LONDON (Reuters) - Author Lionel Shriver counts the financial and emotional cost of healthcare in a new novel begun well before it became a key policy for President Barack Obama and the topic of heated debate among Americans.
"So Much For That," just released in the United States and Britain where Shriver now lives, follows the dwindling fortune of Shep Knacker, whose dream of retiring to a remote island is shattered when his wife is diagnosed with a rare form of cancer.
With chapter headings detailing Knacker's rapidly shrinking bank balance, the book addresses the uncomfortable question of how much a life is worth in the United States today.
"I certainly began the book with a political motivation as well as a personal one, but at that time in 2007 healthcare reform was not even an expression in the United States," said Shriver in a telephone interview.
"Obama was also not a credible candidate for president, so it was an odd experience that by the time I finished the book the debate I had hoped to kick off was already raging."
Shriver said that now the U.S. healthcare reform plan was law, her book was not irrelevant -- it was more than an analysis of the crippling costs of U.S. medical care.
"It is not a thinly disguised polemic about a political issue in the United States. It's fiction and I want it to work as a story.
"It's about what a severe illness does to your friendships, to your relationships with your children and most of all what it does to your marriage and I think that is fascinating material."
Shriver said it was the death of a friend from mesothelioma, a rare form of cancer usually caused by exposure to asbestos, which first inspired So Much For That.
She has written about her guilt at failing the friend during her final months, and in the novel visits by friends and relations of Glynis, Shep's wife, quickly dry up as her condition deteriorates.
The characters in So Much For That are less immediately likeable than in most novels, and Shriver casts an unflinching eye not only on her cast but also on the reality of sickness and what it means to care for someone who is seriously ill.
The 52-year-old, who won the 2005 Orange Prize for "We Need to Talk About Kevin," was aware that its difficult subject matter made So Much For That a risky enterprise.
"One of the risks of the book obviously is that this is stuff people don't necessarily want to read about," she said.
"That's why I tried to make the book as entertaining and energetic as possible."
She argued that despite its grim themes and descriptive passages, the book was funny, and some reviewers have agreed.
Some of that humor comes in the voice of Jackson, Shep's best friend, who rails against government and business in angry outbursts which Shriver says reflect wide public disenchantment.
"That's another aspect of the novel where the political and cultural tide sort of caught up with me and that is that sense of sourness, a popular sourness about everything.
"It is massive (in the United States) and it's in the UK as well where we had the (parliamentary) expenses scandal as well as the whole banking crisis, both in government and commerce.
"And yet it's hard to know what to do about that -- you are stuck with government and companies and this impotent rage eats you up and that is all over the book."
Shriver said she had yet to decide on the subject of her next novel, but expected it to be lighter than So Much For That.
"I want to try something a little lighter and more positive -- it would be good for my soul. I want to give myself and my readers a break."
So Much For That is published by HarperCollins.
Reporting by Mike Collett-White