Vacation, Adventure And Surgery?

By

Rebecca Leung

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(CBS)  This summer, millions headed out to foreign lands for vacation, adventure, tourism, or just a beautiful beach.

But how about hip surgery or a multiple bypass or a facelift?

A growing number of tourists are doing just that, combining holidays with health care, and that's because a growing number of countries are offering first-rate medical care at Third-World prices. Many of these medical tourists can't afford health care at home (the 40 million uninsured Americans, for example). Others are going for procedures not covered by their insurance: cosmetic surgery or infertility treatment, for example.

And as Correspondent Bob Simon reported last spring, the hospitals in these faraway countries are glad to have these medical tourists. In fact, they are courting their business, trying to get more people to outsource their own health care.

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Thailand is an exotic vacation spot known for its Buddhas, its beaches, its brothels, and the bustle of Bangkok.

But for people needing medical care, it's known increasingly for Bumrungrad Hospital, a luxurious place that claims to have more foreign patients than any other hospital in the world. It's like a United Nations of patients here, and they're cared for by more than 500 doctors, most with international training.

The hospital has state-of-the-art technology, and here's the clincher: the price. Treatment here costs about one-eighth what it does in the United States. It's the No. 1 international hospital in the world.

"It's sort of Ground Zero. I haven't heard anybody yet who's told us that they take more than 350,000 international patients a year," says Curt Schroeder, CEO of Bumrungrad. 

(CBS)  One patient is Byron Bonnewell, who lives 12,000 miles away in Shreveport, La., where he owns and runs a campground for RVs. A year-and-a-half ago, he had a heart attack, and his doctor told him he really needed bypass surgery.

"They told me I was gonna die," says Bonnewell, who didn't have insurance.

He estimates he would have had to pay over $100,000 out of his own pocket for the operation he needed, a complicated quintuple bypass. And he says he actually decided not to do it: "I guess I figured I'd rather die with a little bit of money in my pocket than live poor."

But Bonnewell says his health was deteriorating quickly, when he read about Bumrungrad Hospital: "I was in my doctor's office one day having some tests done, and there was a copy of Business Week magazine there. And there was an article in Business Week magazine about Bumrungrad Hospital. And I came home and went on the Internet and made an appointment, and away I went to Thailand."

He made that appointment after he learned that the bypass would cost him about $12,000. He chose his cardiologist, Dr. Chad Wanishawad, after reading on the hospital's Web site that he used to practice at the National Institutes of Health in Maryland.

"Every doctor that I saw there has practiced in the United States," says Bonnewell.

But three days after walking into the hospital, he was on the operating table. Two weeks later, he was home.

How does he feel? "Wonderful. I wish I'd found them sooner," says Bonnewell. "Because I went through a year – I was in bad shape. I couldn't walk across the room."

How was the nursing? How was the treatment?

"I found it so strange in Thailand, because they were all registered nurses. Being in a hospital in the United States, we see all kinds of orderlies, all kinds of aides, maybe one RN on duty on the whole floor of the hospital," says Bonnewell. "In Thailand, I bet I had eight RNs just on my section of the floor alone. First-class care."

That's what the hospital prides itself on: its first-class medical care, which it can offer so cheaply because everything is cheaper here, particularly labor and malpractice insurance. You can get just about any kind of treatment, from chemotherapy to plastic surgery. 
(CBS)  Kim Atwater from Bend, Ore., was on vacation in Thailand when she decided to combine sightseeing with a bit of an eyelift.

Was she nervous about having an operation done in Thailand?

"Yes, yes, I was somewhat hesitant about having any type of operation in a foreign country, and it turned out to be, I mean, it was beyond my expectations," says Atwater.

And it was not beyond her budget: $1,500, and that included a private room.

How would she describe the difference between this place and an American hospital? "It's much nicer than any that I've ever stayed in the United States," says Atwater.

The rooms look more like hotel rooms than hospital rooms, and that's no accident. The idea was to make the whole hospital look like a hotel and a five-star hotel at that. There are boutiques and restaurants to suit every taste and nationality

"Part of the concept was to create an environment when people came in they didn't feel like they're in a hospital," says Schroeder. "Because nobody really wants to go to a hospital."

Bonnewell says he's going back this fall for another checkup. He'll have to take a 22-hour flight, but there's even an upside to that.

"We do have a very unique relationship with Thai Airways," says Schroeder. "So you can buy a ticket. You can use frequent flier mileage to get your checkup."

Whatever it takes to get your business.

