Nation Topics - Health | The Nation

I have eaten more than my share of Whoppers in my forty-one years. As a teenager I liked them so much I'd worry about whether I could afford another one while still eating the first. As I got older, my concerns centered less on the cost to my wallet than to my waistline. Today, thanks to two new books, I have a new fear: the prospect of everlasting damnation.

Eric Schlosser's Fast-Food Nation is a frightening and disturbing update of Upton Sinclair's The Jungle. Spend a few hours with Schlosser and you'll become more intimately acquainted with your ground beef than you ever wanted to be. Consider the people who get the meat into your waiting fingers. The injury rate among meatpackers is the highest of any US occupation. Every year about one-third of all slaughterhouse workers--roughly 43,000 men and women--suffer an injury or an illness that requires first aid on the job. Given the inevitable exchange of blood and other bodily fluids in which these injuries result, their oppression is your health hazard. The same goes for the burger-flippers behind the grill. Fast-food employees are the largest group of low-paid workers in the United States today, earning on average $5.74 an hour. One-quarter of the workers in the restaurant industry are estimated to earn the minimum wage--a higher proportion than in any other US industry. (No wonder the National Restaurant Association is perhaps this nation's most vociferous opponent of living-wage laws.) Again, worker oppression results in consumer health peril. Reading Schlosser, we hear stories of teenage workers serving meat after dropping it on the floor, picking their noses into the food, smoking on the job and watching cockroaches and rats feed and defecate on unprepared foods.

A single hamburger often contains beef from dozens up to hundreds of cattle from as many as six countries. If just one morsel becomes infected with the E. coli microbe, the burger can kill you. For the luckier ones, it can result in kidney failure, anemia, internal bleeding, seizure, stroke and coma. As company lawyers pay victims in exchange for their silence, in the past eight years some half-million Americans, mostly kids, have become seriously ill from E. coli infections. Every week, a few of them die.

I've not even said a word about the economic and environmental destruction the industry routinely wreaks on the farmland it controls, the neighborhood mom and pop operations it destroys, and the evil mind-games it plays with our children. (The McDonald's corporation, the world's largest owner of retail property, is also its leading spender on advertising and marketing, much of it directed at small children.) And forget mad cow.

Still hungry? Peter Singer's new collection, Writings on an Ethical Life, asks you to think again. Singer, whose musings on "speciesism" single-handedly jump-started the animal rights movement a quarter-century ago, wants to know what right you have to be eating what was once a conscious being in the first place. "All consumers of animal products are responsible for the existence of cruel practices involved in producing them. Our moral responsibility should compel us to avoid hamburgers because every time we eat one we are contributing to a cycle of suffering not only of animals, but also of humans, for the grain used to feed the animals we consume is more than enough to end hunger in many less industrialized and affluent countries." (If you want stomach-turning evidence of rampant anti-animal sadism in the beef industry, check out Schlosser's account of a visit to a slaughterhouse "somewhere in the high plains.")

All right, let's say you do decide to transform your life, swearing off not only animals and fish but also dairy. You are now a vegan, and you decide to celebrate by taking your family out to a fancy new neighborhood health-food restaurant serving only the most high-minded meals of vegetables, fruit, nuts and berries. Not so fast, says Singer. The $200 or so you are about to spend on a meal you don't really need would help transform a sickly 2-year-old into a healthy 6-year-old somewhere in the Third World--offering safe passage through childhood's most dangerous years. If instead of going out to dinner, you dial either (800) 367-5437 for UNICEF or (800) 693-2687 for Oxfam and give them your credit card number and 200 bucks, that child will live instead of die. If you go out to dinner instead--well, sorry, but the kid is dead.

OK, now let's say you donated the money--I hope you did--and decide to go out to dinner anyway. Is that enough? Not really, I'm afraid. There are millions more starving kids out there, and I'm guessing you've got more than $200 you don't really need. I know your friends and relatives don't seem to be giving away their extra money, but most people didn't resist the Nazis or Stalinists when they had the chance, either. Does that make it right?

Here's the problem. I can't answer any of these arguments, but I can ignore them. At least I intend to (except for the $200 one--I did stop in the middle of writing this article to fork over $200 to Oxfam). The trouble seems to be that I'm a massive hypocrite. I make sacrifices for my principles but not, apparently, ones involving hamburgers and steaks. I like them too much, torture or no torture, starving kids or no starving kids, E. coli risk or no E. coli risk.

Being an American, you are probably no better. We are the wealthiest people in all human history, and yet our government does not even come close to meeting the extremely modest United Nations-recommended target of a set-aside of 0.7 percent of GDP to overseas aid agencies. Our piddling 0.1 percent is less than one-third of Japan's contribution and a tenth of Denmark's. Don't tell me that these organizations are inefficient at feeding people. Everybody is inefficient at everything. They are good enough. Singer, a vegan who gives away 20 percent of his salary as a tenured faculty member at Princeton, insists that there is "something incoherent about living a life where the conclusions you came to in ethics did not make any difference to your life." He's right. We're living a morally incoherent life, you and I. And as Schlosser demonstrates ad nauseam, it's even pretty stupid from the standpoint of our own self-interest. So how do we justify it?

I wish I knew.

