On The Bloomberg Candidacy

I started out being for Amy. Then I switched to Elizabeth Warren. Then I did a full 180° away from her, favored Amy again and Mike Bloomberg (tentatively), and that's where I stand today. I doubt that my course is aberrant; many people are searching.

But as I'm searching, hoping for the magic bullet that will displace the affliction named Trump and install a high-quality new President, as I listen to what other people think, I worry that Bloomberg's entry into the race is too much of a deus ex machina solution, and maybe I'm overlooking the effect of a billionaire parachuting in. Is it unfair, and is it destructive, just in the way it is being done? Forget his policies for the moment, just look at the method.

That's what I did, and here's what I came up with.

Money and politics have never been strangers to each other – “money is the mother's milk of politics” – and the Michael Bloomberg candidacy has illuminated the connection anew. Rich people have run before, big money has been behind many candidates for a very long time, there have been “kingmakers” with access to money, and even George Washington is reported to have been one of the richest men in the country. But the Bloomberg candidacy is unique. His money is not hidden but in full view, and his bankroll is so immense that he can finance not only his own campaign but the campaigns of many others with no help from others. One man, one bankroll.

I want to examine the criticisms of Bloomberg's campaign, but first, let me briefly mention what some of his proponents say about this kind of campaign. Trump actually made a mendacious defense of his own campaign that could fairly be applied to Bloomberg's – funding ones own campaign avoids entanglements with other funders who will often expect favors in return, if only for access. A second defense is that a very large campaign chest will be necessary to meet Trump's huge cash advantage. Third, proponents rightly declare that Bloomberg's candidacy is not a vanity project, that he is a known political actor who has used his wealth in the past for many worthy causes: gun control, coal factory abatement, public health and hospitals, and many others. Fourth, many welcome his entry to the field as an anyone-but-Trump effort by someone who can arguably win. And finally, many welcome him simply for his qualifications – no candidate rivals him for his combination of private and governmental executive experience, reminding us that New York City has a larger population than 38 of the states.

But those points having been made, others are not so sanguine. Besides criticism on the issues, which I will not take up here, the very fact of a billionaire self-funded candidacy seems to have two basic critiques. One centers simply on his being a member of the billionaire class, who are not to be trusted. The other centers on how the process of running for office is unfairly easier for a billionaire than for someone with more ordinary means. Each observation deserves scrutiny.

Billionaires Are Suspect

Some say that billionaires are objectionable, obnoxious, selfish, exploitative possessors of ill-gotten gain, and probably a lot more. Some say a billionaire will inevitably protect their own interests and the interests of other billionaires, will lower taxes on themselves, maintain their deductions, protect the banks and instruments of capitalistic concentration. Some say they have no feeling for the situation of ordinary people, especially those of color, and will therefore inevitably shortchange them.

I don't know any billionaires personally, but I have no doubt that many billionaires would fit these descriptions. (I love one scientific study that posted observers at a difficult intersection and found that the more expensive cars were more likely than the less expensive cars to disobey the law.) We know that the wealthy and large corporations have lobbied their way to unfair governmental favoritism. To put it the issue more generously, we know that every person has perceptual limitations, and that each person is especially cognizant of conditions of their own background, which is why Sonia Sotomayor and before her, Thurgood Marshall, have been so very valuable on the Supreme Court. Billionaires would be no exception to this rule of thumb.

But while we can be suspicious of how a billionaire might act, we also know how unfair it is to assign attributes of any group to a member of that group – be it gender group, sexual orientation group, religious group, national group, income group, professional group, regional group, political group, racial group. Makimg this assumption is, in fact, the very definition of prejudice. Calling Bloomberg “just another billionaire” is a lazy attribution. For one thing, just look at how different are the billionaires who have been running this last year – Howard Schultz, Tom Steyer, Bloomberg, and (possibly) Trump.

Maybe the most inspirational way to make this point is to cite example of President Franklin Roosevelt. No one could have a more patrician background than FDR, yet no one could have been a better friend to the poor and the working and middle classes than he was. Perhaps triggered by his being afflicted by polio and making friends with the poor white people near Warm Springs, Georgia, whom he befriended when he established his therapeutic community there, certainly reinforced by his equally patrician wife Eleanor, FDR's mission as President was to be a protector of the common person, so much so that he was called “a traitor to his class.”

