If you're looking for ripped-from-the-headlines relevance in your fiction, this is a bumper season. Adam Haslett's Union Atlantic tackles the financial meltdown. Ian McEwan's forthcoming Solar concerns global warming. And Lionel Shriver's outraged and occasionally outrageous ninth novel, So Much For That, takes on our broken health care system.

Her hero, Shep Knacker, is a New York contractor who, at 48, is ready to embark on his lifelong dream — with or without his wife and teenage son — to live out his days in a Third World country where his hard-earned savings will go further. But his timing for this so-called Afterlife is off: Just as he's packing his bags, his steely wife, Glynis (an artist who works with metal, no less), announces she has deadly mesothelioma and needs his health insurance. He hunkers down in his odious job working for the nasty boss to whom he sold his business eight years earlier, and dedicates himself to her care. But he soon learns just how inadequate their health insurance is.

This isn't the first time Shriver has gone for topicality: Her breakout seventh novel, We Need to Talk About Kevin, tackled a mother's guilt over her teenage son's murderous Columbine-like rampage at his high school.

So Much For That raises searching questions about the value of a human life and government's role in a democracy. It is filled with facts about cancer treatments and copayments, but Shriver does not allow this research to clog the arteries of her novel, which pulses with vivid characters.

Readers may wish, however, that Shriver had cauterized some of their diatribes. "Constitutionally obedient" Shep is the straight man to his easily riled best friend and colleague, Jackson Burdina, whose "emotional default setting" is disgust. Jackson, a libertarian anarchist whose teenage daughter suffers horribly from a rare degenerative disease, is no stranger to the inadequacies of the American health care system. (He acquires further gruesome, firsthand knowledge when he succumbs to a vanity procedure widely offered on the Internet.) His rants about bloated administrative costs, "bloodsucking greedy" insurance companies, taxes, "Patsies and Parasites," and "Mugs and Mooches" could benefit from editorial surgery.

Still, Shriver's accrual of details pulls us into the dramas of even her least appealing characters. We share Shep's frustrated alarm at his steadily diminishing bank statements as he hemorrhages hundreds of thousands of dollars not just for torturous, questionable treatments for Glynis but also to keep his father in a private nursing home where bacterial infections run rampant.

Shriver showed herself particularly adept at tying together narrative strands in the ending of her last novel, The Post-Birthday World. In So Much For That, she pulls off a memorable climax that makes a case for dying well and includes a scene that rivals John Irving's The World According to Garp for shock-and-guffaw value. It's sure to be talked about when we talk about Shriver.

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