On October 1, 1996, I was one of three speakers who appeared before fourteen Minnesotans selected to participate in a "citizen forum" on healthcare reform sponsored by the Minneapolis Star Tribune and KTCA-TV, Minnesota's public television station. I made the case for a "single payer" healthcare system; the director of what was then called the HMO Council of Minnesota made the case for "managed competition"; and a third speaker made the case for "medical savings accounts" (MSAs). A single-payer system is one in which one payer (the government) reimburses doctors and hospitals. Managed competition is a theory that assumes that competition among HMOs can reduce healthcare costs without damaging quality of care. MSAs are traditional insurance policies with huge deductibles (typically $2,000 per person). After three and a half hours of discussion, eight of the fourteen citizens voted for single-payer, three voted for managed competition, one voted for a hybrid of single-payer and managed competition, and two abstained.

This vote strongly suggests that a sizable majority of Americans would support a single-payer solution to the healthcare crisis if they were ever exposed to a real debate about it. Other data support this conclusion. For example, a 1991 Harris poll found that 68 percent of Americans preferred Canada's single-payer healthcare system, compared with only 29 percent who favored the US system; a 1999 survey of professors and students at US medical colleges, reported in the New England Journal of Medicine, found 57 percent of students and faculty members of America's medical schools "thought that a single-payer system...was the best health care system," while only 22 percent were willing to say the same about managed care. But despite the public's preference for a single-payer system, and despite solid empirical evidence that single-payer would provide higher-quality care for less money than an HMO-dominated system, managed competition was elevated to de facto US health policy during the early 1990s, while single-payer proposals were kept off the public agenda by big business and its allies in Congress.

In California, the single-payer movement forced a debate--a very lopsided debate, as it turned out--about the single-payer proposal by collecting a million-plus signatures to put the proposal on the November 1994 California ballot. From July until Election Day, the anti-single-payer forces, led by the insurance industry, bought $11 million worth of radio and TV advertisements and financed a direct-mail campaign. Our "good neighbor," State Farm, spent close to a million dollars in October 1994 alone on letters personally signed by State Farm agents urging their customers to vote against the single-payer initiative.

The defeat of the single-payer proposal is one of three examples of corporate agenda-setting told by Barry Casper in an absorbing book titled Lost in Washington. Casper, a professor of physics at Carleton College during the years he wrote this book and, for the first eight months of 1991, Senator Paul Wellstone's policy adviser, also describes two other battles between public interest groups and wealthy special interests--the effort to defeat the National Energy Security Act, a bill promoted by the auto industry and the nuclear and fossil-fuel industries, and the battle for campaign finance reform.

Just as polls indicated a majority of Americans would support a single-payer program, so polls indicated majorities of Americans endorsed the positions the public interest groups took in the energy and campaign finance reform debates. Casper cites, for example, a 1991 poll showing that 86 percent of Americans supported increasing the average fuel efficiency of the nation's automobiles from 27.5 miles per gallon to 40 by the year 2000, a policy opposed by the auto industry and a substantial portion of Congress, including, notably, Senator Bennett Johnston, Democrat of Louisiana, then chairman of the Senate Energy and Natural Resources Committee. "We now have a political system in which a public policy proposal can have enormous popular support and the potential to garner an electoral majority," Casper concludes, "but it may not even get a fair hearing, much less a vote, in the Congress or anything approaching adequate coverage in the media."

Because Casper was a participant in the health, energy and campaign finance reform fights, his recounting of these battles is full of details, many of which have appeared nowhere else. The rich detail of these histories helps the reader to comprehend the myriad ways that big money sabotages democracy. These histories also prepare the reader to understand and evaluate Casper's proposals for reviving democracy. Many books have been written about the causes of and solutions to the corruption of democracy. But Lost in Washington, with the exception of William Greider's extraordinary Who Will Tell the People?, is the only book I know of that combines a detailed analysis of multiple public-versus-special-interest battles with a wide-ranging review of the solutions to the corruption.

As most readers of The Nation know, the corruption that afflicts American democracy is not the old-fashioned kind--the kind that occurs when politicians agree to cast aye or nay votes on particular bills in exchange for cash delivered in suitcases by shady characters wearing sunglasses. If big money were literally a disease, it would more closely resemble cancer than a knife wound--it attacks the body politic slowly, it weakens not just one but numerous systems (elections, committee hearings, the media, etc.) and, because the disease works slowly on many fronts, it is difficult to diagnose and explain thoroughly to the public. The histories of the health, energy and campaign finance reform fights told in Lost in Washington illustrate in disgusting detail how the money cancer has metastasized throughout America's democracy.

We learn, for example, the variety of tactics that Senator Johnston (recipient of gobs of cash from the energy industry) employed to make it very difficult for Senator Wellstone and other members of the Senate energy committee who opposed the National Energy Security Act (S. 341) to prepare for hearings on the bill. These tactics included giving opponents little time to study the bill and short notice on when hearings would be held and what the agendas of these hearings would be. Because the bill dealt with so many topics, Casper (Wellstone's chief adviser on this bill) needed five days in seclusion in order to comprehend the entire bill. But senators and their staffs are busy, and those five days did not become available to Casper until the Senate took a short recess early in spring 1991. But by then, Senator Johnston had held seventeen hearings on S. 341. The environmental groups with which Wellstone and Casper were allied were similarly disadvantaged.

