Image by Tom Palumbo, circa 1956, from Wikipedia

Next Wednesday, Oct. 21 is the 40th anniversary of the death of Jack Kerouac. For a retrospective on Kerouac’s seminal work, On the Road, please read the essay from our guest blogger, Roy J. Nirschel*, below.

In the spring of 1968 as Paris burned and protest filled the streets of  America, including my hometown of Stamford. I traded a Joe Cocker album for a dog-eared copy of On the Road.  In a fortnight I was transfixed, reading about a life I would never lead.

Four decades later I still read Kerouac, buy copies of the book for friends, attend lectures on the Beat generation and make pilgrimages to his hometown of Lowell, Massachusetts. I even run (although I use the term loosely) in the annual 5k road race in his honor that raises funds for a scholarship for a budding local writer. I ask myself why?

What is it about On the Road that compels me to return to it each year, like a homecoming that is both familiar and new with each reading?  Why did Time Magazine consider it “one of the best hundred English language books of the twentieth century?”

On a base level it is a love story; two men exploring the possible on the open road that was America, before the Interstate highway system or the Internet superhighway. Kerouac and Neal Cassidy (Sal Paradise and Dean Moriarity in the book) embark on a journey filled with spontaneous joy as  well as conflict; purposeful and purposeless.  Sal is looking for kicks and finds his muse in Dean, a grown yet still juvenile delinquent.

They travel to see girlfriends and wives that do not welcome them (Dean has women coast to coast as well as male “friends”). They visit lost acquaintances and make new ones. They connect with Bull Lee (William Burroughs) in New Orleans, squabble over their affection for Carlo Marx (Allen Ginsberg) in New York and fail in their Denver quest to find Dean’s wino father; “Old Dean Moriarty, the father we never found.” Paradise, like life for the real Kerouac, always managed to be find in the suburban comfort of his mother’s world.

On bus rides, hitchhiking, trains and stolen cars, Dean and Sal meet hucksters, train brakemen, Mexican laborers, black jazz musicians and drifters. They are wide-eyed innocents abroad; marveling at the simplicity of it all in a pre-Cold War America yet haunted by a personal restlessness.

On the Road is distinctive too in style.  Kerouac, high on caffeine and allegedly Benzedrine (though that claim was later discounted), spent several  non-stop weeks at the typewriter using a teletype roll of paper that he had taped together into one, continuous page. (I saw the iconic “scroll”, now owned by Indianapolis Colts owner Robert Irsay, when it toured last year). While On the Road sat in his backpack and was rejected as too explicit, Kerouac continued to write, although neither Town and the City or Subterraneans were commercial hits. It took nine years for Viking, to publish an  edited On the Road in 1957.

Kerouac believed that all his writing was one continuous story he would connect as his magnum opus.  Alcohol, depression and death intervened on October 21, 1969, when he died at the age of 47. He was with his mother in St. Petersburg Florida, watching Graham Kerr’s “The Galloping Gourmet” on television.

On the Road tapped into a spirit of liberation when a stale, grey, post World War II uniformity reined. It spawned the short-lived “Beat Generation whose writers still resonate today. Perhaps surprisingly, though, Kerouac was a patriot and a man of faith, however unorthodox. He had human flaws and a voracious appetite.  While I did not embrace his appetite, I did his love for language, his descriptiveness, even his internal conflicts, which were intensely human.  Like Kerouac many of us of the generation of ‘68 searched for roots, even while pushing against them. We saw the open road as an invitation to the possible and a warning sign, and craved kicks while returning safely to mother in suburbia.

I do not know what became of Joe Cocker, or whether my high school friend Michael Waters kept the album or scratched it beyond recognition.  I do know what became of Kerouac and what On the Road has meant to me and countless others who keep this story on the popular seller list generations later.

*For more on Nirschel, read his bio box on the bottom right of the blog’s main page.

Still on the search for a fix for his sore shoulder, Reid leaves Canada before the end of the book to visit India and pay out of pocket at an ayurvedic clinic. I’ll save you the suspense: After weeks spent eating healthfully, relaxing, and being intensely massaged, Reid’s shoulder felt better and had a better range of movement.

You probably don’t have to believe in prana or doshas to understand that paying such intense attention to your body may serve you better than pills or surgery. But the out-of-pocket model doesn’t do one thing very well, Reid says, and that’s address any sense of fairness. Most of the world’s poorest countries don’t provide health care, and people are left to pay for the care they can afford. Reid points out that that usually means that poor people go without any care at all, and the poorest in the poorest countries can expect today before their 40th birthday.