Would Bloomberg qualify as a neo-FDR? Probably not; who would? But the point is, it's possible, and dismissing Bloomberg as simply “another billionaire” is foolish.

Self-funders Have An Unfair Advantage In Running

It is undoubtedly true that billionaires who self-fund face markedly fewer obstacles to their candidacies in comparison to the usual candidate. The American system of financing political campaigns is in itself unfair and inefficient. Fundraising diverts the time of candidates and congresspeople away from their actual work in policy and politics. The built-in conflicts are obvious, not only for those who take the traditional route of cultivating wealthy donors, but even for those taking only small donations. The poor cannot contribute, and a decision to take only small donations contributes to social conflict – witness the fury against the rich manifested by Sanders and Warren, both of whom refuse large contributions and eschew super-PACs.

(In fact, if you think about it, it's amazing that so much about a campaign is focused on money. How to raise it, who is raising it, who gains favor by it, how people vote with their pocketbooks as to who gets to be on the debate stage, that it is to some extent a microcosm of how much our whole society concentrates on money. It's really quite an indictment of our society, from an anthropological point of view.)

Clearly, a self-funded campaign avoids the pitfalls of raising money that others face. I can well understand the fury of those candidates who have had to scrape and beg for money and been hamstrung by its lack, and who now face the disadvantage of not being able to match, despite their efforts, the huge Bloomberg resources for advertising and campaigning.

Nonetheless, can one really say that he is “buying the nomination?” I think not. If so, Schultz and Steyer would be more relevant. Yes, you can buy access and attention, but the voters still have to like what is presented to them, and the media will give free rein to those who would criticize.

Moreover, if one could buy the nomination, why didn't Bloomberg come in early and sweep the field preemptively? He did quite the opposite, waiting until is was almost too late. When his early analysis led him to conclude that he was an unlikely winner – despite his resources – he let the game play out without him. It was only when Biden showed weakness and Sanders showed strength that Bloomberg concluded that he was needed, and that he had a chance.

Moreover, it's not only billionaires who have enhanced access to running. What about movie actors? Their fame provides access, which can be viewed as unfair – what does fame have to do with governing? But they have not been able to sweep into office any more than Bloomberg can, although if they perform well they can be elected. Generals have also had access to nominations that others don't enjoy, and some have measured up while others haven't. Bloomberg is not just some random billionaire who thought to himself, hey, it would be nice to be President. He is arguably one of the best prepared people in our history to take on the job.

Conclusion and Suggestion

So, in sum, I think it's hard to say that Bloomberg has no business using his money to leverage himself into the race. He will still have to sell himself to the people, and it might be an uphill battle. In the end, he will have to prove himself acceptable as a prospective President, and as someone who would have the total capacity to beat Donald Trump. If he can prove himself worthy, we shouldn't deny him the nomination just because he is a billionaire. We shouldn't cut off our nose to spite our face.

Finally, presumptuously, let me offer a couple of suggestions.

I have always been taken by the brave way JFK chose to address the Catholic issue in 1960, when he gave his famous Houston speech to the Protestant ministers, asserting that a Catholic could be a good President, and how he received a standing ovation. I don't think Bloomberg has Kennedy's oratorical gift, but it might make sense for him to give a speech “Why I Am Not A Bad Billionaire.” He could take on the issues directly – Will I try to protect my billions and those of my rich friends? Why are my taxes better than Warren's wealth tax? What objectives of Bernie and Elizabeth and the other candidates do I share? (I would go for anti-trust and universal health care with lower copays and deductibles)?

Then I would take Amy Klobuchar's example of FDR's poor mourner, “I didn't know him, but he knew me.” I would praise Amy for citing that. I would say, we should all aspire to that. Then I'd say, none of us can be everything, so we all need to work together to give the country leadership. I see huge strengths in this party and in the other candidates. My hope would be to assemble us all as a team, to overcome the depredations of the last four years, to return to lawfulness, to return to decency, to return to humanity, to correct the course of this country, to raise the level of our prosperity for everyone, to become an ever fairer country, to be good global citizens, and to establish an order of dealing with the environment in a way that will last beyond our years.