"And this is not the only hospital trying to outsource healthcare, is it?" asks Simon.

"My goodness, no. I, we certainly have not gone unnoticed," says Schroeder. "There are hospitals throughout Asia. There are hospitals throughout Asia, throughout India." 
(CBS)  India wants to become the world leader in medical tourism, and it might just make it. Alongside the familiar images of the country (teeming, dusty streets, and poverty) you can add gleaming new, private hospitals.

The hospital boom in India was fueled by India's growing middle-class who demanded access to quality health care. Now, the country known for exporting doctors is trying hard to import patients.

The most important player is the Apollo Group, the largest hospital group in India, and the third largest in the world.

Why is it so important to get foreign patients here?

"It makes sense to establish India as sort of a world destination for health care," says Anjali Kapoor Bissell, director of Apollo's International Patient Office.

But why should foreigners come here? Well, it's even cheaper than Thailand for most procedures, with prices about 10 percent what they would be in the United States.

Anne Bell works at the British High Commission in New Delhi. She just had a baby and says she's glad she was here, and not in England: "There's been no pressure to go home after the delivery. We've been welcomed to stay as long as we want. They're looking after the baby. They're looking after me, giving me enough time to get settled and get confident enough to go back home. Often in the UK, you might be out of the hospital within five hours if you've had a normal delivery."

And in the UK, she wouldn't have had a private room and a private bath. Not to mention massages, and yoga, too. And the doctors? Indian doctors are known worldwide, they speak English, and they're often the very same doctors you may have had in Europe or America, where many of them practiced before returning to India.

"Do you find that many Indian doctors are coming back now because of hospitals such as this one?" asks Simon.

"Yes, a large number are coming back," says Bissell. "Because they have something to come back to."

Dr. Praveen Khilnani, a pediatric intensive care specialist, worked at several American Hospitals, including Mass General. Dr. Vikas Kohli is a pediatric cardiologist who worked at hospitals in New York and Miami.

Both need sophisticated equipment to care for their patients, something India didn't have before the birth of private hospitals like Apollo. They both wanted to come back to India despite the fact that medical care costs much less here, partly because doctors make much less.

"How much less do you make here than in the United States?" asks Simon.

"Maybe a tenth or a twentieth of what we were making the U.S.," says Khilnani.

They wanted to come back, they say, because they felt their expertise was needed here in India much more than in America.

"There are probably 1,500 to 2,000 pediatric cardiologists in the U.S. I would be one of them," says Kohli. "In India, there were just four of us. I was very passionate about working for Indian kids."

Since there are so many Indians who require the kind of care that only they can offer, why is there such a strong drive to attract foreign patients?

"Who doesn't mind extra money flowing in?" says Kohli.

Stephanie Sedlmayr didn't want to spend the tens of thousands of dollars it would take to get the hip surgery she needed. And she didn't have insurance, either. So with her daughter by her side, she flew from Vero Beach, Fla., to the Apollo Hospital in Chennai. She'd never been to India before, but she already knew quite a bit about Indian doctors

"My doctor, actually, in Vero Beach, she's an Indian doctor. So, why not go where they come from?" asks Sedlmayr, who says her friends questioned her decision. "Hardly anybody said, 'Oh, great idea.'"

But she didn't just come here to save money; she came for an operation she couldn't get at home. It's called hip resurfacing, and it has changed people's lives.

It hasn't been approved yet by the FDA, but in India, Dr. Vijay Bose has performed over 300 of them. He showed 60 Minutes the difference between a hip resurfacing and hip replacement, which is the standard operation performed in the United States. He says his patients usually recover faster because his procedure is far less radical and doesn't involve cutting the thighbone.

Instead, Bose fits a metal cap over the end, which fits into a metal socket in the hip. The result, he says, is that patients end up with enough mobility to do virtually anything.

"So my patients, you know, play football, basketball, whatever you want. Not a problem," says Bose.

Until the FDA approves it, the only way to have this operation in the United States is by getting into a clinical trial. But be warned: It isn't cheap.

How much does it cost in the States?

"I believe it costs something from $28,000 to $32,000 U.S. dollars," says Bose.

And in India, Sedlmayr says it costs $5,800: "Private nurse after surgery. And, feeling always that they were just totally attentive. If you rang the bell next to your bed, whoop, somebody was there immediately."

Sound too good to be true? Don't forget: It's at least a 20-hour trip, there is malaria in parts of India, patients have complained of intestinal disorders -- and if something goes wrong, you could end up suing for malpractice in an Indian court.