We learn, to take another example, that Pacific Gas and Electric, a California utility with much at stake in the debate over S. 341 (and in the headlines these days because of California's blackouts) wined and dined Casper and eighteen other Congressional staff members at expensive hotels and restaurants in California over a four-day period in March 1991. During those four days, PG&E lobbyists and top officers, including its CEO, had access to the legislative staff that public interest groups can only dream about. The Sierra Club, Public Citizen and other groups that opposed S. 341 did not sponsor similar junkets.

How do we excise the money cancer from our democracy? The last three chapters of Lost in Washington sketch an answer to this question. Casper endorses a half-dozen reforms, including full public financing of elections, the "none of the above" option on election ballots, proportional-representation elections (instead of the current winner-take-all system), free or low-cost access to the media and third-party participation in debates. He devotes considerable attention to what he calls a National Citizens Agenda-Setting Initiative under which citizens could, if they were sufficiently organized, force Congress to hold hearings on proposals despised by big business and the Congressional pooh-bahs who set the legislative agenda.

Note how this proposal differs from the initiative process we know today. The initiative Casper is proposing would not establish a law but would, rather, force a vote in Congress on a proposed law. Casper, who was intimately involved in the unsuccessful 1994 citizens' campaign to pass a single-payer system in California by initiative, is well aware of the difficulties citizens' groups encounter in the traditional initiative process. The health insurance industry and other opponents of the single-payer initiative vastly outspent the advocates of the initiative, which lost 73 percent to 27 percent.

"The basic concept [of the National Citizens Initiative] is a simple one," Casper explains: "If a designated percentage (say, 3 percent) of registered voters in a designated fraction (say, one-third) of Congressional districts signed a petition saying they wanted a certain proposal considered and voted on, Congress would have to hold full and fair hearings and both houses would have to vote on it."

In order to assist citizens' groups in participating in this new process, Casper proposes that all citizens be given $50 vouchers annually that they could contribute to any initiative they choose. (Casper credits Greider for this idea. In Who Will Tell The People? Greider proposed an annual tax credit worth $100-$200 to each citizen that could be used for a wide variety of political purposes, not just initiatives.)

As someone who has spent the past twenty-five years organizing for underfunded citizens' groups, I am attracted to both parts of Casper's proposal--a national mechanism for forcing Congress to vote on issues of public interest and the proposed voucher. One can immediately think of a dozen reasons why the national initiative and voucher proposals might not work well. These reasons all boil down either to the maldistribution of money--big business simply has more of it than citizens groups do--or to the ineluctable fact that a small but substantial number of human beings are bigots or worse. We may ask, for example, whether the seed money needed to organize enough citizens in enough Congressional districts to contribute their signature and $50 to an initiative campaign will be more available to "astroturf" groups (fronts for big business) than to truly grassroots citizens' groups. Once an initiative forces hearings and a vote in Congress, what will prevent big business from buying the votes (indirectly, of course) needed to secure the outcome it wants? Won't bigots of all stripes get more access to Congress?

But similar objections can be made to virtually every other proposal for reviving democracy currently under discussion by small-d democrats. Forcing the media to give all candidates free exposure, for example, helps bigots and fools at the same time that it helps ordinary people with good hearts and functioning brains. One could argue that efforts to pass clean-election laws of the sort enacted in Maine, Vermont, Arizona and Massachusetts will soon be thwarted by big-business groups as they figure out that controlling candidates elected with the help of public money is a lot harder than controlling candidates who took big-business bucks to get elected.

There is no perfect or obviously best solution to the big-money cancer. I share Casper's belief that the solution to our anemic democracy is more democracy, not less, and that an effective solution will be one that embraces multiple proposals, including clean-election laws and Casper's national agenda-setting initiative proposal.

Four days into the new Administration, President George W. Bush in effect declared war on Africa and Africans (though the corporate media failed to notice). Bush's very first foreign policy action was to defund international public health and family planning services by withdrawing US money from providers who also offer reproductive health education and abortion services using money from other sources. Bush's next action was to place under review an executive order signed by President Clinton that supports African countries' right to import or produce generic versions of HIV/AIDS medications that are still under US patent. The reversal of this order--done in the name of American pharmaceutical companies--would be the moral equivalent of imposing the death penalty on 25 million Africans.

These actions constitute an assault on Africans' health at a time when the continent faces the world's greatest health crisis, and they suggest a return to the blatantly anti-African policies of the Reagan era, which were characterized by a fabricated perception of Africa as a social welfare case. During the campaign, Bush and his advisers repeatedly stressed that Africa did not fit into the strategic interests of America, and Bush said during the debates that Africa was not a priority. (He did, however, announce his qualified support for debt relief for poor countries.)

Vice President Cheney's perspective on Africa is epitomized by his support for keeping Nelson Mandela in prison and his opposition to sanctions against apartheid South Africa while he was a member of Congress. More recently, as CEO of Halliburton, the world's largest oil services company, he was complicit in lining the pockets of the dictatorship of the late Gen. Sani Abacha in Nigeria. National Security Adviser Condoleezza Rice was, until this year, a director of Chevron, another oil company that buttressed military rule in Nigeria and even hired the regime's soldiers, who fired on unarmed protesters at the sites of its operations. (A Chevron oil tanker bears her name!) With Bush himself coming from the oil industry, as do so many in his Cabinet, oil is likely to top the list of US interests in Africa as defined by the Bush "oiligarchy."