I have no idea what kind of a President Bloomberg would make, or if any of the suggestions I make here will turn out to make sense for him. I'm hopeful. I'd love to see a good President come in. And it's vital, of course, to beat Trump and to foil his ongoing coup.

But we shall see.

Budd Shenkin

Adding Insult To Injury - Discoordinated Care In Large Medical Centers

How Hospitals Abuse The Fathers Of Physician-Daughters

Discoordinated inpatient care for acute conditions is a chronic disease in Academic Medical Centers, and other large medical centers as well. No one is in charge! No one person takes responsibility! Too many of the “team members” - what a misnomer that is! – partake of “it's off my plate” disresponsibility. I'm using the prefix “dis” rather then “un” because it seems to me there is a sense of active neglect, not just passive. J'accuse!

With any task, two basic factors affect your performance – incentive and ability. Is there something that makes you want to do it? It can be internal ideals – I want to be a good doctor, I want to help these patients. Or it can be external influences – it makes me money, or it helps my prestige.

The second factor is ability. Do you have to tools to bring to the task? Has the necessary procedure been invented, and all you have to do is apply it? Or, if the procedure isn't at hand, can you invent it? Are you smart enough to apply the tools, or invent them?

So, why is it that we hear so repeatedly about the discoordinated care, the poor quality care for an individual patient so often? I've blogged about this before, referring to a Health Affairs article where a doctor-daughter was unable to intercede in her father's acute cardiac care at a big medical center to forestall obviously poor actions by the doctors and nurses. http://buddshenkin.blogspot.com/2018/10/the-hazards-of-hospital-care.html. 

Now comes a similar article in the current New England Journal of Medicine – https://www.nejm.org/doi/full/10.1056/NEJMp1910499.

Here, a geriatrician-daughter finds her 72 year old father grievously mistreated after a high intensity cardiac event that brings him to an academic medical center, where team after team prescribes drugs discoordinating with the other teams, and where her father becomes severely delirious. Ironically, it is the daughter herself who in the past invented exactly the procedures to use in an inpatient setting to prevent delirium – the large medical center has not implemented these procedures, and or course she is unable to intervene in the rigid procedures of the discoordinated team to help her father. Luckily, he recovers and even goes back to his medical practice for a number of years, as did the father of the Health Affairs patient. Both cases have successful outcomes, thanks to advanced medical science, despite the severe errors and thus over-extended medical stays because of complications due to discoordination.

Why does this continue to happen? Why isn't a single person held responsible for each patient? Why isn't this obvious, repetitive problem solved? Why are not proved administrative procedures instituted universally?

Is there sufficient incentive? I guess there isn't. No doubt there are many doctors and others within the system who see the problem and wish it could be solved, but most don't understand the problems and see possible solutions, and those who do are in no position to effect the changes they would like to see.. In large bureaucratic operations, the power at the top is separated by many layers from the problems down below – and indeed, insulated from the human relations that impel any decent human being to want to solve the problem. Are they blissful in their ignorance? Maybe. Administrators are a different lot from doctors, and even doctors who become administrators can be sucked into the administrative maelstrom of ignorance and focus on goals other than patient care. If you have been a doctor, you know what problems beset the ill, you know what procedures militate against good integrative quality. If you are an administrator, you lack that experience. The best ball teams have former players at the top, some of whom are brilliant and can build great teams based on their knowledge and ability. Where are the Jerry Wests of medicine?

So, those in power might not have the knowledge necessary to detect the problem, and those with the knowledge might not have the power. So, the power of ideals is blunted by bureaucratic structure. What about external incentives, like money and prestige? Would they accrue from overcoming the iron structure of poor bureaucratic medicine? Would quality measures detect the better care afforded by coordinated care? Probably not; maybe a little. Certainly not enough so as to be palpable proof that “we are a superior medical center!” Local areas tend to be monopolistic, so in the end there are no local comparisons, and even nationally, they are hard to detect and not well publicized. Yes, there are awards and there are groups of hospitals that sign up for progressive high-quality agendas, but it takes a lot of effort to do this, and it's not clear that one receives any competitive advantage for aspiring to these higher ideals. If you are a high ideals leader of a medical center, you can do it, you can lead a medical center to high quality, just don't expect anything other than internal satisfaction and team celebration from having done it. Once again, as we are seeing in national politics, “high character” is essential.