And one could only wish you the best of luck. But Sedlmayr feels she's already had more luck than she had any right to expect. By the time 60 Minutes left India, she was into the tourism part of her treatment, convalescing at a seaside resort an hour's drive from the hospital.

"Is this standard, that when somebody gets surgery at the hospital to come to a resort like this afterwards?" asks Simon.

"Yeah, they suggest it. They recommend it," says Sedlmayr. "[It cost] $140 day for myself and my daughter, including an enormous fabulous breakfast that they serve until 10:30."

"I think a lot of people seeing you sitting here and what's usually called post op, and hearing your tales of what the operation was like, are going to start thinking about India," says Simon.

"Yeah, and combining surgery and paradise," says Sedlmayr.

ALAN HOLLINGHURST IN COPENHAGEN

Denmark’s oldest museum is all about a single artist. Alan Hollinghurst, author of “The Line of Beauty”, revisits a temple of idiosyncrasy ...

From INTELLIGENT LIFE Magazine, Summer 2011

 

I’d had no more than a quarter of an hour there, five years before, but it had left me with strong and peculiar memories. The works themselves, the hundreds of sculptures in plaster and marble, had been impressive, but the building that housed them was what stayed in my mind. I’d seen nothing else like it: a massive free-standing Egyptian temple, painted a bright ochre; figures moving in frescoed procession around its outer walls, cream and ochre and plum against black backgrounds; a glazed inner cloister, in which statuary gleamed or hid in stripes of sunlight and shadow; and running round it, red, green or purple rooms in enfilade, like cells or stalls, each holding a white marble hero or goddess. The inspired colour scheme of these rooms, faded and subtilised by time, was unusually striking. It continued in the long central courtyard, frescoed with soaring palm trees, where the great Danish sculptor Bertel Thorvaldsen himself was buried, as if in a northern dream of the south.

 

I’d been in Copenhagen for a book fair, and my Danish publisher, knowing I was interested in buildings, had urged me at least to have a glance at this “most singular” museum before catching my plane home. At the time I had barely heard of Thorvaldsen. The museum’s collection was evidence of a major artistic figure, if not exactly of a major artistic personality. The neoclassical idiom of his work, with its idealising reliance on antiquity, lacked the kind of expressive individuality that I felt I most prized.

 

Thorvaldsen (1770-1844) was the son of a poor Icelandic woodcarver and a Danish mother. He was sent as a boy to the Royal Danish Academy of Fine Arts in Copenhagen, where he won prizes at every stage, culminating in the Great Gold Medal, which came with a travelling scholarship. So in 1797 he went to Rome to learn carving in marble (not readily available in Denmark), rapidly developed a successful practice and ended up staying there for the next 40 years. I had seen him likened to Keats as a humble-born genius who had mastered the educated repertory of classical allusion, but I had seen nothing of the teeming individuality of Keats, the intimacy or originality. I wasn’t sure I knew how to look at Thorvaldsen. Could I even tell him apart from Canova, the great contemporary whose death in 1822 left him the most celebrated and sought-after sculptor in Europe? 

The city itself, with its wonderful walkable network of old streets and squares and its many towers outdoing each other in fantasy and strangeness, had been turned into a hell of hoardings, barriers, Portakabins, pile-driving and excavations. A new metro was being installed, traffic was diverted, and in the cold early morning the streets were possessed by thousands of cyclists, red-faced in the wind, yelping at any incautious pedestrian who strayed into their lanes. On my way to the museum I warmed up (not quite the right word) at Vor Frue, the cathedral of Copenhagen, designed by the severely neoclassical court architect C.F. Hansen and completed in 1829. The great bare barrel-vaulted nave is lined with Thorvaldsen’s monumental figures of the Apostles, but the eye goes at once to the high altar, dominated by his immense bearded Christ, standing with hands stretched out and down to show the stigmata. It still leaves me cold, but I see that the trick of it is to draw the viewer forwards, so as to meet Christ’s downcast gaze. Noble and impersonal, it has lent itself to endless reproduction: copies of it adorn Temple Square in Salt Lake City and other Mormon churches across America.  