Neither Rice nor Secretary of State Colin Powell, both African-Americans, has demonstrated a particular interest in or special knowledge of Africa (General Powell's recent courtesy calls with generals Paul Kagame of Rwanda and Joseph Kabila of Congo notwithstanding). Moreover, both Powell and Rice are loyal Republicans with a shared orientation toward international affairs that derives from a narrow militaristic understanding of security. They are also unilateralists at a time when the need in Africa is for multilateral support for peace and security. Meanwhile, the basic illegitimacy of the Bush Administration in the eyes of the vast majority of African-Americans will make it more difficult for it to be taken seriously on democratization in Africa, support for which should be central to US policy toward the continent.

In the context of a Bush Administration and a divided Congress, breaking through the systemic US disdain for Africa will not happen unless there are dramatic shifts in public perceptions comparable to those of the 1980s regarding apartheid in South Africa. Public pressure will make the difference, just as it did then. AIDS must be seen for what it is: a consequence of global apartheid, in which basic human rights, including the right to quality healthcare, are denied along the color line. On debt cancellation, activists may find support in unexpected places: They can look not only to large segments of the religious community with close ties to the Republicans but also to Republicans skeptical of multilateral institutions, including the World Bank and the IMF.

The real foreign policy priority for the United States is the threat presented by the structural inequities that perpetuate war and poverty in a world where race, place, class and gender are the major determinants of people's access to the full spectrum of human rights. It will take democratizing the US foreign policy to make Washington understand this and public pressure to get government to act upon it.

There wasn't much good news to report from the year 2000, but topping the list in health terms was the long-overdue final shutdown of the Chernobyl nuclear power station on December 15. Unit Four at the Ukrainian complex blew up in 1986, spewing radioactive death and destruction around the planet. Evidence points to a skyrocketing death rate among the 800,000 "liquidators" who were forced by the Soviet government to help clean up the stricken reactor, while new studies also show escalating cancers among civilians in the downwind areas.

Earlier in the year, on the fourteenth anniversary of the Chernobyl debacle, the Radiation and Public Health Project and Standing for Truth About Radiation (STAR), a national safe-energy organization, released a pathbreaking study showing that radioactive emissions from commercial reactors are having catastrophic health effects on people living near them comparable to those experienced by nuclear weapons workers, for which the Energy Department has finally admitted responsibility. The study, by Joseph Mangano, a nationally known epidemiologist, compared infant death rates in areas surrounding five nuclear power plants while they were operating and in the years after their shutdowns. Mangano found that from 1985 to 1996, average nationwide death rates for infants under the age of 1 dropped 6.4 percent every two years. But in the areas surrounding five reactors closed down between 1987 and 1995, infant death rates dropped an average of 18 percent in the first two years. "It's hard to imagine a clearer correlation," says Mangano. "The fetus in utero and small babies are the most vulnerable to even tiny doses of the kinds of radiation emitted from nuclear power plants. Stop the emissions, and you save the children."

Published in the journal Environmental Epidemiology and Toxicology, Mangano's study covered these reactors: Wisconsin's LaCrosse, which closed in 1987; Rancho Seco, near Sacramento, and Colorado's Ft. St. Vrain, both closed in 1989; Trojan, near Portland, Oregon, which shut in 1992; Connecticut's Millstone plant, which closed in 1995. Later research on two additional reactors, Maine Yankee and Big Rock Point in Michigan, both of which went cold in 1997, showed that infant death rates fell a stunning 33.4 percent and 54.1 percent, respectively.

"Forty-two million Americans live downwind within fifty miles of commercial reactors," says Mangano. "The Nuclear Regulatory Commission allows nuclear plants to emit a certain level of radiation, saying that amount is too low to result in adverse health effects. But it does not do follow-up studies to see if there are excessive infant deaths, birth defects or cancers." Additional research by Mangano also indicates a drop in overall cancer deaths among elderly people living near nuclear plants once they are deactivated.

On June 5 the Supreme Court ruled that some 1,900 central Pennsylvanians living downwind from the Three Mile Island nuclear plant could sue for health damages. Local residents and researchers claim that a plague of death and disease followed the March 28, 1979, radiation leak at TMI Unit 2.

Even longer-overdue justice is coming to workers in the Energy Department's nuclear weapons production facilities. From the 1943 beginnings of the Manhattan Project to the ongoing enrichment of uranium at gigantic plants in Ohio, Kentucky and Tennessee, the government has denied virtually all claims from thousands of workers suffering from a range of radiation-related diseases. But the DOE finally issued a series of sweeping admissions after DOE-sponsored research found excess worker deaths from cancer and other causes at fourteen DOE facilities. A DOE report issued in May confirmed that hundreds of workers at Ohio's Portsmouth Gaseous Diffusion Plant, whose supervisors did not require them to wear protective masks, routinely inhaled uranium dust, arsenic and other lethal pollutants. President Bill Clinton signed into law a federal compensation program for DOE workers exposed to radiation, beryllium and silica. The program will cover some 600,000 people involved in making nuclear weapons.

The DOE's admissions give new weight to public demands that the commercial reactor industry come to terms with public health risks now that numerous aging and leaky reactors are waiting in line for extended licenses from the NRC. "How much more of this bodies-in-the-morgue approach to public health research do we need?" asks Robert Alvarez, executive director of STAR. "Shutting reactors may save lives. What more needs to be said?"

