Lionel Shriver’s anticipated follow-up to The Post-Birthday World tackles a tricky subject: health care in the United States. Not exactly the most engaging topic for a novel—but then neither is school violence, which Shriver managed to make into a gripping page-turner (2003’s We Need to Talk About Kevin). Though So Much for That does occasionally groan under the weight of its heavy subject, overall it is a thought-provoking novel that goes beyond the managed care/private insurer debate to explore the ways we face and respond to illness in people we love.

Shep Knacker (Shriver has a fondness for Dickensian names) has sold his business to fund a retirement escape to a tropical island. With hundreds of thousands in the Merrill-Lynch account, Shep thinks he and his family are all set—until his wife Glynis comes home one day with a cancer diagnosis. But they are insured, so Shep trusts that the treatments will be paid for and Glynis will be cured. It isn’t long before their premiums and Glynis’ body are both maxed out, leaving the disillusioned Shep to watch their retirement fund dwindle and wonder whether a dream should be sacrificed to fight a battle that may not be won.

So Much for That showcases Shriver’s deep understanding of family dynamics. One of the most moving relationships in the novel develops between Glynis and Flicka, the daughter of Shep’s best friend. Each is facing death, but due to the cheerful jargon and “we’ll beat this” philosophy of the medical establishment (ably lampooned by Shriver), no one they meet will acknowledge that fact. Jackson and Shep’s conversations, on the other hand, are not quite as authentic—some of their discussions about the trials of the health care system recall the type of chats that women in birth control commercials have about Yaz. Still, the plot never gets too bogged down in polemics; rather than advocating one solution, Shriver mainly sticks to pointing out the problems of the current system.

Near the end of the book, Shep has his first honest discussion with Glynis’ doctor and discovers just how much extra time their nest egg bought his wife. It’s a poignant moment that highlights the limits of even the most modern science in the battle against death, while acknowledging our human need for hope against the odds. Though So Much for That might not be the best introduction to Shriver, it is a wry, astutely observed book that delivers all the way up to the unexpected conclusion.

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