 

Seen after Hansen’s fine but chilly work, the architecture of the Thorvaldsens Museum seems all the more exhilarating. The building trumpets its own idiosyncrasy. Its 39-year-old architect, M.G. Bindesbøll, had only one previous work to his name, a grain drier in Norway. Somehow, in competition with far more established figures, for what was to be the first museum in Denmark and a celebration of a national hero, his vibrant novelty won out. The times were changing, and Bindesbøll seems to have been ahead of them. Absolute monarchy in Denmark was to end in 1848, the year the museum opened, and the academic classicism associated with the old order was subverted and reinterpreted in a colourful, eclectic and newly democratic light. Bindesbøll had travelled widely in Greece and Turkey, and his liberated delight in coloured decoration is shown in the drawings he made there, which fed into the vivid decor of the museum.

 

The temple-like front is as powerful as I remembered, with five huge splayed doorways, outlined in white against ochre, and tall, pleasingly trapezium-shaped brown doors—a shape repeated in the articulation of all four façades. It is what gives the exterior of this Greco-Roman building its Egyptian look. The magical feature, though, is the two sequences of frescoes by the artist Jørgen Sonne, which run round three sides of the building. They tell the story of the museum itself. In the first strand we see Thorvaldsen’s return to Denmark in 1838. Excited crowds gather and wave; in one panel a woman has fallen into the water and is helped back into a boat. Thorvaldsen himself steps ashore in the final panel, to be greeted by various dignitaries and friends, while behind him the mauve-shirted, white-hatted rowers raise their slanting yellow oars in the air. The drawing is lively and clear, and the faces of the unnamed figures typically more strong than handsome, but this side of caricature. The action, all round, unfolds against a black sky, and the boldness of the colour scheme is, oddly, both powerful and charming.

 

On his return to Copenhagen, the elderly Thorvaldsen announced that he would leave the contents of his Roman studio as well as his own large collections of antiquities and paintings to the nation if a museum were specially built to house them. Around the other two sides we see the arrival of these numerous objects, with the frigate that brought them, anchored along one corner of the building. From it emerge, first of all on rowing boats, and then on primitive wagons and litters, the accumulated spoils of Thorvaldsen’s immensely productive career. There are echoes of a Roman triumph, but here the labouring townspeople who are pushing and heaving the trophies are themselves the victors, or at least the beneficiaries, barefoot in accordance with classical precedent, but otherwise in modern breeches, waistcoats and rolled-up sleeves. The Phrygian cap of the kneeling marble Ganymede bobs along beside the red peaked cap of the foreman supervising his transport. The pensively inspired Lord Byron, perched on a broken Grecian column, pen raised to chin, is tended by five men earnestly involved in their own practical task (a sheet caught in a wheel of the truck threatens to be a problem). Noble artworks are shown in the care of the common man. His appreciation of them remains a matter of conjecture: an element of latent comedy coexists with the expression of a tribute. One group of men rest and mop their brows from the effort of pushing Copernicus. Another man with a bust under each arm has a profile to rival either of them. It is hard to convey the simultaneously workaday but momentous, festive but solemn nature of this frieze, which also forms an unusual advertisement for the contents of the museum, “like a sign for a menagerie”, as Bindesbøll said, depicting highlights of the show inside.

 

In the upstairs picture galleries there’s a painting by Friedrich Nerly that shows the transportation involved at an earlier stage of the artistic process. A gigantic block of marble, with “Thorvaldsen Roma” marked on it, is dragged along a road from the quarry by a team of six exhausted and collapsing buffaloes. We sense that something superhuman will in due course take place. In another painting we see Pope Leo XII visiting Thorvaldsen’s studio, a tiny figure in pink dwarfed by the congregation of immense white sculptures. (The artist appears to be introducing the pope to Jesus Christ.) Thorvaldsen and his team of assistants worked often on a colossal scale. Yet all the largest works in the museum are plaster—usually the original plasters that served as models for the marble, or occasionally bronze, final works, and so fresher and closer to the artist’s original vision for all their ambiguous air of being merely copies, or plaster casts. But, being plaster, they have discoloured over their nearly two centuries of existence, from the stove and candle smoke of their days in the Roman studio and from the different pollutants of modern life; they show varying degrees of grubbiness, and many of the smaller busts look as if blackened by incessant handling, though really it seems only by the air. It takes a bit of getting used to, and is shown up all the more by juxtaposition with the sculptures in flawless white marble.

 

Those giant works call for giant rooms, of which there are two, one of them a church-like space containing the original plasters of “Christ and the Twelve Apostles” where groups of young schoolchildren tend to gather. The other, larger hall was originally the entrance, running the width of the building behind the five great doors, and with its high barrel vault and attic windows it reminds me just a little of the concourse of some very grand neoclassical railway station.

