THE RED CRITIQUE
So Funny About Healthcare Today?
A new breed of medical TV show has emerged in the US in the last year. In contrast to older programs, such as St. Elsewhere, Chicago Hope and ER, which highlighted the seriousness of the medical practice and the moral and social pressures exerted on larger-than-life doctor characters, new shows like Scrubs and MDs are playful, ironic and irreverent. They mock the image of the heroic doctor, parody the ideals of medicine and turn science into a joke. In new shows such as Scrubs, the most "reliable" medical figure is the stumbling anti-hero whose motto is "I'm No Superman" (the theme song of Scrubs), and the ever deepening contradictions between what has become possible in medical science and technology and the actual reality of healthcare today become occasions for cynical comedy and ironic laughter.
Premiering last fall on NBC, Scrubs is a fast-paced sitcom layered with music and pop culture references designed to appeal, as Scrubs producer Bill Lawrence indicates, to the MTV demographic. It centers on the daily struggles of 3 interns just out of medical school, who find that what they have learned in 8 years of training has not adequately prepared them for the realities of being a doctor in an urban hospital. Along these lines, the main character, J.D., is an earnest, conscientious intern, whose voice also provides each episode's narration, and whose subconscious fears and desires are literalized in fantasy sequences which blur the line between reality and illusion. The show's comedy largely derives from the highly ironic and absurdist treatment of the contradictions between what is represented as J.D.'s "idealist" expectations (such as wanting to take time to explain to a young patient who is on the verge of developing throat cancer the serious consequences of continuing to smoke) and the real situations he confronts (which require speed, cost-effectiveness and, as J.D.'s mentor Dr. Cox reminds him, the need to stay "sane" by not getting involved in patients' personal lives). The main premise of the show is that no matter what you learn, life is always more "absurd".
Reviewers have embraced Scrubs as a hilarious and refreshing alternative to the more serious, sentimentalizing medical shows because it provides a hipper, more "realistic" view of the medical world—a world whose "ground state," as surgeon Atul Gawande has recently argued, "is uncertainty" (Complications: A Surgeon's Notes on an Imperfect Science 2002). They have thus either focused on the formal aspects of the show that highlight uncertainty—such as the fantasy sequences, the absence of a laugh track, or the narrator's breaking of the fourth wall and speaking to the audience. Or, reviewers have focused on Scrubs as "progressive" in content because, as a biting satire of the medical world, it is "upfront" about the contradictions of healthcare and drops all pretenses that healthcare is anything but an industry guided by the principles of profit. As one reviewer puts it, instead of "glamorizing" the healthcare system, Scrubs "suggests that, yes, your insurance company is out to screw you" (F.L. Carr, "Just What the Doctor Ordered", Pop Matters; my emphasis).
But the real significance of Scrubs is neither its formal qualities nor its progressive "realism". Rather, it is the way it turns the contradictory effects of a healthcare system based on profit into humorous tales of human fallibility and ironic narratives of scientific mastery "undone", and teaches viewers how cope with and accept a system which is increasingly unable to meet the basic healthcare needs of the majority of people. The viewers of Scrubs not only learn to laugh ironically at scenes in which new doctors hide in closets to avoid treating patients and experienced doctors make serious medical errors, they also learn to accept such situations as the new norm.
The state of healthcare in the US has reached such a crisis point that TV shows depicting the medical world now must drop all pretenses to seriousness, or else appear as "un-hip" and "un-knowing" of the new realities of global healthcare and thus un-watchable by the culturally savvy middle class viewers trained in postmodern skepticism. The growing ability of the medical industry to provide increasingly advanced healthcare for all people on the one hand, and the growing rate of people without access to the most basic healthcare on the other, has given rise to the necessity of a cultural explanation which displaces the class roots of healthcare inequities in a "new" way: by shamelessly silly "exposures" of the "ironies" of healthcare today, as if these were inevitable, inexplicable and, above all, unconnected to the systematic privatization of all social resources at the expense of peoples' needs. As if, for example, the drug companies' drive to accumulate larger shares of profit is unrelated to the rise of people who cannot afford medicine. Scrubs treats such contradictions as isolated ironies which are "funny" because they exceed all rational understanding. Through ironic exposures (which, like Gawande's book, foreground the fundamental "uncertainty" of society), Scrubs produces a "sophisticated" viewer, who shows she "gets" the contradictions of social practices by responding to them—not with analysis or the understanding that they can be changed—but with an ironic laughter which is resigned to the fundamental irrationality and uncertainty of society. Which is another way of saying that she is cynically resigned to social inequality, and not afraid to admit it.