Eileen Myles's new novel, Cool for You, is much more a writing-out of female madness than a book about it. Framed around the author's search for the medical records of her grandmother, who spent the last years of her life in a state mental institution, Cool for You is about the institutionalized life in general. Though she begins with a description of the sanctioned squalor of the state asylum, really Myles is looking at the big picture: the processing of people into grades and schools and genders, cliques and classes. Like the writing of the late Kathy Acker, Cool for You is a kind of fragmented autobiography. Both Acker and Myles write adventure books in which their lived experience becomes the engine, not the object, of a narrative. Both present an "I" as large as the narrators of Heart of Darkness or Tropic of Cancer, although in female hands, the use of "I" is often misconstrued as memoir. Like Acker, Myles values the most intimate and "shameful" details of her life not for what they tell her about herself but for what they tell us about the culture. In this sense, Cool for You makes the classic Female Madness Tale, from Sylvia Plath's The Bell Jar through Susanna Kaysen's Girl, Interrupted, look like a kind of psychic liberalism.

Unlike Plath and Kaysen, and dozens of practitioners in between, Myles has no particular belief in the possibility of a fully integrated female self. She doesn't think her experience will be redeemed. The circumstances of Myles's life--she is the daughter of a Polish secretary and an alcoholic Irish mail carrier in class-riddled Boston--are no more dire than those of millions who daily feel the disparity between their own lives and the surfaces of upper-middle-class life that are projected blandly on TV and intricately probed in most contemporary literary fiction. What's harrowing is the detail in which this disparity is experienced and recorded.

Nellie Reardon Myles entered the Westborough State Hospital at the age of 60. Her complaint: "I don't feel well." She was a refugee of the Irish potato famine who'd cleaned houses all her life in Boston and given birth to seven children. Appetite: normal. Sleep: normal. Speech: normal. Nellie was stricken with grief over the death of her daughter, Helen. The color of her urine is fully documented over the fifteen years she spent before her death at Westborough. Teeth missing: thirty-two. Economic condition upon her entry: marginal. Her mental state: sometimes resentful. What Myles remembers most are the Sunday outings of her family to the asylum: "Dad went inside. My mother stayed out with us and the camera. Nellie is led out with great aplomb. The queen mother. The camera clicks.... It was our Buckingham Palace."

It's fitting that Cool for You begins with a quote from the Modernist hero Antonin Artaud. Just as Artaud's experience as a wartime inmate of the Rodez asylum became a launching pad and paradigm for his rage against the military-corporate forces that were then gathering toward a new postwar order, Myles reads the cursory entries on her grandmother's life at Westborough State Hospital, where she waswarehoused by the State of Massachusetts, as proof of something she already knew: The Poor Don't Matter.

The writing of both Myles and Acker is dependent on a great belief in myth, the conduit through which we may experience the Modernist passion to be larger than oneself. To use a very public "I" to speak, as Myles has put it, "to her time..." But mythification doesn't happen much to female writing. We have great hagiographies through which to read the works of Jack Kerouac, Neal Cassady, Allen Ginsberg and William Burroughs, but in the case of their contemporary, Diane di Prima, the twenty books she's published must suffice. Criticism also helps create a myth around the lives of certain male contemporary fiction writers. Girls in my writing class refer to the author of A Heartbreaking Work of Staggering Genius as "Dave," as if they knew Eggers, and memorize his interview remarks as if they were late-night phone confessions. Female myth, it seems, is something much more self-created.

Myles and Acker have both succeeded in bringing difficult work that goes against the grain of contemporary commercial narrative to wider audiences through the sheer willingness to cultivate and engage with myth. Acker hit large in the United States and England following Grove's rapid publication of her books in the mid-1980s. She knew the game and cultivated straight-girl celebrity with a vengeance: sex and motorbikes, tattoos, black leather. Acker Junkie, screamed the headline of her review in The Independent. She could be seen at 10 am hailing taxis on Third Avenue in full Punk Priestess regalia whenever heading uptown to meet her agent. By 1995, she knew myth inside out. "The kathy acker that you want...," she wrote to a friend in Australia, "another mickey mouse, you probably know her better than I do. It's media, it's not me. Like almost all the people I know, and certainly all the people I'm closest to, all of whom are 'culture-makers' and so-called successful ones...our only survival card is fame.... We're rats walking tightropes we thought never existed. Oh sure, we all look good while traveling. We're good at media images."

Myles, who isn't straight and is best known as a poet, approaches myth from a different angle. Since the publication of her first book, The Irony of the Leash, in 1982, she's been offering audiences fleshy, candid slices of her consciousness and life. A friend and apprentice of the late James Schuyler, Myles writes in a style that is deceptively immediate and conversational, giddily expressing a huge range of speculative thought. She arrived in New York City in 1974, a working-class butch lesbian from Boston, and adapted the literate candor of New York School Poetry to her needs. Her very presence at that time and place was perceived as confrontational, and it was a challenge she accepted. In 1992 Myles ran as a write-in candidate for President in eleven states, memorizing her poems and delivering them like stump speeches. In "An American Poem," she poses as a Kennedy and implores her listeners:

Shouldn't we all be Kennedys?
This nation's greatest city's
home of the business-
man and home of the
rich artist. People with
beautiful teeth who are not
on the streets. What shall
we do about this dilemma?...