But say the incentives are in place -- are there tools available? In a word, yes. Here in the NEJM article the anti-delirium protocols are poignantly present in the very person of the patient's daughter. I don't know the field well enough – I was an outpatient doctor – to know all the coordination tools available for high intensity inpatient care, but I'm sure they are there. They could be picked up and used, if there were a structure amenable to their use.

But in the end, of course, money rules. The medical centers are doing just fine, making lots of money, protected by their deep roots in the campaign financing lobbying system that we currently enjoy. If there were big bucks available for coordinating care, the resources of medical centers would be employed to drill those wells. ACO's might possibly supply some incentive, but it's minor in extent, and the fight over who gains what part of the extra bucks can be exhausting and disincentivizing – it's just not worth it, much of the time.

To coin a phrase, if we are to improve medical care, we need “deep structural change.” Until we have that, we will continue to read rueful articles where parents of doctors are enfolded in the arms of large systems of care where poor care is administered and the doctor-daughters find themselves unable to affect the machine they see abusing their parents and they issue a cri du coeur and the medical journal regretfully publishes it and we read of the horror and say to ourselves, maybe we'll go quickly, and we won't have to endure the insult medical centers add to injury.

Budd Shenkin

On Pete Buttigieg

Pete Buttigieg is, basically, a great example of chutzpah, trying to vault ahead of the pack with one great step. He must figure, nothing ventured, nothing gained. But accommodating to his audacity of hope by nominating him would be a vast mistake.

Let me explain.

Pete Buttigieg is an eloquent, fast-thinking, intelligent and stately young man. Some have said that he's an old person's idea of a young man, but let's just say he seems to have a wonderful temperament. He is well educated, Harvard and Oxford, has management advisory experience from working at corporate consultant firm McKinsey, has military experience at a low level in a combat venue, and has been a mayor without spectacular achievement and with some notable weaknesses, of a small city. Nice resumé for a promising young man.

But is it enough? My analogy: “I just met a really nice guy! He really seems to understand surgery, from what he says. I was so impressed! He has worked in many different settings, progressing from an aide to a medic to a physician's assistant. He is critical of many of the surgeons he has seen work. I'm thinking of asking him to do my hip replacement.”

Picture this instead: his name is placed before a corporate board. He is interviewed and his work history is reviewed. Discussion ensues; everyone has been impressed. His chief advocate to the board says, “This guy is so terrific, I think he should be our CEO!” The board members look at each other; one smiles, another smiles, and the board then erupts in laughter, understanding that it must be a joke. The laughter dies down, no one knows what to say, and then they turn expectantly to the most respected senior member of the board. She says, “Yes, you're right, he's a wonderful find for us, and the mark of a superior organization is to be able to identify quality, attract quality, nurture quality, promote quality, and utilize quality. Let's not miss our chance with this wonderful candidate. Let's jump over a couple initial steps. What division could we offer him to be the head of? Let's make sure he's on track! Let's see if he can fulfill his promise.”

He'd make a wonderful cabinet officer, wouldn't he?

Budd Shenkin

A Matter Of Sexual Taste

Colombian-American actress, model, and business-woman Sophia Vergara (https://en.wikipedia.org/wiki/Sof%C3%ADa_Vergara) has trouble ridding herself of her Spanish accent, even after years in an English-speaking environment. A mean-spirited woman observed that she speaks English as though she had a penis in her mouth.

Vergara had an amazing retort: What's wrong with having a penis in your mouth?

We think of blowjobs as something shameful. Vergara makes the point eloquently – sexual practices are not a question of morality. It's better to think of them as a matter of taste.

Budd Shenkin

A Friend's Reaction To Dershowitz's Performance

Thought this email sent by a friend to Alan Dershowitz after his impeachment performance was worth noting:

Subject: You are a fucking cunt

Aloha Professor Dershowitz,

I won’t waste your time I want you to know that I think that you are a fucking CUNT.

The arguments you made today are treasonous and I hope that a righteous America governed by our children with remember you as a charlatan. You, sir, are the definition of a self-righteous academic narcissist. Your belief in your intelligence has guided you to take such asinine positions as the one you have now made your own.

TL:DR; Fuck you, have a stroke, get hit by a car, we lost Kobe but kept YOUR shit ass??????

