Hillary and Louise’s Excellent Adventure – Or – Hillary Gets Even

State of Terror, the political thriller by Hillary Clinton and Louise Penny, is a satisfying romp. 

Sticking close to her bailiwick, Clinton casts her heroine, Ellen Adams, as the US Secretary of State. Ellen’s girlhood friend, Betsy, functions as her Counselor. I googled whether Secretaries of State really had Counselors. Yes, they do. 

Both women are smart, gritty and brave. Yet, because they are women, and late middle-aged women at that, they are underestimated by almost everyone, including a corrupt and venal ex-president. But they prevail, even with the Ayatollah! (This is not a spoiler. Of course, they prevail. The fun is in the “how” of it.)

I cannot help but hear Clinton’s voice and see her blond hair when Ellen Adams speaks. I remember all the times when, unlike Ellen Adams, the real Hillary was dismissed, denigrated, discounted: “Hillarycare!” Monica Lewinsky! Bengazi! And being stalked around the debate stage by Donald Trump. 

I could not help but remember all the times that I, too, was discounted by men in power. In fact, our life arcs crossed in the mid-1990s. It didn’t end well for either of us. So, I danced a little revenge dance when Ellen and Betsy took on evil doers – terrorists, traitors, dictators, government bureaucrats – and won.  

Hillary Clinton has had a hugely public life as First Lady (1993 -2001), US Senator (2001 -2009), Secretary of State (2009 -2013) and presidential candidate (2016). Louise Penny is the author of the beloved Three Pines mysteries with Inspector Armand Gamache. I have reviewed two of her books,  Kingdom of the Blind and All the Devils are Here.

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With the influx of Medicare money into hospitals starting in 1965, healthcare morphed from its roots in charitable, often religious, organizations into a humongous business. The MBAs and lawyers circled like sharks around chum.

But for those not eligible for Medicare and for those whose employers didn’t offer health insurance, getting sick often led to debt and bankruptcy. On becoming president in 1993, Bill Clinton launched an effort to provide coverage for everyone. Universal health care. 

Hillary Clinton was in charge of this project. Every person would get coverage through a health maintenance organization (HMO). The final document ran over 1000 pages. 

Hillary presented this proposal to Congress and testified before five Congressional Committees. There she sat – young, achingly earnest, whip-smart – facing a semi-circle of men in suits. The plan had powerful opponents, among them, health insurance and drug companies. They derisively called it Hillarycare. 

I am the same age as Hillary. At the time that she became First Lady, I had been practicing general internal medicine for about ten years.  I worked in conjunction with a local hospital system. It helped support my office; I taught the residents. 

I was pretty clueless about – and frankly, bored by – the business aspects of medical practice. I liked taking care of patients. I enjoyed interacting with the residents in the clinic and on hospital rounds. I preferred reading The New England Journal to spreadsheets.

I needed help with the mechanics of running an office, but I was too insignificant to the hospital administration to deserve such a benefit. It wasn’t just that I was female, or Asian, for that matter. I was not in a high-income generating specialty. 

Then one day, I was called to the CEO’s office. He was more than a foot taller than I, and had a golfer’s tan. He spoke but his words just bounced off me. I knew the meaning of the words, but not strung together, like software upgrade agreements. 

On my way out, I walked by the office of the CFO, another tall golfer. I strained to make my five-foot frame look tall. I was not going to give them the satisfaction of seeing me downhearted. It turned out that the hospital wanted to shift its presence from the City of St. Louis to the County. My office was in the wrong location. I had been cut loose, like a baseball player put on waivers. 

I kicked around working locum tenens – filling in for docs on leave. The hospital did ask me back after a few months on a similar – still not ideal – basis. I accepted. 

So, this is what I was doing when the Clintons floated their plan. 

The Clinton plan would require internists, family practitioners and pediatricians – now collectively categorized as “primary care providers” – to be the backbone of these HMOs. I had always been important to my patients but now I would be necessary to the bean counters! 

A major insurance company decided to sponsor a network of medical offices in preparation for Hillarycare. I was recruited, along with another internist, a pediatrician, an OB-GYN and a nurse practitioner, to a beautiful new facility. Coincidentally, and happily, we were all women. I felt freed up from administrative responsibilities to do what I loved – and was good at. 

Alas, it lasted only a couple of years. 

When Hillarycare failed in Congress, primary care providers lost their position as the linchpin in the healthcare delivery schema. The insurance company pulled out. The hospital systems gobbled up doctors’ practices and each other. I ended up working for an outfit whose motto was: We eat what we kill. 

Well, evidently, my kill record was insufficient. I couldn’t see patients at the clip they insisted on. I was sacked, and a three-year non-compete clause ended my career as a medical practitioner. I took a desk job. Ironically, at an insurance company. 

Hillary kept getting up after she was knocked down. I wonder how often Hillary had acted as Ellen Adams does:

“Ellen looked at herself in the mirror one last time. She took a deep breath. Stood up tall. Shoulders squared. Chin up. Head high.” 

Oh, yeah. I know exactly what that feels like. 

I wonder what I could have done differently. Was I not smart enough? Savvy enough? Or just treated badly? 

Throughout the novel, Ellen uses men’s underestimation of her as a weapon. “She knew that men like Ivanov [read Putin] and Dunn [read Trump] would always undervalue and underestimate women. Especially one who was disheveled. It was a very small advantage for her.”

Yet I wonder how many times Hillary, like me and so many other women, was sold short. And we, not the men who discounted us, paid the price.  

I imagine letting Ellen Adams get her licks in was wonderfully satisfying to Hillary. Many years ago, I started writing a murder mystery. The plot revolves around the race to find a cure for a virus – the one that causes HIV/AIDS. A tall, tanned hospital administrator dies under mysterious circumstances.

Hmm, I wonder if I can find that manuscript. 

Tell me: Anyone you want to murder in a novel?