US Pop Culture Has Long Raged Against Health Care Injustice
The memes celebrating Luigi Mangione are far from novel: they represent a long tradition of American popular culture voicing outrage at the injustices of our health care system, from Dog Day Afternoon to Star Trek: Voyager to John Q.
Denzel Washington stars in the 2002 film John Q. (New Line Cinema)
On November 1, 2000, less than a week before a presidential election in which health care was a central issue, Americans tuning into Star Trek: Voyager got a critical look at a dystopian alien medical system that uncannily resembled their own.
In “Critical Care,” Voyager’s holographic (artificially intelligent) doctor (known simply as “the Doctor”) is abducted and sold to for-profit administrative consultants who run a hospital ship floating above a polluted extraterrestrial city. Although he protests his kidnapping and demands to be released, when he is presented with dozens of seriously ill patients, the Doctor’s Hippocratic Oath obliges him to act.
Because he comes from the United Federation of Planets, a postcapitalist society where health care is a universal right, the Doctor expects care to be freely given “to each according to their need.” But he soon learns that’s not how things work at this hospital, which is divided into brutally unequal levels of care based on the algorithmic calculations of an artificial intelligence called “the Allocator.” Far from a right-wing caricature of universal health care as “rationed care,” the Allocator’s dubious calculations present a clear stand-in for the immorality of capitalist health care, providing boutique anti-aging treatments to patients deemed “valuable to society” while leaving those deemed “a drain on resources” to die of easily curable infections.
Refusing complicity in this lethal economy, the Doctor takes increasingly drastic actions. He begins quietly, pilfering a handful of medications for poor and working-class patients with more urgent needs. Tricking a supervisor into ordering surplus medications for elite patients enables the Doctor to scale up this medical Robin Hood operation. But he is soon discovered, and his working-class patients are sent home to die, including a beloved young patient who dreamed of becoming a healer himself. The Doctor’s anger and grief lead him to do something totally uncharacteristic: he poisons the hospital’s administrator, providing the antidote only in exchange for sufficient medicine to cure the neglected patients.
Despite airing close to an election, “Critical Care” could hardly be said to be taking the side either major political party. Vice President Al Gore did run on a platform of universal health care for children in 2000. But Gore began emphasizing that platform plank only after his rival for the Democratic nomination, Bill Bradley, slammed the Clinton-Gore administration’s welfare “reform” legislation for causing many children to lose health coverage in the first place. George W. Bush, meanwhile, sought to “modernize” Medicare through a suite of market-based privatizing reforms. If anything, “Critical Care” challenged both positions from the left, indicting a profit-driven system that in 2000 left 42.6 million Americans uninsured.
Perhaps the most haunting aspect of “Critical Care” is the Doctor’s uncharacteristically violent response to health injustice. When he returns to Voyager, the Doctor asks a comrade to perform a diagnostic on his AI program. To his surprise and alarm, there is nothing wrong with his “ethical subroutines.” The Doctor’s conscience, Voyager suggests, has been working just fine.
Today “Critical Care” has proven prophetic, anticipating insurers’ creeping use of AI to deny access to sometimes-lifesaving medical coverage. The Doctor’s extreme micromanagement by the Allocator, which tracks and directs his work process down to the second, readily recalls the invasive and exhausting conditions faced by health care workers and warehouse workers alike. Even the episode’s small humorous touches ring true to anyone familiar with the US health care system. For instance, when Voyager’s captain finally locates her missing chief medical officer and contacts the hospital, she can’t get through to anyone and is diverted to an irritating automated message.
From Voyager to Luigi Mangione
Revisiting “Critical Care” is instructive in a moment when popular memes expressing sympathy for Luigi Mangione, the alleged shooter of United Healthcare CEO Brian Thompson, have been subject to moralistic condemnations and warnings of a supposedly unprecedented callowness in contemporary popular culture.
As many have suggested, reactionary claims about pro-Luigi memes misread popular culture — at the risk of stating the obvious, memes are not literal. But “Critical Care” reminds us that such claims are also ahistorical. Mass culture has long given expression to popular rage and even violent fantasy about the brutally unequal state of the US health care system. “Critical Care” is in good company: Take Al Pacino’s ill-fated bank heist to pay for his partner’s gender-affirming surgery in Dog Day Afternoon (1975), or Helen Hunt’s colorful screed against HMOs in As Good as It Gets (1997), or Denzel Washington’s armed occupation of a hospital to demand a heart transplant for his underinsured son in John Q. (2002).
The killing of Thompson has prompted renewed interest in John Q, which was panned by critics and condemned by private insurers and care providers but modestly successful at the box office. In both John Q. and Dog Day Afternoon, the latter of which clearly inspired the former, raucous crowds cheer on the hostage-takers and boo the police, expressing popular outrage at widening inequality.
Although John Q. was not based on a real-life incident, Dog Day Afternoon was. The Life Magazine story that provided a basis for Dog Day Afternoon even gushed about the bank robber’s movie-star “good looks,” much as some Luigi memes do today. Ironically, John Wojtowicz, the bank robber who inspired Pacino’s character, would ultimately pay for his ex-wife Elizabeth Eden’s gender-affirming surgery from prison with money he received for the film rights to his story.
As an educator who works with the generation most impugned by the moral panic over Luigi memes, I am hard-pressed to find evidence of growing indifference to the value of life among young people. What I do see and hear from many are a deep anxiety and sincere frustration about the active and passive complicity of both major political parties in a genocide in Gaza as well as police racism, climate change, gun violence, the proliferation of student debt, the terrorization of trans people and migrants, and all manner of health injustices in an increasingly oligarchic country. When I use “Critical Care” to teach about health injustice, even many affluent students uncomfortably recognize its salience to the contemporary US health care system.
In one of John Q.’s most memorable moments, the hero’s best friend resists a question from a television journalist about John’s motivations, instead giving a damning indictment of US health care inequality. “It seems to me ‘something’ is out of whack, not ‘someone,’” he concludes.
People across the political spectrum rightly sense that “something” about our health care system is “out of whack,” to say the least. The pressing political question is how to translate this rage into the collective work needed to build structural alternatives. When I teach “Critical Care,” I accompany it with histories of the fights for Medicare and the racial integration of US hospitals, and the health justice work of groups like ACT UP, the Janes Collective, the Young Lords, and the Black Panthers. Returning to these histories reminds us that giving coherent political form and direction to the sense that “something is out of whack” in US health care remains both imperative and possible.