John Q and Health Care Policy
Thursday, March 7 2002, 4:53 PM
John Q is on theater screens nationwide, but the healthcare debate it sets out to provoke is missing in action. As the film's lead actor, Denzel Washington is doing a better job leading healthcare debate than the legislators who have an electoral mandate to deal with the issue.
The film tells the story of a behind-on-bills Illinois metalworker, cut to half-time hours due to the recession, who discovers that his young son has a fatal heart illness. Unfortunately, he also discovers that his firm has changed health insurance providers and that the new plan will not cover the cost of a heart transplant.
Callous hospital administrators are more concerned with profitable patients than cash-only working class patients. Despite John Q's best efforts at raising cash and the contributions from his neighborhood, he remains far short of the funds needed.
When the hospital is about to put his rapidly-declining son on the street to die, John Q invades the emergency ward to take hostages and get his son onto the transplant list. As the media take hold of a dramatic story, a mob of citizens surrounds the police lines chanting for John Q and healthcare. John Q is on the verge of making the ultimate sacrifice by putting a pistol to his own head to provide a compatible donor heart, when a convenient Hollywood miracle gives his son a fresh heart and a chance at life.
Cinematically, it's not much of a film. John Q packs too many hackneyed dramatic conventions onto celluloid to count. But then, in narrative terms, the immensely influential Uncle Tom's Cabin wasn't much of a novel. Mixing sentimentalism and human rights, however, remains just as potent a formula in the twenty-first century as the nineteenth.
As John Q bends over his barely-conscious dying son, tears flowing and prepared to sacrifice himself from a father's love, the scene's unlikeliness does not prevent an audience from sympathetic identification with that love. That improbability only expands on realities where loved ones do die because health care that should be available is not.
Since sentimentalism proceeds from an underlying cause of complaint against injustice, the villain is clear: it's all the fault of a healthcare system that caters to the rich and well-insured middle classes while denying quality care -- or even life itself -- to the uninsured and to poor people.
That over forty million Americans do not have health insurance and many more have inadequate insurance is a national scandal.
That morbidity and mortality indices rank the United States so low internationally -- and at Third World levels for the inner city and rural poor -- is just as much a national scandal.
And that the action thriller film has to substitute for a serious reform initiative is worse than a scandal. Instead of socialized health care, we make do with populist films that stage a radical discontent.
The root cause of illness in the US health system does not require complex diagnosis. In the United States, unlike many other countries, health has been treated as a commodity rather than as a human right. Health care has been commodified in the same sense that one buys a can of peas from a store shelf.
Health care costs money, industry 'experts' remind all listeners quite superfluously. Education also costs money; we nonetheless view it as both human right and public benefit. A high school education is a social entitlement but cardiac surgery is not?
Political debates on US health care center almost exclusively on delivery models, cost and cost containment, not on entitlement. These debates represent a contest between different sectors of the health care industry, not a broadly democratic discussion. John Q voices public demands for immediate change, which on the Bush administration agenda is about equidistant with the Andromeda galaxy.
It says a great deal about the frozen debate that Hollywood scriptwriters evidence far more acute vision than do the political classes concerning this long-needed re-centering of debate towards entitlement, replacing accountancy with human decency.
Precisely this sort of paradigm shift must happen in health care debates in the United States. A change from economic paradigms to a human rights paradigm is the most important beginning for change. Too many in the United States remain convinced that health care is a cash-and-carry item, largely because they know no other system.
In Europe, as counter-example, the proposed new Charter of Fundamental Rights, which will serve as constitutional map for the European Union, states "Everyone has the right of access to preventive health care and the right to benefit from medical treatment A high level of human health protection shall be ensured in all Union policies and activities."
Many EU countries have established social health systems that are three generations old already, despite the setbacks endured under health privatization initiatives since the 1970s. The basic framework of socialized medicine remains in place because the concept enjoys extraordinary popularity, even among conservative voters. Whatever their own problems with surgery queues, Europeans usually view US health care provisions with horror.
In the United States, by contrast, a major overhaul of the health care system died beneath a full-scale assault by the health care industry and Republican ascent to Congressional power in 1994. The Clinton administration managed to obtain an extension of health insurance to children, where sentiment could obtain political results, and accomplished little more. After all, the Clinton family had perfectly adequate health insurance.
The most basic health care need in the United States is a paradigm change, from commodity to human right. An amendment to the US Constitution to guarantee health care provision would provide a dramatic initiative towards realizing this change in political consciousness. A guarantee of life is the most basic of human rights and health care realizes this right.
Joe Lockard is a member of the Bad Subjects Collective.