I guessed that the essential thing, with work of such restraint, was to have plenty of time for it; and this spring I returned for a whole day, starting with a privileged hour before the public was admitted. I would be able to dwell on the sculptures, and return to them in changing aspects, as the shafts of sunlight steepened and slid across them. For nearly a century after its opening in 1848 the Thorvaldsens Museum was lit only by natural light; in the depths of the northern winter it must have been a most mysterious and sepulchral place, the works emerging from the shadows only for a few hours each day. On a dazzling March morning it promised to come to life.

It is dominated at either end by two equestrian figures that seem all the more stunning for their size, each over 15 feet high, and further raised on substantial plinths. On the left Prince Josef Poniatowski rides forward in classical dress, like a supersized Marcus Aurelius, but flourishing a sword rather than the open hand of command. Facing him, Maximilian I, elector of Bavaria, sword sheathed but right hand pointing forward and up, bears down on us magnificently. Poniatowski was designed for Warsaw, Maximilian for Munich. Between them, along the walls, are the seated Copernicus, for Warsaw, and Pope Pius VII, for his tomb monument in St Peter’s. It is like some ad hoc Pantheon. Thorvaldsen seems to have been unconcerned by the ideology of his subjects or patrons, though the commissioning of a Danish Protestant to do a papal tomb was evidently controversial. The Poniatowski monument suffered repeated vicissitudes, at the hands of Tsar Nicholas I, who wanted it destroyed, and of the Nazis, who blew it to bits when they evacuated Warsaw in 1944. It seems to me both powerful and elusive, because of Thorvaldsen’s characteristic way of sublimating the thrilling drama of his subject’s end (riding his horse into the River Elster to avoid capture during the Napoleonic retreat) to some more timeless and impersonal image of noble leadership. The original commission had been for Poniatowski to appear in Polish cavalry uniform, the horse rearing before its final jump. Thorvaldsen’s quite different conception is impressive and even inspiring, but not a bit dramatic.  

 

It helps to know the stories behind the works, and part of their remoteness to me is due to a patchy classical education. In the long sequences of smaller rooms I am more struck by this distance, and by the rewards of overcoming it. There is a famous “Mercury”, perched on a tree-stump: a fine youthful figure with the perfection of feature and worryingly tiny penis one expects from a neoclassical artist. He has been playing panpipes, now held away from his lips, while his other hand, behind him, has begun to pull his sword from its sheath. I need to be told that he has just charmed Argus to sleep, and is about to kill him. Then the graceful young man in his winged helmet becomes more than picturesque, and I see that Thorvaldsen has chosen a moment, not of drama, but of tense equipoise between two actions. I need, too, to come close and, as with the heroic Christ, meet the downward gaze of the now rather terrifying blank eyes.

  

The question of how these works were viewed when they were most prized is an interesting one. When the museum first opened, children under confirmation age were not admitted alone for fear of the nudity. In a nearby room there is the superb “Jason with the Golden Fleece”, naked but for sandals and helmet. Eyeing it from across the room is the bust of the wealthy Anglo-Dutch art collector Thomas Hope, who commissioned it, and thus enabled the young Thorvaldsen to stay on in Rome. Thorvaldsen took 25 years to produce the marble figure, which is both a spectacular showpiece and a kind of emblem of his Roman career. Nearby are Hope’s wife and his two sons. Like many other subjects of busts, Hope tests Thorvaldsen’s neoclassical code; what we see of him is conventionally naked (great men, like Byron and Frederick VI, may have togas or sword belts across bare chests) but portraiture still requires a likeness, in this case involving exuberant Regency sideburns. The relationship between Jason and his owner, and his owner’s wife and children, has an historical piquancy and even a faint comedy of a kind Thorvaldsen generally prefers us not to see.

 

Upstairs there are half a dozen portraits of Thorvaldsen himself, which cumulatively show what a lion he was, and prove, rather as pictures of Liszt do, that here was an irresistible subject. He had (the one thing his own sculpted self-portrait cannot convey) the most mesmerising grey eyes, so persistent in portraits from youth to old age that the emphasis on them cannot be mere romantic exaggeration. Indeed, they tend to be rendered with a virtuosic lifelikeness that seems conscious of the distinct responsibilities of paint as opposed to marble. They are the eyes, one realises, as one wanders on from room to room among the things he made and the things he collected, that are the occasion and sine qua non of this whole extraordinary place.  

