Friday, 14 August 2009

Fiction and Health CAre

The current debate about health care in the USA presents a difficult dilemma for someone like me with a health care background that is also trying to write fiction.

At an emotional level I would love to see the USA adopt a health system that gave coverage to the whole population. On the other hand such a system would be such a loss to the entertainment industry and fiction in general.

Take for instance the Film As Good as it Gets, starring Jack Nicholson and Helen Hunt. It is a great film that pulls apart all sorts of different layers of human emotion. Without the completely screwed up American health care system the film makes no sense at all.

Helen Hunt, in the film, has a son who has asthma; he gets poor medical care because she can’t afford to see a specialist, and has to take him the hospital emergency rooms when he has a bad attack. He has no continuity of care, no real depth of diagnosis, and we suffer with him and with her. Her ambivalent attitude to charity, in effect to Jack Nicholson offering to pay for her son to be looked after properly, is based on having acquired a set of values that believes that everyone must somehow look after themselves, even though fate deals us all a different hand.

There is another story line in which the young gay artist who lives opposite Nicholson is beaten up and then effectively bankrupted by his health care bills as he recovers from his injuries. This allows the exploration of various attitudes to art, to Gays, and so one. Altogether a great film made all the better by brilliant acting.

You simply could not make that film and base it in the UK because we all know that the story line makes no sense. Over here we all know that the NHS gives the best care that it can to everyone regardless of means, and has done for sixty years. The story of Helen Hunt’s son simply could not happen in the UK.

I’m prepared to admit that you might be able to make a story out of a scenario where what he needed was some very expensive drug, that only works now and then. You might just squeeze a story out of such a one in a million chance, because sometimes we don’t fund those because we need to make the most of the NHS funds to do more good for more people. We all know that those stories are very uncommon and didn’t really apply to us. Hard to make a whole movie out of that, though you might manage an ad for the Republican party. In the US the Helen Hunt story line could happen to virtually every waitress in the USA, that is it’s power.

The gay artist story doesn’t wash either, you might just manage some sort of plot line about prejudice against gays, we do have that over here, but the idea of being bankrupted and made homeless by health care costs is just ridiculous. It doesn’t happen in any country with a sensible system of social solidarity, and that includes the UK, most of Europe, Australasia and Canada. Fortunately for us the movie industry is mostly based in the USA and they still have these wonderful plot lines.

The American health care system leaves their citizens with shorter lives than most of Europe and condemns a significant proportion of the population to live in fear of sickness and unnecessary suffering, but hey, surely that’s a small price to pay for some great movies.


  1. Interesting; though I'm surprised the gay character didn't have health insurance.

    I guess the equivalent over here is the extreme inequality of pension provision, ranging from MPs' enormous hauls to those who get by somehow on the state pension, a free bus pass and the odd cold-weather handout. But films tend not to be made about the aged.

  2. I think he must have but even that runs out. On top of that as a result of his injuries he couldn't work or put himself about in the art world. In the UK he'd probably get housing benefit and sick benefit and be more able to survive.
    I did wonder if I was being too obnoxious with this post but I do find it annoying that such ignorant things are said about the NHS on US TV. I thought it was particularly crass that someone actually said that Stephen Hawking couldn't have survived in the UK - that seems to be ignorance on such a grand scale that I felt justified in being a bit ruder than I might normally be.