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BOOK REVIEW: Looking back on life, medicine
JUST LIKE SOMEONE WITHOUT MENTAL ILLNESS ONLY MORE SO: A MEMOIR
By Mark Vonnegut, M.D.
Delacorte, $24, 224 pages
“Just Like Someone Without Mental Illness Only More So” is Dr. Mark Vonnegut’s second stab at a memoir. The first one, “The Eden Express,” told the story of how he went crazy in the 1970s. It was a commercial and critical hit but also a professional embarrassment. Before it was published, he was accepted into the fiercely competitive Harvard Medical School. The fact that Harvard admitted an applicant with trouble upstairs was not lost on donors and parents of other disappointed applicants, who rained down grief on the school.
That grief is the reason Dr. Vonnegut gives for the 30-year hiatus between his first effort and the present one. The other reason isn’t spelled out, but it’s pretty obvious. His father was the novelist Kurt Vonnegut. It was one thing to write a memoir about cracking up, but while the old man was alive, the son regarded him as the real writer in the family - a “better writer than Hemingway or Fitzgerald,” in fact. One of the 14 publishers that passed on “The Eden Express” wrote, “This book is good but with your last name it would have to be better.” It’s telling that Dr. Vonnegut considers that rejection his “favorite” one.
This book is a bit of a mess, but that’s not so bad because it’s a Vonnegut-shaped mess. The son has inherited many of his father’s writerly gifts and just a few of his bad habits. He uses the smallest words and the simplest constructions. He tells the truth as best he can, even when that’s painful. (The chapter on Dr. Vonnegut’s divorce is titled “Short Chapter.”) He laughs a lot, especially at his own wounds and follies. His prose reads like an old, sad song. And he manages, almost accidentally, to put his finger on what really was wrong with health care in the United States pre-Obamacare.
Dr. Vonnegut sits on the admissions committee at his old alma mater, so he can say with some confidence that “the process whereby one gets to be a doctor is one where you pretty much have to be a grade-and-approval junky. This eventually has unfortunate consequences - all a hospital or insurer or pharmaceutical company has to do to get doctors to jump through hoops is set up a grading system and put some doctors in tier one and others in tier two or three or four.” Put more simply, “The problem for young people today IS the Harvard Medical School admissions committee” and their imitators at other U.S. medical schools.
The system is such because the number of applicants and medical schools is capped by law. Regardless of the number of Americans willing and capable enough to become doctors every year, we have created a system that will only allow so many new doctors to be minted. (Many students have to get around this by applying to medical schools in other countries.) This bumps up the cost of medical school, which has knock-on effects for all of the medical services that we consume.
So do the Scylla and Charybdis of third-party billing: insurance companies and, especially, Medicare and Medicaid. “In the fine print,” Dr. Vonnegut writes, “it became illegal for us to charge the uninsured or anyone else less than we charged our insured patients and it also stipulated that the insurer would pay us at a discounted rate for our charges. The net effect was that my professional services went from something that my patients could easily afford to something that, without insurance, they couldn’t.”
Now, he’s a Vonnegut, with the vaguely leftish politics that entails, so it would be too much to hope for policy solutions. But that would miss the point. The Vonneguts have always been good at showing how the world has gone wrong. Kurt never did figure out how to put it back together. Mark has done so, beginning with his own mind, until now. As he nears retirement from the medical profession, it is this critic’s hope that the son will decide to go into the family business.
Jeremy Lott is editor of RealClearReligion.org and author of “William F. Buckley” (Thomas Nelson, 2010).
© Copyright 2014 The Washington Times, LLC. Click here for reprint permission.
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