The reviewer's comments above are telling here: what is "effective" according to Carr is that Scrubs shows the "reality" of the medical world—it doesn't try to "fool" you into believing that it is anything but rooted in profiteering, efficiency and careerism. Rather, it suggests that the real "fool" is the viewer who believes that healthcare can be anything else—for instance, that, rather than being a commodity available only to those who can afford it, healthcare could be made available to all people as a universal right. Scrubs appeals to a savvy viewer who "knows" both that healthcare operates on irrational and unjust priorities, and that it is impossible to do anything about it. In fact, those who still believe anything can be done to seriously address the crisis of healthcare today are represented as naïve, unsophisticated dupes, who are the butt of all jokes.
When, for example, the "idealist" J.D. attempts to convince his superiors that a certain patient—who is constantly hospitalized due to various illnesses but doesn't have healthcare coverage—needs to have his gall bladder removed, he is represented as absurdly naive. What is "funny" in the end is that J.D. learns that the patient should be treated—not because he is sick and should, like all people, have the right to healthcare—but because it will be more profitable for the hospital in the long run to do so. In other words, J.D. learns, with the viewer of Scrubs, to accept the "ironic" reality today that, despite their formal commitment to the Hippocratic Oath, doctors are increasingly compelled to treat patients only to the extent that such treatment maximizes profits.
But this is a very one-sided view of "reality". What is "exposed" is the corporate view of reality: that is, that this is the way healthcare should function, in the interests of the few. What is violently suppressed is that such an irrational structure of social relations can and must be changed to meet the needs of the many. What Scrubs excludes through mockery and derision is any possibility that healthcare could be organized according to a different set of priorities. In doing so, it alibis the monopolization of healthcare in the interests of the few, and helps to produce a citizenry which refuses to change or even question the status quo.
The media, in other words, has turned to ironic exposures—not to actually lay bear the underlying reasons for the crisis of healthcare (of course for the sophisticated viewer, any search for "underlying reasons" leads to ironic ruptures and reversals)—but as a strategy of crisis management. For it is no longer possible to simply avoid addressing problems such as the inaccessibility of healthcare, the dramatic rise of medical mistakes, and the notoriously grueling working conditions of interns, or to turn these objective conditions into intersubjective "dramas" which are overly sentimental or moral (as in the case of St. Elsewhere, for instance). These problems—which are the effect of organization of healthcare around profit not need-- need instead to be confronted in what appears to be a more "direct" way because they have become urgent national questions. But far from providing knowledge of the healthcare crisis that serves the needs of people, the new portrayal of the medical industry provides the viewer with the illusion of knowledge: cynical "exposures"—which support the privatization of healthcare by separating the effects of the healthcare crisis from their roots in private property relations.
It is precisely because Scrubs doesn't ask why the healthcare system is structured the way it is that it is such a popular show. It does not ask why patients without insurance should not be treated, or why the priorities of healthcare are speed and cost-effectiveness, or why interns must endure such long and exhausting work hours. To ask why is to begin to address the causes of inequality, which are rooted in the commodification of all social resources under capitalism, turning the means to meet basic needs such as healthcare into commodities which must be purchased. To address why is to raise questions, for instance, about the status of "democracy" in a nation where the elderly and the poor are forced to choose between food and medication. Instead, it takes these conditions—the conditions of the market—as inevitable, and turns them into hilarious occasions of subversion. J.D.'s high expectations, for instance, are routinely dashed by the reality of hospital life, where the priorities of treating large numbers of patients as rapidly as possible, hospital profits and avoiding lawsuits take precedence over doing whatever is necessary to ensure every patient receives the best possible care. "Look, I became a doctor because I wanted to help people", J.D. tells viewers in his voice-over narration in the pilot episode. But, "four years of pre-med, four years of med school and tons of unpaid loans have made me realize one thing: I don't know jack".