Sent from my iPhone

Budd Shenkin

Conservative Groups Fight Back To Preserve Surprise Billing

There is no stronger incentive than the profit motive.  Public good vs. private gain?  Capitalists will go for the latter over the former every time. 

What is the answer?  It could be regulation, but only if the government were stronger than it is.  It's really hard to think that anything positive is possible without election financing reform.

Here are the details of how reform of surprise billing is looking worse and worse.  The alternative to the Pallone-Alexander-Walden-Murray solution mentioned here, sponsored by conservative forces, which would force a bill by bill review of disputed charges, rather than a systemic revision of the system of billing out of network, is clearly unworkable, as I detailed earlier -- http://buddshenkin.blogspot.com/2019/03/regulating-to-fix-surprise-billing-and.html.

Here are the details: https://thehill.com/policy/healthcare/478818-conservative-groups-aim-to-sink-bipartisan-fix-to-surprise-medical-bills.

And to save you the trouble of clicking the link, here is the text of their account: (by the way, note involvement of Democrat Richie Neal, Chairman of Ways and Means, who has gone so easy on the Trump Administration.  (https://prospect.org/power/democrats-richie-neal-problem/)

Conservative groups are gearing up for battle with GOP leaders over bipartisan health care legislation that lawmakers view as one of the few election-year bills that has a shot at making it to President Trump’s desk.

A broad swath of free-market conservative groups is mobilizing to oppose a measure that would ban the so-called “surprise” medical bills patients sometimes receive from hospitals and providers when their services aren’t covered by insurance.

The strategy, in part, is to link the bipartisan proposal to “Medicare for All,” the single-payer health care plan backed by some progressive presidential candidates like Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.).

“There’s not much legislation out there that will make it to the president’s desk this year and this has a chance,” said Brandon Arnold, president of the National Taxpayers Union (NTU), which has spent more than $1 million attacking the bill.

Arnold warned that proponents of the measure are “going to run into broad opposition from a wide array of conservative groups who are united on this.”

“We plan to have an impact,” he added.

Patients are subject to surprise bills when they go to a hospital or emergency room that is in-network but treated by an out-of-network doctor.

A bipartisan deal reached last year by the leaders of the House Energy and Commerce and the Senate Health, Education, Labor and Pensions (HELP) committees would essentially ban providers from sending surprise bills and instead require insurers to pay them. The cost would be based on the average price for the services provided, a method called “benchmarking.”

But groups like NTU and Heritage Action argue the legislation is on par with “price controls” or “rate-setting” that would give the government too much power in the private sector and pave the way for Medicare for All, even though Republican backers of the bill proposal fiercely oppose Medicare for All.

“I’ve heard all the terminology,” said Rep. Greg Walden (Ore.), the top Republican on the Energy and Commerce Committee, in response to the “rate-setting” criticisms.

“It’s not. That’s an easy moniker to throw at it,” he said. “At the end of the day, we didn’t ask for this problem, but we’re going to solve it. We just see it as good policy.”

About a dozen right-leaning groups have come out against the bill, including some of the most well-known fiscally conservative organizations in Washington, like Club for Growth and FreedomWorks. The groups join a high-dollar fight launched last year by hospitals, insurance companies, doctors and private equity groups that are all trying to tilt the measure in their favor. 

After facing angry lawmakers and headlines about patients getting saddled with expensive bills, insurers and providers now agree patients shouldn’t be receiving them. But the two sides have engaged in an all-out war over who should take the biggest hit if changes are made.

Insurers favor the proposal offered by Walden, Energy and Commerce Committee Chairman Frank Pallone Jr. (D-N.J.), Senate HELP Committee Chairman Lamar Alexander (R-Tenn.) and Sen. Patty Murray (D-Wash.), the ranking member on the HELP panel. The lawmakers had planned to include their bipartisan measure in the 2019 year-end government funding package, but it was left out amid opposition from hospitals and providers and after a rival proposal was offered by the House Ways and Means Committee.

Lawmakers are now pushing to include the legislation in a May spending package, setting the stage for a new round of fights with conservative groups.

Alexander and Walden are retiring at the end of this term, putting extra pressure on them to get the legislation passed.

