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PORTSIDE CULTURE

US POP CULTURE HAS LONG RAGED AGAINST HEALTH CARE INJUSTICE  
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David K. Seitz
February 26, 2025
Jacobin [[link removed]]

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_ 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
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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
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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
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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
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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
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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
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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
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and warehouse
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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
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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
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Q_, which was panned by critics and condemned
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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
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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
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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
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the racial integration [[link removed]] of US
hospitals, and the health justice work of groups like ACT UP
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the Young Lords
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the Black Panthers
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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.

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Contributors

David K. Seitz is associate professor of cultural geography at Harvey
Mudd College and author of two books, most recently A
Different Trek: Radical Geographies of Deep Space Nine.

 

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