Like Acker, Myles uses "autobiographical" material, but her deployment of it is more revelatory, less strategically conceptual. In Cool for You, Myles's first published novel, she sees much of her own life in tandem with her grandmother's madness. "It seems people go nuts," she writes, "from a number of things," and then proceeds to tell us what. The trajectory of a lost, dissatisfied working-class girl who wants to be a boy is necessarily less insulated, more wide open to a scary form of chance than that of the Harvard Blessed, whose lives she naïvely tries to emulate. She takes a job at Harvard Coop and gains twenty pounds stealing expensive candy bars while marveling at her co-worker, a girl who'd come from Beaver Country Day School who took time off from school to work a little job. "All these people had a certain colored skin, kind of golden peachy and expensive. It was leisure skin." Meanwhile, she was getting pimples. She attends the University of Massachusetts, Boston, imagining "images of the past--college, some bunch of bright young people in sweaters dashing up the steps to their astronomy class," only to find that "it was not school. There was no campus." She commutes on a string of suburban trains and buses to her classes and sits with her fellow students at a seedy coffee shop called Patsio's, as close as U Mass got to an off-campus hangout:

We would sit...and drink our bleary morning coffee and see the first street people we had ever laid eyes on. An old woman pulled up her skirt for us and showed us her bald old pussy. We were going to school. There was an Irish bar around the corner where we'd go after jazz class and smell stale beer and a trio would play there on Friday afternoons, a really old man and a really old woman and some third thing, I can't remember, but I know it was a trio. They were so drunk the music was incredibly bad...and one afternoon they weren't there because one of them had died.... This could not be college.

She knows she's lost. She feels the future opening up into the present and looping back again; she sees a girl dancing to the Doors and it is Jim Morrison's voice that keeps repeating in her head as if the voice were hers, and she wants to be the one to take the dancing girl on a ride into a parallel universe. Like Sade's Justine, Myles has many picaresque adventures. She quits her taxi-driving job and starts working as a nurse-assistant at The Fernald School after a chance conversation with a fare. The Fernald School is an institution for retarded men, and there she finds three classes: the institutionalized men; the staff, consisting of "the slightly educated well-meaning down and out confused," like her; and the Harvard-trained behavior-modification therapists, who rarely venture out into the wards but devise a program in which the staff pass out handfuls of M&Ms to reward appropriate behavior. The Fernald School is as dead-end an institution as any Myles encounters. She recalls: "All around us was the subtle feeling of a campaign for self-improvement. If we were daily...improving these men's capacity to live 'normally' then what could the therapy do for paragons of intelligence like ourselves. When the buzzer went off we would hug each other for not smoking."

She saves up; she travels to the West. She remembers blueness and the perfection of the air and mountains and working lots of different jobs. She wants to be James Joyce, get rid of everything and write, but then there's nothing to hold on to. She starts a book but can't get past line one, about gerbils running around a cage. At night she hears a million voices. The only thing that held her still was taste, and she kept thinking if she could taste the right thing then she would have something to hold on to. "The day was some runs that I knew with my mouth." One time in the park she floats, and realizes she's not anyone or thing. "I was not connected...not in at all. Not outside either. It wasn't like a movie."

For Myles, madness is not exactly something to be overcome. It is a permanent state, because it is a correlate of the female struggle against poverty. Madness isn't ever isolated from the dead-end jobs, the crummy schools, the institutionalized future that awaits the unconnected. Therefore, madness is something richer, darker, more inevitable than a way station on an affluent, rebellious girl's journey to success. In one of the book's most terrifying scenes, 14-year-old Eileen is working part time in her neighborhood at a nursing home. Delivering trays one night, she gets a glimpse of a familiar body, a woman she'd known as Mrs. Beatty. Seven-year-old Eileen had known the same Mrs. Beatty as the most elegant lodger at her friend Lorraine's mother's boardinghouse. She was a large woman with chestnut hair, joyful, with an air of sophistication, who wore hats with veils. But now she's naked, no longer wrapped in an elaborate fox-fur coat, and she's being lifted off the potty by a nurse and she's not a person anymore, she is a smelly shapeless thing. "She turned or a I saw her face and there was nothing in it. She was gone.... I wanted it to be someone else so I wouldn't have to have seen what I saw. This is Mrs. Beatty, said the nurse, disgusted."

Cool for You is a difficult, painful book to read. It is a construction of identity that's truly public, absorbent of the lives of others. With the audacity of Henry Miller, without the protection of his bravado, Myles lets the voice of poverty-madness-shame speak through her and proves the past is never operable.

Foundations formed when nonprofit hospitals became for-profit are often not living up to their obligations.

The Journal of Nutrition wrote about
Some researchers who tested chocolate out.
It may help stave off heart attacks, they claim.
Red wine, we've known for years, can do the same.
Without the need of any doctor's urging,
I feel a healthy diet plan emerging.

If politics got real...the debate over costly prescription drugs would turn to more fundamental solutions like breaking up the pharmaceutical industry's patent monopolies, which generate soaring drug prices, and rewarding consumers for the billions of tax dollars spent to develop new medicines. As a business proposition, that sounds radical, but it would actually eliminate outrageous profit-skimming at taxpayers' expense and liberate lifesaving medicines from inflated prices so millions of people worldwide could afford the health benefits.

At present, the government picks up the bill for nearly all basic research and development, mainly through the National Institutes of Health. Then private industry spends about $25 billion a year on more R&D--essentially taking NIH discoveries the rest of the way to market. The companies mostly do the clinical testing of new compounds for safety and effectiveness, then win regulatory approval for the new applications. This is one instance where a bigger role for government, by taking charge of the scandalous pricing system, could produce vast savings for the public--as much as $50 billion to $75 billion a year.

