Inflammation

ɪnfləˈmeɪʃ(ə)n/

Noun

A localized physical condition in which part of the body becomes reddened, swollen, hot, and often painful…

I’ve been working hard over the past month on my new book, The Hourglass. An old and cantankerous British professor  used to greet his doctoral students with the words “Don’t tell me how hard you’ve worked, tell me what you’ve done.”

Truth is, Professor, I haven’t done very much.

I’m struggling with the characters—none of them jump out at me and clamor to be in the book—it’s been a real challenge, because the ‘big idea’ that underpins the book is terrific (and terrifying).

A good book needs a good plot line, but a great book needs a big idea and a great plot line, with the requisite sub-plots.

I read a lot of good books, mostly for entertainment, and Kindle has made it possible to go back in time and access stuff that would otherwise be undiscoverable. An an example, I was a fan of Elmore Leonard for years. But he’s dead and I’ve read all his books. If you go back in time, you get to Richard Stark, and the Parker novels—which are fantastic.

Stark, who was really Donald Westlake, wrote superbly terse and twisted page turners—but you won’t find a single big idea in those books.

Historical novels automatically contain the ‘big idea’. In Clear Eyes it’s the discovery of a western route to Asia. They also contain compulsory characters who jump out of the book—Columbus and the Huntress, Beatriz de Bobadilla, spring to mind. So in many ways, the book is half-written before you start.

Perhaps I’ll kill off the characters who’ve made it into the first three thousand words of The Hourglass and start again. Part of the problem may be that I organized them all beforehand, thinking I could write better with a structured approach.

Follett pre-plans everything, so I gave it a try. Westlake said he starts out with no idea where the book is going. He makes a good point: if the author doesn’t know what comes next, then neither will the reader. When it came to Clear Eyes I did no planning, and it all worked out.

The big idea in Atmos Fear was the paradigm shift brought about by the collapse of oil prices. In that light, it’s amazing how many Western players are now pushing for higher oil—when I wrote the book we were at one hundred bucks a barrel—since then we’ve touched twenty-five.

Consistently low oil prices mean the end of Mid-East sponsored terrorism, but the West didn’t cheer the low prices. Gas prices in Europe should have halved, but instead a lot more money is going into a few people’s pockets.

Which brings me to The Hourglass. The demise of the middle class, the widening gap between haves and have-nots, the enormous and insoluble drama of youth unemployment in Europe—these are unquestionably big ideas.

Associated with them are two huge topics: education and medical care—I’d like my new book to dig deep into both.

When it comes to medicine, one of the fascinating aspects is called medical inflation. Excuse me for thinking of inflation as a unified concept—blessed ignorance.

Apparently there’s the one we all deal with, which governs pay increases, negative interest rates, baskets of goods… then there’s the special one. I don’t suppose that medical inflation, a particular subset of inflammation, is the only one, but it’s the one that most affects us.

Thar she blows! The incredible disconnect between real world and med world.

Thar she blows! The incredible disconnect between real world and med world.

Suddenly, at the end of the 1970s, when Ronald Reagan and Margaret Thatcher came to power, the gap between the consumer price index and so-called medical inflation began to widen—the fun thing is it’s been widening ever since.

Last year, UK medical inflation was in the region of thirteen percent, at least for insurance purposes. That means your premium goes up by that amount even before factoring in other costs—after all, you are one year older.

Gap in medical inflation (MPI) and CPI world wide over the last two years (source: AON)

The numbers in the table are stunning, but the comparison will be more evident if we take the ratio of MPI/CPI and look at the various world areas. You see, a quick glance at these data shows a jump of 20% in Latin America, or 11.6% in the Middle East and Africa. Shocking, right? but their MPI/CPI ratios are both 1.8—that was the US in the late 1990s.

Whereas the European and US ratios are 3.7 and 3.9 respectively, and the UK takes the cake (or perhaps the bitter pill) with 4.9! That means the price of medical care in Britain rose five times faster than pizza and beer.

For reasons that are nebulous, to say the least, medical insurance in the UK is up almost seventeen percent this year, the lion’s share of which is due to MPI. I’m sure this trend is identical in the US and in continental Europe.

What it means for the poor, the Brexit left-behinds, can be stated in one word—nothing. The bottom of the hourglass has no hope beyond the National Health Service. In an emergency, if the lines are backed-up three months, they’re screwed.

What it means for the top of the hourglass is more expensive services. So MPI will be followed by an equivalent inflation disconnect in legal fees, investment banking fees, and any other high-value professional services.

What it means for that squeezy middle bit of the hourglass, where the sand can only fall through one grain at a time, is that workers will increasingly receive very minimal complementary health benefits.

Middle class families who aspire to an alternative treatment option for aggressive cancer or other life-threatening emergencies—the medical equivalent of the safari Big Five—are shit out of luck. That’s why I need to write this goddamn book.

The India Road, Atmos Fear, and Clear Eyes. QR links for smartphones and tablets.

The India Road, Atmos Fear, and Clear Eyes. QR links for smartphones and tablets.

 

 

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