Reid points to an Institute of Medicine study to show that about 22,000 Americans die each year from otherwise treatable ailments because they can’t afford insurance. He tells us that about 85 percent of Americans believe health care is a fundamental right. So what’s to be done? Reid says we have to decide the moral question first, commit to universal health care, and then worry about how to pay for it. He argues that framing the issue as an economic one was one of the problems in the reform effort of then-President Bill Clinton in 1993, while at the same time Taiwan and Switzerland passed universal health care. That’s because Taiwan and Switzerland framed the issues in ways that resonated within their cultures — national pride and solidarity — Reid says.

Part of what he wants to do in the book is combat some common misconceptions: that every other country has socialized care with wasteful bureaucracies and sacrifice free-market style choice. But the prescription contains elements that may be a hard sell for Americans. Everyone — rich and poor, young and old, healthy and sick — is in it together in countries that make health care universal. That means that the rich subsidize the poor and the healthy subsidize the sick. But it also means the healthy version of yourself subsidizes the version of yourself that inevitably needs medical care. That’s what insurance is meant to be, a bulwark against bad luck.

It also means that in most countries no one makes a profit from health care insurance. That  might have been the biggest obstacle all this time: that really entrenched interests benefit from our current system.

I’ve realized, somewhat belatedly, that in my post about not reading enough fiction I erred in adding Angela’s Ashes by Frank McCourt to the list. My conscious brain realized that it was biography/memoir, but my subconscious brain always confuses McCourt with Ian McEwan, who actually does right fiction.

Angela’s Ashes is still more narrative and novelistic than anything I’ve read in awhile. Which is leading toward a bit of a problem. Young Frank McCourt is so hungry throughout his Irish childhood, lived in grinding poverty, that all he talks about is wanting food. And he rhapsodizes about it so much, repeating the same delicious-sounding phrases over and over, that all I want to eat  now is mashed potatoes with salt and butter, boiled cabbage, ham, milk straight from a cow, fried bread (whatever that is) and apples stolen from an orchard. I broke down and had the potatoes last night, as salty as I could stand them, and see cabbage in my near future. The rest is going to be a little harder to come by.

As you all probably know by now, the Senate Finance Committee, one of five Congressional committees critical to health care reform, rejected two proposals Tuesday that would have created a public insurance plan to compete with private health insurance companies.

The public option has been a constant demand of more liberal lawmakers but is widely seen as a dealbreaker for most Republicans and moderate Democrats. The Finance Committee, as exhibited by Max Baucus’s chairman’s mark, left it out in favor of non-profit health care cooperatives.

As we know now from reading T.R. Reid’s book, France, German, and Japan (along with other countries) use non-profit insurance companies to provide health insurance to their citizens. Citizens then use the insurance companies to obtain care from doctors and hospitals that work for profit. But as Timothy Noah pointed out in Slate, for-profit insurance companies aren’t allowed in those countries. Also, as I think I can channel Reid to say, we don’t really have a model for non-profit health insurance companies in America.* What we do have are to big government-run programs, Medicaid and Medicare, that could be expanded.

But as Brian Lehrer pointed out in Wednesday’s show, none of this means the public option is completely dead.

*At least, not any more.

Whenever politicians talk about health care reform, Americans probably fear most the systems Britain and Canada have. It makes no difference that Reid and many others who have benefited from them extol their virtues. These systems are so different from what the U.S. does that they’re not likely to be implemented soon anyway.*

Britain is one of the few democracies that goes whole-hog: Your health care is paid for through direct taxation by the government, which also employs the doctors and nurses who see you. The downside, of course, is that taxes are high. Britain still spends less on health care than the United States does, but it may not feel that way if you’re paying 17 percent tax on a sandwich at the Pret-a-Manger.

Also, the government has to pay attention to cost, and can act like a gate-keeper on certain kinds of medications. This might feel like it makes more sense when you’re the taxpayer than it does when you’re the sick person who wants a treatment. In any event, Reid was not approved for shoulder surgery, or really any other kind of intervention, except the stiff-upper-lip treatment. Just learn to live with it, they told him.

