Barrish, Phillip http://orcid.org/0000-0003-4509-6678
Article History
First Online: 2 June 2018
Change Date: 29 June 2018
Change Type: Correction
Change Details: Due to an editing error, this article was initially published with an incorrect title. The correct title is reflected above. The original article has been corrected.
Endnotes
: Superscript removedThe movement for teaching “structural competency” in medical education is highly relevant to my argument here. At intellectual, pedagogical, and institutional levels, however, structural competency, too, takes clinical education and the clinical encounter as its points of origin (Metzl and Hansen 2014). Within literary studies, the emergent critical paradigm known as “infrastructualism” also relates to my approach in this essay. Critical infrastructuralism thinks “about how fiction approaches and relates to social and political questions of public goods, economic development, governmentality and, as a founding part of the project, a renovation of the concept of the commons” (“Infrastucturalism” 2016). See also Caroline Levine 2010; Rubenstein, Robbins, and Beal 2015.Superscript removedI would like to imagine health policy fiction as providing an opening for the health humanities to involve itself in the education of, for example, medical economists, policy makers, and even insurance executives. Political scientist David A. Rochefort (2014) also employs the term health policy fiction.Superscript removedThe first half of this paragraph borrows phrasing from Barrish 2016, 108.Superscript removedConsider a Trump tweet sent on March 27, 2017: “ObamaCare will explode and we will all get together and piece together a great healthcare plan for THE PEOPLE. Do not worry!”Superscript removedUnlike healthcare, many other concrete questions about the set-up of Lee’s imagined future remain hazy, as the late sci-fi writer Ursula K. Le Guin (2014) complained in a diatribe again “literary” writers who attempt speculative fiction without respecting the genre’s full demands.Superscript removedWhen Lee began writing the novel he intended to set it in a present-day Chinese factory town in Shenzhen, which he had researched and visited for the purpose. It was while gazing out his Amtrak window at street after street of boarded-up Baltimore row houses that he determined to change the setting to a future B-Mor populated by Chinese immigrants (Lee 2014c).Superscript removedA JMH reviewer suggested that healthcare in B-Mor may be intended to evoke a corporate-controlled HMO system more than some version of government-controlled socialized medicine. I emphasize the latter reading because of the text’s own emphasis on B-Mor’s healthcare as the single most salient element in the ethos of collectivity that the community takes as its guiding principle, for better and possibly, as Lee’s text also proposes, for worse. Regarding the latter, the most significant potential downsidesOn Such a Full Seaassociates with B-Mor’s healthcare system are not those for which HMOs are commonly criticized—that an overriding concern with the bottom line limits HMO members’ choices and the amount and kind of care for which they are eligible. Although these are indeed features of the B-Mor system, the potential downsides Lee focuses on correlate more closely with long-standing American fears that “socialism” undercuts not only individual choice but individuality as such.Superscript removedDespite its mixed reviewsOn Such a Full Seawas selected as a finalist for the National Book Critics Circle fiction award.Superscript removedBy briefly bringing yet another community into its narrative, albeit a tiny one,On Such a Full Seaemphasizes that the way in which B-Mor’s social programs undercut classic individualism is quite different from the utter annihilation of individuality imagined in Zamyatin’s and Rand’s totalitarian communist states. The community, referred to only as the Girls, consists of seven women, whom a wealthy charter woman has acquired from the open counties and keeps as a kind of private collection. With “utter acclimation to their lot,” the seven Girls abandon their names and use numbers instead. In order to further advance what has become their own desire to merge into a single collectivity, they request that Miss Cathy arrange for them to receive “identically altered eyes” from a plastic surgeon so that they will look as much alike as possible (225, 212). The Girls function in Lee’s novel as a foil to B-Mor: they signal that the social welfare programs of B-Mor, no matter how imperially run they may be, represent at worst a relative diminishment of the sovereign individualism celebrated in American ideology.Superscript removedA reviewer for JMH pointed out to me that Lee’s choice earlier in the novel to use a dialysis machine as an example of healthcare rationing is apt. In the early 1960s, when dialysis machines were new and still scarce, a Seattle hospital became famous for appointing what some called a “God Committee,” which used a metric of “social worth” to decide which medically eligible patients would actually receive the treatment (Levine 2009). Arguably, media coverage of such panels in the twentieth century helped lay groundwork for the conservative fantasy of “death panels” in the ACA.Superscript removedMy claim that the health systems portrayed inOn Such a Full Seaare speculative realizations of polemical predictions put forth on the U.S. political scene does not preclude the likelihood that Lee’s conception of healthcare in B-Mor is also influenced by international models. The most probable of these is the system of urban Community Health Service (CHS) centers in China, where Lee first planned to set the novel and spent time doing research for it. In this sense, the anti-collectivist tinge I identified above in reviewers’ aesthetic criticisms of Lee’s novel may reflect not only a recurrence of anti-Soviet Cold War propaganda but also contemporary American stereotypes and attitudes towards China. Regarding the CHS system in China, see Bhattacharyya et al, 2011 and Wang et al, 2013.