The National Institutes of Health and independent scientists working with NIH grants generally do the hard part and take the biggest risks, yet there is no system for sharing the drug companies' subsequent profits with the public treasury or for setting moderate prices that don't gouge consumers. Instead, the drug industry reaps revenues of $106 billion a year, claiming that it needs its extraordinary profit levels in order to invest heavily in research. The companies are granted exclusive patents on new products for seventeen years (or longer if drug-company lobbyists persuade Congress to extend them). Meanwhile, the manufacturers collect royalties (and less profit) on the very same drugs under licensing agreements with Europe, Canada and other advanced nations where the governments do impose price limits. Thus, Americans pay the inflated prices for new medicines their own tax dollars helped to discover--while foreign consumers get the break.

Years ago, although reform was mandated by law, NIH abandoned its efforts to work out a system for moderating US drug prices--mainly because the industry refused to cooperate and had the muscle in Congress to get away with it. Now that soaring prices have inflamed public opinion again, Dean Baker of the Center for Economic and Policy Research proposes a more radical solution. NIH should be given control over all drug-research policy, Baker suggests, and Congress should put up public money to cover the industry's spending (probably less than $25 billion because marketing costs get mixed into the research budgets as well as money spent to develop copycat drugs, which are medically unimportant). The exclusive patent system would be phased out, perhaps starting with cancer drugs and other desperately needed medicines whose prices are too high for poor nations to afford. For $25 billion or less in new public spending, brand-name drugs would largely disappear, but, Baker estimates, prescription costs for Americans would shrink by as much as 75 percent overall.

A less drastic solution, suggested by James Love of Ralph Nader's Consumer Project on Technology, would limit use of exclusive patent rights and, if needed, compel drug-makers to grant royalty licenses to other US companies to make and sell the same medicines, thus fostering price competition. Competing companies would be required to contribute a minimum percentage of revenues to R&D to maintain research spending levels. The government could also require companies to help fund government or university research.

The prescription-drug debate of Election 2000 is a long way from either of these visions for reform, but events may lead the public to take them seriously. Drug prices are inflating enormously. If Congress fails to make it legal, the bootlegging of cheaper medicines from Canada and other countries where the prices are controlled is bound to escalate, and the present system might break down from its own lopsided design. As a matter of public values, the discovery of new health-enhancing medicines ought to be shared as widely--and inexpensively--as possible, especially since public money helped pave the way to these discoveries. Jonas Salk never sought to patent his polio vaccine. He thought his reward was knowing how greatly his work had advanced all of humanity.

The number-one healthcare issue facing the country is not which prescription drug plan is best for seniors or whether a handful of patients will be able to sue their HMOs. It is the 44 million people, or nearly 20 percent of the population under age 65, who have no health insurance and, for many, no healthcare at all. The myth that emergency rooms provide all the care the uninsured require continues unchallenged. But the emergency room is not the place to get primary care, follow-up care or care for chronic conditions, which most people need. Federal law requires emergency rooms to stabilize patients. After that, they are sent on their way, especially if they have no money to pay for further treatment. When they are given prescriptions, 30 percent of the uninsured don't fill them because of the cost.

Rationing specialty care for the uninsured is common. In Washington, DC, the uninsured wait four months for an MRI and two months for a CT scan. In California, some counties have money to screen women for breast cancer but no money for treatment. During the four to seven years following an initial diagnosis of breast cancer, one national study shows, uninsured women are 49 percent more likely to die than women with insurance. Community clinics that treat the uninsured rarely have specialists on their staffs and resort to begging area physicians to help out--not always with success.

The Bush and Gore solutions do little to help the uninsured and a lot to keep the healthcare system safe for insurance companies, the AMA, employers and the pharmaceutical industry, all of which have shoveled money into their campaigns. Bush proposes an annual refundable tax credit (that is, one that's given even if a person owes no taxes) of up to $1,000 for individuals and $2,000 for families. His campaign literature makes tax credits sound ideal: "If a family earning $30,000 purchases a health insurance plan costing $2,222, the government will contribute $2,000 (90 percent)." Trouble is, most families can't buy insurance for $2,222. The average premium for a family policy is $6,740 and for an individual, $2,542. Gore calls for a credit equal to 25 percent of the premium. Using the average premium as a benchmark, that's about $1,700 for family coverage; a family wanting a policy would still have to cough up more than $5,000.

Tax credits, moreover, leave intact the ability of insurance companies to select good risks and exclude sick people who will cost them money. That, of course, is what the industry wants to protect--and is part of the payoff for its campaign largesse.

Both Bush and Gore would also fiddle with the Children's Health Insurance Program (CHIP) to boost coverage. CHIP has brought health insurance to some 2.5 million kids, but 10 million still have none. Bush's solution: Give the states more flexibility in administering the program. But many states have not even spent federal dollars already earmarked for them, and could be tempted into using the money for something other than insurance. Gore's solution: Stretch the eligibility rules to include children whose families have incomes up to 250 percent of the federal poverty level, or $41,000 for a family of four. But what if a family's income is above 250 percent, say $43,000? Gore's answer: tax credits.