Both Britain and Canada also install waiting-lists for non-emergency procedures, with the justification that if health care is free for individuals the temptation to overuse it is strong. This is the way a non-market system can internalize a cost on its users. Britain invested a lot of money after true and exaggerated scandals involving their wait lists; tales of patients waiting on gurneys while they slowly died. That’s the upside to government involvement, the government is ultimately answerable to voters. In Canada, the wait-list problem hasn’t been overcome, and that was the only country in which Reid didn’t get to see a specialist because of the wait. The upside, if he’d waited around for about a year, is that everything would have been totally free.

Reid posits that Canada provides the U.S. with another important lesson: Universal health coverage started first in one province, and then after it was proven popular and workable spread to the entire country. It’s called the demonstration effect. Maybe,he says, if more states like Massachusetts could provide universal coverage and actually control costs, the entire country would eventually get on board.

Another benefit, though, is that because both Canada and Britain will have to pay for the entirety of their citizens’ care from birth to death, they have a great incentive to keep you relatively healthy. So it really is care for your health, more than managing your sickness. Something tells me that wouldn’t wash in the U.S., though:  you basically have the government telling you what you should and shouldn’t do.

*Though, as Reid points out, the VA system works just like the British NHS, and Medicare and Medicaid work like the Canadian single-payer system.

Next week is Banned Books week. Sponsored by library, publishing and journalism organizations, this week celebrates, among other concepts, the First Amendment, the right to know, the right to free and open access and the importance of access to unpopular or unorthodox viewpoints.

In 2008, the ALA Office of Intellectual Freedom received reports of  513 challenged books. Check out the Top ten.

For more information check out http://www.bannedbooksweek.org/ which provides a map of book challenges and the ALA site.

This is my first time over at BookEnds, and I’m slowly slogging through T.R. Reid’s “The Healing of America” because I foolishly began reading four books over the past few weeks and I’m only close to finishing one — “The Long Goodbye,” by Raymond Chandler. Yes, cheesy private detective fiction holds my attention longer than both “American Lion,” Jon Meacham’s account of Andrew Jackson in the White House, and “Over the Edge of the World,” Laurence Bergreen’s history of Magellan’s circumnavigation of the Earth. Thankfully for the reader, I’ll save my recent troubles with historical non-fiction for another post. I’m here to talk about French health care, because, simply put, that’s last the chapter I read in “The Healing of America.”

I want a carte vitale — which means “vital card” in English, I think. It’s like a credit card but with a computerized chip that digitizes a patient’s medical record from age 15 onward. As Reid reports, “…it is the secret weapon that makes French medical care so much more efficient than Americans are used to.” French doctors and medical facilities don’t have to keep patient records in file cabinets, because it’s all on the patient’s carte vitale. What’s more, get sick in France or just go to the doctor for a check-up, you take this card with you and it not only tells the doctor all about your past treatments and illnesses, it also tells which private insurance fund covers the patient, how much they paid the doctor, how much the insurance plan pays back to the doctor, etc. It does everything, including eliminate the need for administrative workers so heavily relied upon by doctor’s offices in the United States.

The French carte vitale keeps administrative costs low. Coupled with a national health insurance system that makes it mandatory to be insured — no one is denied coverage — and some top-flight doctors, as Reid reports, the carte vitale is “a symbol of what the French have achieved in designing a health care system to treat the nation’s 61 million residents.” The card is by no means a cure-all. French politicians routinely campaign on health care reform platforms, and many now decry the the cost of their system and say doctors aren’t paid enough. But the carte vitale seems a simple yet effective way to streamline a cumbersome health care system, perhaps one of many first steps in reforming the U.S. system.

I’m often embarassed by the paucity of fiction books on my shelves. I don’t know why I care. But while many I know suck down the latest Oprah book or books at the top of bestseller lists for weeks, like The Kite Runner and anything by Nicholas Sparks, I find out about a new Andrew Jackson biography and I’m distracted again to a non-fiction wasteland where I can discuss what I’m reading only with my former history teacher.

I like what I like, but I’m trying to correct for this. When I picked up our most recent book club choice, I spotted a few fiction gems on a buy 2 get 1 free table, so I took advantage of the deal and got Angela’s Ashes and Olive Kitteridge.* Now a colleague, staff editor Robin Watson, has recommended The Gargoyle by debut novelist Andrew Davidson. But don’t think this in any way is enough to round out my to-read list. So, suggestions welcome.

*The third, I must admit, was this.