 

Thorvaldsens Museum  Bertel Thorvaldsens Plads, DK-1213 Copenhagen K, Denmark; +45 33 32 15 32; www.thorvaldsensmuseum.dk. Open Tuesday to Sunday, 10am to 5pm; closed Mondays, and December 24th, 25th, 31st and January 1st. Admission DKr40 (approx €5.40/£4.70), under-18s and art-history students free; everyone free on Wednesdays 

Alan Hollinghurst won the Booker prize in 2004 for his novel "The Line of Beauty". His latest book, "The Stranger's Child", is out now. Picture credit: Mikkel Ostergaard 

 

Goodbye to bricks and mortar

TO DESCRIBE the woes of bricks-and-mortar bookstores is to join the dirge-singing chorus. Everyone knows the tune: sales at bookstores have fallen because buyers are ordering books online or downloading them to e-readers. Bookstores may be great places to browse and linger, but online is where the deals are. In the latest chapter in the Borders saga, the bookstore chain has agreed to sell its assets for $215m to Direct Brands, a media-distribution company owned by Najafi, a private-equity firm, which would also assume an additional $220m in liabilities. This will serve as the opening bid for the company’s bankruptcy-court auction, scheduled for July 19th.

Whatever happens at the auction will dictate the fate of the bookseller, which has already closed more than a third of its stores. Because Direct Brands is an online- and catalogue-based distributor of music, DVDs and books (such as the mail-order Book of the Month club), some speculate that a deal with Najafi will do little to keep the remaining bookstores open. Rather, the company will probably see value in the Borders distribution network and liquidate most everything else. Regardless, the story doesn’t look good for store employees and their dwindling patrons. (The company, which employs more than 11,000 people, has racked up more than $191m in losses since seeking bankruptcy protection in February, according to the Wall Street Journal.)

Like Barnes & Noble, Borders has a reputation for being a brutish corporate behemoth that has been edging out more humane book-selling competition for decades. Isn’t this just a story of comeuppance? But as we noted in March, these colossal book empires have also played an important role as often lone bookstores in small American towns and suburbs, where readers may otherwise be limited to what can be found at Wal-Mart. A friend and former colleague who grew up in Texas often bristled when New Yorkers kvetched about stores like Borders. When one of these multi-storey bookstores moved into his home-town, he couldn’t believe his luck. Urban centres can be counted on to provide affable places to buy tomes, flirt with bookworms and listen to visiting authors. Elsewhere it is stores like Borders that have provided a rare, atmospheric and pressure-free space for bibliophiles, often in strip malls next to a Home Depot.

But alas, this precious “pressure-free” element may be the problem. Now that these bookstores are closing, local papers are lamenting the loss even as they profile customers who never quite managed to open their wallets. A recent article in the Elk Grove Patch, for example, considered the precarious fate of its local Borders bookstore—the only non-religious bookstore in the Californian city, just south of Sacramento. Yet the locals quoted are perfect examples of the problem:

"I just come in here to have coffee and say hi to my friends," said John Vega, 73, a former Marine and amateur novelist who lives in Elk Grove. "I wouldn't buy a book here."

"People come in and they take a $25 book, read the whole thing and put it back on the shelf," he said.

Then there’s Emmanuel Evans, a 19-year-old “comic-book aficionado who says he's burned through at least 50 books while crouching in the store's cozy aisles.”

Nashville, Tennessee, is still reeling from several bookstore closings, including a Borders and the more beloved Davis-Kidd. The result, as reported in the Nashville Scene, is an “object lesson in how truly awful it is to live in a town where used bookstores and the pitiful offerings of Books-a-Million are all we have.” The problem, however, is that no one seems willing to buy full-price books anymore. Campaigns to get people to buy books from their local bookstores—such as “Save Bookstores Day” on June 25th—miss the point. While there is demand for real bricks-and-mortar places to gather, drink coffee and read new books, such places can’t exist if the market can’t accommodate them.

Besides coffee, access to Wi-Fi and the occasional yoga mat, what will people pay for to enable a bricks-and-mortar bookstore? Could independent stores charge membership fees, which grant access to books at slightly lower prices? Would a corporate-sponsorship model work? (For example, Eli Lilly could sponsor “Books by authors on Prozac” month at the local haunt.) Perhaps bookstores could become tax-subsidised places where people can browse and linger, but only borrow the books for limited periods of time—what the hell, let’s call them libraries.

At any rate, the market is squeezing out a meaningful public space. It will be interesting to see what fills the void these bookstores leave behind.