Then there are medical savings accounts, which Bush likes and Gore doesn't. Congress now allows self-employed people and employees in small companies to buy MSAs, which are a combination high-deductible insurance policy and tax-deferred savings account. But at the end of 1999, only 45,000 policies of the 750,000 Congress authorized had been sold. Still, Bush wants to let more people buy them, a move that will spark interest mainly among the healthy, who won't need the savings account to pay for care, and the wealthy, who can assume the costs not covered by the large deductible and who will simply get another tax break.

The major battleground in healthcare, though, is over a prescription drug benefit for Medicare beneficiaries, with pharmaceutical companies replacing HMOs as this year's healthcare villains. Under Bush's scheme, the very poorest seniors would get help paying for the entire cost of a drug benefit. Individuals with incomes greater than $14,600 and couples with incomes up to $19,700 would get a partial subsidy. Bush would pump $48 million into the state pharmaceutical assistance programs to give free drugs to those with the lowest incomes. But more than half the states have no programs, and those that do lace them with restrictions.

Under Gore's plan, Medicare would cover 50 percent of the cost of prescriptions, first up to $2,000 and later up to $5,000, for seniors willing to pay a premium that would start at $25 a month. As with Bush's plan, seniors with very low incomes would get help. Both candidates offer help for those with catastrophic expenses: Gore's benefit would kick in after seniors have spent $4,000 on drugs, Bush's after they've spent $6,000 for all services. Neither, however, includes a way to control pharmaceutical prices. Controls of any sort are anathema to the drug companies.

The fight over whose plan provides the bigger benefit obscures the real fundamental Medicare issue, and that is the future structure of the program itself. Under the guise of "consumer choice," Bush wants to transform Medicare from a social insurance program with a defined benefit available to everyone into a voucher plan under which seniors would be given a fixed amount to buy whatever insurance they could afford. Even if a voucher were sufficient to pay for a policy today, there is no assurance that it would do so in the future. In effect, the Bush proposal could make seniors, rather than government, bear the cost of healthcare inflation. Gore speaks of putting Medicare in a lockbox, which presumably means he wants to maintain it as a social insurance program.

Unresolved in the candidates' discussions is the larger question: Is healthcare a right in America or a commodity available only to those who can pay? On this the public may be way ahead of its leaders. When the Kaiser Family Foundation asked people earlier this year if healthcare, like public education, should be provided equally to everyone, 84 percent said yes. The candidates, however, are listening to the special interests, whose money speaks louder than the people.

It took twelve years for the FDA to approve mifepristone--also known as
RU-486--and most of that time had less to do with medicine than with the
politics of abortion. Still, the late-September decision was a
tremendous victory for American women. In approving RU-486, the FDA
showed that science and good sense can still carry the day, even in an
election year.

The long delay may even backfire against the drug's opponents. In 1988,
when mifepristone was legalized in France, it was a medical novelty as
well as a political flashpoint. Today, it's been accepted in thirteen
countries, including most of Western Europe; it's been taken by more
than a half-million women and studied, it sometimes seems, by almost as
many researchers. By the end of the approval process, the important
medical professional organizations--the AMA, the American Medical
Women's Association, the American College of Obstetricians and
Gynecologists--had given mifepristone their blessing; impressive
percentages of Ob-Gyns and family practitioners said they would consider
prescribing it; thousands of US women had taken it in clinical trials
and given it high marks, with 97 percent in one study saying they would
recommend it to a friend. Against this background of information and
experience, the antichoicers' attempt to raise fears about the drug's
safety sounds desperate and insincere.

In a normal country, RU-486 would simply be another abortion method, its
use a matter of personal preference (in France it's the choice of 20
percent of women who have abortions, while in Britain only 6 percent opt
for it). But in the United States, where abortion clinics are besieged
by fanatics and providers wear bulletproof vests, mifepristone's main
significance lies in its potential to widen access to abortion,
especially in those 86 percent of US counties that possess no abortion
clinic, by making it private--doctors unable or unwilling to perform
surgical abortions could prescribe it, and women could take it at home.

It is unlikely, however, that Mifeprex, as the drug will be known when
it comes on the market, will prove to be the magic bullet that ends the
war on abortion by depriving antichoice activists of identifiable
targets. The nation has been retreating from Roe v. Wade for a
quarter-century, and a good portion of the patchwork of state and local
regulations intended to discourage surgical abortion will apply to
Mifeprex as well: parental notification and consent laws (thirty-two
states), waiting periods (nineteen states), biased counseling and
cumbersome reporting and zoning requirements. States in which
antichoicers control the legislatures will surely rush to encumber
Mifeprex with hassles, and small-town and rural physicians in particular
may find it hard to prescribe Mifeprex without alerting antichoice
activists. Doctors are a cautious bunch, and the anticipated flood of
new providers may turn out to be a trickle, at least at first. Abortion
rights activists should also brace themselves for a backlash from their
hard-core foes: Just after the FDA's decision was announced, a Catholic
priest crashed his car into an Illinois abortion clinic and hacked at
the building with an ax.

But in the long run, Mifeprex will make abortion more acceptable. In
poll after poll Americans have said that when it comes to terminating a
pregnancy, the earlier the better. Mifeprex, which has been approved for
the first forty-nine days after a woman's last menstrual period--when
the embryo's size varies from a pencil point to a grain of rice--may
well prove not to arouse the same kinds of anxieties and moral qualms as
surgical abortion. Then, too, Americans are used to taking pills. That,
of course, is what the antichoicers are afraid of.