“I get it. You serve for a long time and think you’re doing what you should for your constituents, and I respect that. But we disagree with this legislation,” said David Williams, president of the Taxpayers Protection Alliance, which opposes the bill. “But it’s not the right thing for the health care industry. I won’t begrudge the effort, but I’ll disagree and make sure it won’t get passed.”

The concerted effort of influential conservative groups has irritated GOP lawmakers who had already been hearing from constituents about separate ads airing in their districts sponsored by private equity groups.

Envision and TeamHealth - staffing firms backed by Blackstone Group Inc. and KKR & Co. - spent a combined $54 million on ads last year targeting the proposal.

NTU piled on, spending more than $1.2 million since early December on radio and television ads across the country, including in states and districts represented by lawmakers who are working on the legislation.

Last month, NTU spent $38,000 on 165 radio spots that aired in Nashville, Tenn.
“The only people who don’t want to protect innocent patients from unaffordable surprise medical bills are the people profiting from this anti-competitive flaw in our health care system,” said a GOP official for the Senate HELP Committee.

“Chairman Alexander will continue to keep his bipartisan, bicameral agreement to end the practice of surprise billing at the top of Congress’ to-do list until it is done,” the official said, noting that the measure has President Trump’s backing.

NTU also spent more than $261,000 on ads in the Houston market, which is in part represented by Rep. Kevin Brady (Texas), the top Republican on the Ways and Means Committee.

That spending included $112,000 for an ad that ran Jan. 12 on local TV station KHOU during a Houston Texans playoff game.

In December, Brady and Rep. Richard Neal (D-Mass.), the chairman of the Ways and Means Committee, released a competing approach to ending surprise billing favored by doctors and hospitals. Their measure would still ban providers from sending surprise bills to patients, but it would let a neutral, outside party determine how much the insurer will pay the doctor if an agreement can’t be reached privately.

The proposal is cautiously backed by some of the conservative groups opposing the Pallone-Alexander-Walden-Murray measure, though they are reluctant to offer their full-throated support until the legislative language is introduced.

“The early outline provided by Ways and Means is a step in the right direction and we look forward to working with them more closely,” said Heritage Action Executive Director Tim Chapman in a statement.

Regarding the other measure, Chapman said, “We view this as a direct step towards Medicare for All and government-controlled healthcare.”

The introduction of the Ways and Means proposal complicates matters since the committee also has jurisdiction over health care.

Pallone and Neal are to meet soon to discuss their plans and find a path forward, Neal said this past week. Walden and Brady’s teams are also talking.

“I actually think we are closer together than people realize,” Walden said. “Our teams are talking. Frank [Pallone] and I remain joined at the shoulder, the hip and probably the ankle too on this matter because consumers are getting ripped off and it’s time to move.”

Budd Shenkin

I Meet Emma Bovary Again

I met Emma for the first time maybe 15 or 20 years ago. Catching up on my education, I took the Teaching Company course on great books, and of course Emma was rightfully there. I didn't like it much. Such disagreeable characters and such a confined, judgmental society.

But that was then and this is now – and as Heraclitus said, “No man ever steps in the same river twice, for it's not the same river and he's not the same man.” For one thing, this time around I read it in French, in a dual language book with French on the left hand page and English on the right. (My edition's English translation was from 1886 by Eleanor Marx-Aveling, Karl Marx's daughter – imagine their dinner table conversations about the bourgeoisie!)

This second time through I liked it a lot more! I'd like to say that reading it in French made all the difference, appreciating Flaubert's style and his famous “le mot juste.” But truthfully, since I'm still just an intermediate French student, hopefully on the way to advanced, I have to say that the real difference was probably that I had to go slower, and had time to think and notice and to wonder. And then there's the “me” part of it. They say you decline with age, but I actually feel smarter and wiser (except for math), and I've read a lot more literature and experienced a lot more life since I first met Emma et al.

It's an amazing book. You always want to keep reading, but all the characters, emphatically including Emma, are famously unsympathetic. Julian Barnes called Madame Bovary “the greatest shopping and fucking novel of all time,” which is of course a great line. “Great novel” paired with “shopping and fucking” is a master statement, certainly more overt than Flaubert's more subtle combination of base characters and masterpiece prose. It's really amazing: no character wishes anyone else well, no one thinks of helping anyone else, no one expresses any ideals or much ambivalence about anything, no one seems to empathize or understand anyone else.

