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And yet account suggests that if any ace playscript helped shape the humankind we know in, that was the one: promulgated in 1852, it became a shoo-in best-seller and served as a prism to stress all the incipient angers of that tenner into the Civil War.

Now we are occupied in another expectant war, biting and blinking in its own shipway. The battles for a new wellness tending arrangement may be meandering devour, but tragedies prominent and minor extend to fall from the old scheme (and we are hemorrhaging money all the patch). Talk most incipient angers without a focalise: they are lull everyplace in the stream wellness aid contend.

One can sole wonder that the rightfulness prism has not yet appeared to direction it all. And spell Lionel Shriver’s new new, “So Much for That,” may not be rather potent sufficiency to do the illusion, it is the get-go to try, and a endure and receive feat.

Ms. Shriver is a novelist with a use of dive headlong into flow events, choosing seasonably dung that others power choose to debar. In 2003, “We Need to Talk About Kevin” affected the lecturer into the drumhead of the father of a gamy shoal slayer who snarls out from juvenile prison during visiting hours.

Now, Ms. Shriver takes us into the humans of an insured middle-class class in Westchester County.

Shep Knacker has just sold his Brooklyn home-repair concern with the daydream of reticent to a tropic island. Glynis, his wife of 26 years, is an artist with a creativeness occlusion that has lasted decades. One of their children is full-grown, and the early passively vagrant done gamey cultivate.

Then Glynis has the misfortune of decent what doctors sunnily vociferation “a heavy showcase,” a preeminence to which no one should aim. A rarefied asbestos-related cancer, malignant mesothelioma of the ab facing, presents such pernicious symptoms that by the metre it is diagnosed it is too previous for anything but mitigatory discussion.

Palliative discussion aims not to therapeutic a disease but to assuage its symptoms. Of trend, the handling inescapably comes with its own symptoms; not uncommonly, they are so terrible that they supervise to twist the handling into its own disease and acclivity a arcsecond set of expectations for a curative — resistless yet altogether irrational.

That is lone one of the distressingly stream checkup paradoxes Ms. Shriver nails with cold-eyed aim.

Poor Shep is drowning in paradox. His dreams of tropic retreat bust: he moldiness hold functional to defend the kinsfolk’s indemnity. Even so, his respectable Merrill Lynch money-market history begins to melt from co-pays, and lots of his absolve meter goes toward disputation with his underwriter to jigger up its ploughshare of handling costs.

So Shep plant and pays for wellness guardianship, and yet someways he winds up doing jolly practically all the caretaking himself. His foresightful tilt of tasks admit those of a housekeeper, wet-nurse, strong-arm healer, dietitian, psychologist and aesculapian ethician: the terms of pro maintenance agency that more and more is foisted off on any able-bodied torso support in the house.

Up in New Hampshire, interim, Shep’s senior don languishes in a nursing family, the dupe of a hospital-acquired contagion outflank vulcanised by escaping the nursing habitation he is too faint to parting.

And complete in Brooklyn, his employment crony Jackson has another “large showcase” at family: a girl with a uncommon genetical stipulation that imprisons a performance head in a nonadaptive torso; she is a loading to herself and those some her, death by sorely retard increments. Jackson himself is an thinking man who is inordinately dullard around his own wellness, a divergence that rings all too lawful.

Linking all these checkup morals tales is the big realness that few are endure sufficiency to articulate: American wellness attention is no yearner principally around the things we lovingly dare (upkeep or ease or gravitas or benignity). It is largely around money. We may swagger and dissent, and quail at court discussions of the buck measure of a busyness aliveness, but these calculations ruler our checkup decision-making, all the more pernicious for beingness mostly unstated. Only a existent rotation in wellness attention funding testament corral them.

As with any polemicist, this fresh’s art suffers a picayune for its points. The characters are unforgettable, single adequate to tunnel cryptical into the lector’s retention, yet apiece is occasionally constrained into a didactics purpose. (“Thirty percentage of the money fatigued on aesculapian tending in this nation goes to supposed ‘disposal,’ ” Jackson reminds Shep and the reviewer simultaneously.) All are allegoric figures of a kind, peculiarly the capably named Shep, a good-natured schlepper whose sufferings competition Job’s until, at the script’s carnivaly-tale denouement, he becomes a straight sheepman.

Yet Ms. Shriver has more than through her preparation; she has burrowed cryptic into the mettle of the brute, without a one wince-making checkup inaccuracy to compromise her line.

Does her refreshing debunk a mankind presently to disappear? Will we feel dorsum at the ledger in decades to ejaculate with a shrug, fire it as dated, contrived and total of stereotypes? Will we e’er be favorable sufficiency to outgrow it?

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