"Not knowing jack" is a code here for (still) believing that the healthcare system should in principle provide for all members of society—that is, a code for a naïve "idealism" and "optimism". "Knowing jack" on the other hand recognizes that equality is (forever) unrealizable—it is "realistic" because it "knows" there can only be pragmatic working within the system.
The effectivity of Scrubs is that it turns "knowing jack" into a hip, savvy form of knowing. A kind of knowing, that is, which is aware that the world is unjust, but concludes—and this is what is supposed to be "sophisticated" about it—that nothing can be done. Just knowing that the ideal of a healthcare system which meets the health needs of all always turns in on itself ironically to reveal its unrealizability becomes, on these terms, a more "subversive" act than the actual attempt to intervene in unjust relations.
Thus in an exemplary episode the lesson taught to viewers regarding a female intern, Eliot, who wants to confront the chief of medicine about his reference to her as "sweetheart", is that she is not in on the "joke" that it is absurd to question the practices of someone in such a high position of power. Eliot does speak to Dr. Kelso about the matter (without effect)—but she does so only after asking Dr. Cox for his advice and misunderstanding that when he enthusiastically encourages her to confront the chief of medicine he is doing so ironically. In other words, what is reinforced here is a deeply conservative argument that a democratic conviction that men and women should be treated equally in the workplace is "fine"—as long as you don't actually think you should expect people in positions of authority to be accountable to it. Such convictions are "funny" when people try to put them into practice; when they don’t realize they can never really "work". To be naïve is to know that we live in an unjust world which should be changed; to be savvy is to know it can't be.
Far from being "progressive", this is a most effective means of justifying unequal social relations. It manages—rather than intervenes into—the crisis of healthcare today because it simultaneously acknowledges the crisis and diffuses it. It turns helplessness into a subversive form of "doing", and lack of knowledge about the wider global relations which shape healthcare into a shrewd mode of knowing. At the same time, the very structures that produce healthcare inequities remain intact.
But while NBC is teaching viewers that nothing can be done, the corporation that owns NBC—General Electric, which is heavily invested in the health insurance and medical industry—has recently been very active in ensuring that nothing does change to threaten the priorities of profit. As a FAIR report indicates, NBC was instrumental in the successful blanketing of the airwaves with negative representations of a bill in Oregon for a single-payer healthcare plan which would have provided much wider accessibility to healthcare for significantly less money than people currently pay, by lowering the costs of healthcare through government funding, and thus lowering the profits of the healthcare industry ("NBC Slams Universal Health Care", Fairness & Accuracy In Reporting, November 12, 2002).
What is being represented in Scrubs as the irreconcilability of the "ideal" of healthcare (that it meets the needs of all people) and the actual practices of the healthcare industry is actually the effect of the determination of all aspects of social life by the rule of profit. Like everything else under capitalism, healthcare is not produced to meet human needs but to increase the amount of profit that is accumulated by corporations. All aspects of healthcare—from the research to the technology to the medicine to its application in the medical practice to…—are oriented around this private accumulation.
It is this logic of profit which turns the ideals of
healthcare—making sure all people have access to the healthcare they
need—into ironic and base-less claims, not some immanent conceptual
slippage in all social ideals. It is the substitution of profit for
need—not an inexplicably irrational and uncertain world—that leads
to the denial of medicine and procedures to the people who need them
most. Scrubs' ironic laughter is, in the end, meant to rally the
many behind this substitution. But healthcare is "funny" only
for the few whose health needs have already been met.
RED CRITIQUE 6 (September/October 2002)