Maybe this is Flaubert's “realism.” Forget the ideals, forget the melodrama, what are people really like, what really happens? Flaubert paints them as all underside, always looking out for themselves. Emma inflates her first love affair, with her first lover Rodolphe, into a great passion with a dramatically envisioned course of running away and living on love, but he is already thinking how he will get rid of her before he has even bedded her. Homais the pharmacist eggs on Emma's physician husband Charles to try an experimental surgical cure on a servant's club foot that costs him his whole lower leg, all in the hopes of admirable postings about their fair city of Yonville in the regional newspaper. The base villain Lheureux (the happy one? Come on, Gustave, give me a break!) lures Emma into debt, bankruptcy and suicide in pursuit of filthy lucre. The gossips of the town spy maliciously. The justly famous public holiday scene displays the fatuous mediocrity of speaker and listeners without compassion – only the peasants get off easy as mindlessly happy at an event. No one, no one helps anyone else, except Emma's deadly dull physician husband Charles who, in the process of doing good and working hard, and I don't know if Flaubert suspected this, couldn't do much good at all in an era of medical ignorance – and neither could the self-important uncaring consultant physicians and surgeons who appear. My God, what a group of no-goodniks! Only the ignorant peasants are happy in their simplicity. You can understand why “bourgeois” is an epithet.

I guess most people are very critical of Emma – prideful, deceitful, adulterous, shallow, selfish, cruel, and worst of all, an unloving mother. It's warranted, although I would give her a pass on what the book makes the most of, adultery. But still, for all her shortcomings, I found myself being sympathetic to Emma. I thought, what were the alternatives offered to a spirited, highly-sexed, not naturally conforming woman in 19^th century provincial France? What else was she supposed to do, being who she is, and living where she does? Raised in the provinces, reading romances secretly as she is educated in a convent, reading the Parisian ladies' magazines after that, is she going to let life go by, her with her dull husband and some needlework? She grabs what the winds of chance provide her. She is criticized for being self-conscious when she sees her reflection and the physical signs of her fulfillment and says, “J'ai un amant ! Un amant !” In other words, “I did it!” Well, good for her, I say! Give it your best! It's not an aberrant reaction. I remember my son Pete when he got his first acceptance to a law school – he looked at me, he looked at the sky, he said with some wonder in his voice: “I'm going to be a lawyer.” It's not that big of a difference, and I don't mean as a cynical lawyer joke. Dreams are dreams, who are we to judge?

It turns out the guy Emma chooses first is a turkey, but that's life. Then she tries again with the younger Léon, where they have a regular room at a hotel in Rouen. I've often thought we should have the right to health, education, and sexual fulfillment. Why not? I'm on her side. Again it works out badly, but again, you do what you can do in the circumstances you find yourself, with whatever resources you have. At least she tried. I remember my wife's comments when Clinton got into his Lewinsky trouble – she said, if he wanted some action on the side, couldn't he have found someone with class, who knew how to keep a secret? You do what you can do.

(Just as aside, I wondered what the clerks at the hotel thought, what their views of life were as they saw all that happened in their hotel. Maybe it was like Love Boat. I remember that when I was first in practice the older pediatrician who was my office mate had certain patients that his staff booked for longer visits, calling them GLM visits – good looking mothers. Propriety can be just a question of how far you go.)

And the fact that Emma was lured into being a spendthrift just makes me sad, and angry at the perpetrator. I thought, at least Flaubert didn't make him Jewish. I think about Emma being led down the garden lane by this slime – who was there to help her? Who was there to consult with, someone who knew more and wished her well? What do you do when no one prepares you, when your parents were no help at all? It's so sad when you are all on your own, YOYO. What a wasteland when no one cares for anyone else or helps anyone else.

Of the millions of words that must have been written about Madame Bovary, I sampled some on Google. I was surprised that my readings didn't emphasize the feminist issue more – I just missed them in my cursory search, I'm sure. But the plight of the woman in provincial society is so obvious. Talk about oppression! I mean, what were the choices?

(Just one more by-the-way comment before I set out what I thought most interesting of the comments I read – how come there isn't more talk about pregnancy, not here, not in The Red and the Black, nowhere. What did these people do? Propriety reigns not only in the provinces but on the page. To be fair, in Les Liaisons Dangereuses, the sixteen year old does get pregnant.)

