were disturbing many worldwide. Although the violence eventually receded, the Cultural Revolution — in reality prompted by an internecine power struggle — wouldn’t really end until after Mao’s death in 1976.

The extent of the damage caused China is incalculable. We’ve gained insight into the Cultural Revolution’s economic, cultural and personal costs as, over the years, memoirs of those caught up in it have become almost a genre unto themselves. One of the most recent is Wei Yang Chao’s Red Fire: Growing Up During the Chinese Cultural Revolution. Like many of its predecessors, such as Red-Color News Soldier and Red Scarf Girl, it makes for compelling — and stupefying — reading.

Chao and his family moved Beijing in 1965. When the Cultural Revolution was declared the following year, he was 13. Perhaps because of that the first several chapters of Red Fire provide as much a historical perspective as a personal one. Yet Chao would witness several significant events in the transformation of the Chinese political and social landscape that year.

Among other things, he details going to see the first big-character poster. This and other posters were huge sheets of paper with revolutionary slogans that were posted in public places. The first appeared at Peking University in late May 1966. They were a method of debate dominated by what would become the Red Guard. As “an ocean” of posters saturated the country and attacked not only ideas but individuals, the Red Guard began physically attacking those they viewed as “revisionists,” i.e., older generations. Public humiliation and beatings became common as the posters achieved a status where, Chao says, “they could end a career, if not a life.”

On August 18, 1966, a 14-year-old Chao was among the nearly one million college and high school students who crammed into Tienanmen Square for a rally called by Mao for the “Proletariat Cultural Revolution.” Red Fire reviews the rally, at which Mao endorsed the Red Guards. In so doing he essentially released millions of zealots intent on destroying what would later be called “the Four Olds”: old customs, old culture, old habits and old ideas.

Chao recalls tears streaming down his face and feeling ecstatic when he saw Mao after he waded into Tiananmen Square’s massive crowds. He attributes those feelings and the students’ fervor to the Chinese education system, which he says “fashioned China’s youth into die-hard revolutionaries.”

The education we received in those years left no room for us to question what we were learning. None. Your only option was to ingest what you were given and to believe everything you were told. Anything short of total credulity marked you as being against the revolutionary cause.

Violence erupted throughout the country. Chao admits joining in on the Red Guard’s chants, slogans and rituals. He also attended “struggle sessions” in which teachers and others were severely beaten, some fatally. He claims he “looked away” at the the latter and drew a line at personal violence and destruction. Yet in 1968 he would personally experience what the Red Guard was doing.

Two immutable things brought the Cultural Revolution to Chao’s front door. His father, a journalist, had attended college and graduate school in the U.S. That, of course, made him a spy. His mother came from a landowning family and landowners were one of the Red Guard’s “black five categories.” In April 1968, his parents were subjected to a public struggle session in their own home. Chao and his sister were forced to watch as their parents were beaten and humiliated. Within a year, Chao’s parents and sister were sent into the countryside for “re-education.” He, meanwhile, would be sent to do farm work in a different village, where he shared a cave residence with another man.

The personal stories allow Red Fire to portray the human effects of the Cultural Revolution. This is also true when he talks of going to historic sites he loved and seeing the destruction wrought by the Red Guards’ attack on their own history and culture. Chao’s detailing of the birth and initial development of the Red Guard movement and the Cultural Revolution, though, seems held at more of a distance. Moreover, the story largely stops after we learn of Chao and his family returning to Beijing. Thus, readers get no perspective on how they and their nation mended the wounds and how long it may have taken. Likewise, there’s no discussion of any ramifications of the Cultural Revolution on 21st century China. Despite that, this is a lucid account of a family and country caught in the throes of revolutionary fervor.

Nothing makes you grow up faster than pure misery.

Wei Yang Chao, Red Fire