I enjoyed the articles I read on Google, and here are a few for your interest:

Nick Fraser, The Guardian, 2010

https://www.theguardian.com/books/2010/nov/28/madame-bovery-flaubert-lydia-davis-review

But I also know that I shall never really comprehend the full extent of the damage done to our illusions by Flaubert's great book.

Are we capable of being truthful? Do human beings ever really tell the truth about the things that really matter?

Me: I guess others feel this way, but I don't. My problem is always the opposite – I do good things, and then I'm suspicious I did them for selfish reasons that I am hiding. I suspect my own generosity. Flaubert's conceit was that he revealed the selfishness by finding it everywhere, pervasive, and exclusive. I think that's excessive. What would he have done with righteous gentiles who hid and saved Jews, who must have existed even there in Normandy?

"... None of us can ever express the exact measure of our needs," he observes in what must be the book's most celebrated mot, "or our ideas, or our sorrows, and human speech is like a cracked kettle on which we beat our tunes for bears to dance to, when we long to move the stars to pity."

Me: Reminds me of Robin Williams saying “Everyone you meet is fighting a battle you know nothing about. Be kind. Always.”

Me: I don't know where I got these quotes below, which speak for themselves

The art of writing is the art of discovering what you believe.

acknowledged before anyone else: that the single-most important character in any novel is the narrator.

the very last stages of composition when, in a portentous gesture, Flaubert excised what had long served as the novel’s opening sentence in favor of a first-person plural pronoun that suddenly emerges out of nowhere. It’s arguably the world’s most famous last-minute revision of a canonical text’s opening line: What in the copyist’s final-stage typescript is still “The school clock had just struck 1:30 when the Prefect came in followed by a new boy” becomes, in the novel’s published version: “We were in class when the Prefect came in followed by a new boy”: Nous étions à l’étude quand le Proviseur entra suivi d’un nouveau (included below). The impersonality of the classroom clock is replaced by an unidentified we, not because the narrator wants this particular classroom to appear any less depersonalizing, but because he wants all of us all inside that classroom even as the author himself, slyly, cruelly, maintains his distance from the proceedings under way, like a clinician who registers but does not judge.

Reading Madame Bovary in the Provinces, Birger Vanwesenbeeck LA Times 2016

https://lareviewofbooks.org/article/reading-madame-bovary-in-the-provinces/

Madame Bovary is in part a long novel because boredom, and how it so fatally affects its protagonist

For what’s beautiful about Madame Bovary is ultimately less its stylistic bravura than its author’s deeply felt ambivalence about provincial life.

Me: Interesting point that boredom is best portrayed in a long book. I didn't get the ambivalence about provincial life, I thought Flaubert just skewered it, but on second thought, ambivalence is probably right.

Book Blog in Considering the Classics Madame Bovary, c’est toi!Dorothy Reno June 12, 2017

http://www.washingtonindependentreviewofbooks.com/reviewer/dorothy-reno

But as critics have pointed out, these are Flaubert’s thoughts, not Emma’s. And as the book carries on, the humor feels increasingly weaponized. Had this cutting wit been her own, Emma might have used it to better forge a resolve against the confines of her unhappy marriage. Instead, she takes herself all too seriously amid the grunting weasels and plopping sounds of overripe fruit. Emma Bovary lacks the comic instinct to cope with life’s follies, so it’s only natural she’ll eat arsenic.
The nothingness at the center of most hearts can be spontaneously filled with delight and the occasional act of kindness. But there is none of this in Flaubert’s masterpiece. What we find instead is a world not so much real as hypo-real, a dimension sapped of joy where misery is never instructive, where authentic human connection — of which even the unhappiest among us can experience — is missing. Madame Bovary is at once a painful correction to the romantic movement and an ever-relevant stripping down of middle-class hypocrisy.

Me: Interesting in pointing out the lack of humor of Emma, and indeed all the characters. What a vital thought. Also, apparent lack of being able to view themselves objectively, judge themselves, second guess themselves. I guess you could say all the characters are pretty stupid. I really like thinking of the book as hypo-real. I don't know if she thought of this word herself, but I find it very interesting.

Well, that's it for Emma and me. Great books can be talked about forever. Emma has certainly met that test. I'm so glad I read it again.

Budd Shenkin