| The Doctor's mobile emitter has been stolen, and delivered by a shady merchant to an overcrowded alien medical facility. Once activated, he is outraged that he has been stolen, but is compelled to help care for his new patients out of compassion. He quickly finds that his new colleagues are not as compassionate, and health care is strictly rationed by how valuable any particular patient is to society. He begins by stealing medicine from the wealthy clients, but once he is caught he has to up the ante. The Doctor hacks into the social value computing system, and down-ranks the facility administrator's position, before deliberately infecting him with a treatable but deadly illness - one for which the computer system will no longer dispense medications, since he's no longer considered important. Once the administrator gives in, Voyager finally finds him and takes him home. |
So, in 1986, congress passed, as part of another act, EMTALA - the Emergency Medical Treatment and Active Labor Act. The wikipedia article does a great job of describing the act, but I'll summarize here as well. EMTALA is an effort to prevent hospitals from turning away patients or denying medical treatments to patients based on their ability to pay. I consider that to be a laudable goal, and obviously so does this episode, based on its incredibly thinly-veiled commentary. But the issues surrounding EMTALA are so much more complicated than this episode suggests that it makes my brain ache. Since there's no funding that goes with the act, congress is basically saying: "we feel like you should do this, but we don't think it is important enough to help pay for it." Because of the act, emergency rooms have become a source of free primary care for those who can't pay, but ER visits are not cheap, so this is an incredible drain on the health care system. It is essentially a band-aid solution to a bigger problem; it would be much more cost-effective to find a way to fund primary care visits for people without insurance, but that's a tougher pill for taxpayers to swallow.
I don't mean to push an agenda here - I just want to illustrate that the reality of the problem is significantly more complicated than this episode gives it credit for. I've certainly never met a health care provider who could look at someone with an emergent, treatable medical condition and want to see some cash first - which is what the aliens in the show are essentially doing. I know the writers are going for intelligent commentary here, but when they draw the characters and situations with all the subtlety of a political cartoon, it makes their arguments seem empty. It is hard to imagine that anyone would argue that the doctors of that world are right in their actions, but that's not doing anything to educate people about important health care issues. Instead, it gets people riled up without giving them important facts. EMTALA was born out of justified moral outrage, but given its unforeseen consequences, I'd like to see more education about the system, not less.
While the big picture of this episode fell flat for me, it did play host for the more interesting choice that the Doctor made. The aliens are undeniable jerks, so does that make it okay to intentionally infect them with a deadly disease in order to affect social change? While I'd say this definitely counts as prime directive territory, Trek doctors have a history of being the crew members who are most outraged when it restricts their actions. Without anyone else around, I find it unsurprising that the prime directive wasn't the Doctor's primary concern. Anyways, was it right? I don't know. I do know that it says something about the Doctor that he was willing to do it - and it relates to my concerns about his ethical subroutines from Equinox, Part II. I wasn't comfortable with the idea that a hologram that has matured as much as the Doctor has could be turned evil at the flip of a switch. But this situation has got to go outside of the scope of his subroutines, I like to think that he made this choice on his own. It is somewhat confirmed when he has Seven check the subroutines at the end of the episode, and I think he must have outgrown them at this point.
Another real life health care issue that seeped into this episode is that of ordering unnecessary tests and treatments. That's another extraordinarily complicated issue - people with better insurance, on average, receive more tests and treatments. Unfortunate, but true. Whether that is due to a provider wanting to pad their income or because they know that a certain treatment is better and can be used because the patient's insurance can pay for it is a subject of intense debate. Then there is the issue of the fear of lawsuits driving doctors towards ordering more diagnostics, which adds yet another angle to it. It is just used as a more minor plot point here - the Doctor orders unnecessary treatments and steals them for the indigent, but talks his way out of trouble with the second in command by justifying the extra medicines as a means to keep the facility's budget up. Since this issue only plays a minor role, I'll give some leeway here in the simplification department. In addition, I find it perversely pleasing that something that is often cited as a major cause of health care's current dire situation is twisted into being an instrument of good.
What else? Oh, yes, there's the whole part where Neelix tortures the swindler for information about the Doctor's whereabouts. It is played off as being cutesy, but Neelix feeds him something that will give him stomach cramps, and then offers a cure only if they get the Doctor back. Tuvok voices concern about this tactic, but Neelix just brushes him off. Tuvok's plan had been to threaten him with a mindmeld, which genuinely sounds like a great idea. But even better would be not to threaten, but to just go ahead and do it! You have a known criminal here, and you have a telepath who can find out what you need to know. Just read his mind. It's that easy. Then you won't have to torture him with Neelix's cooking.
One last thing - it was just one brief scene, where Voyager was looking for information about the thief's location, but the unthinkable happened. I liked Janeway's performance. There, I said it. For the last part of a sequence of different aliens-on-the-viewscreen, we come to Janeway, bored out of her skull, rolling her eyes through the last interview. It was hilarious. She went on to pretend for the sake of the interviewee that she and Tuvok were a couple, and he was appropriately disturbed. Well done.
Watchability: 3/5
Bottom Line: This is a hard episode to give a score to. On the one hand, I was disgusted with how ham-fistedly the alien metaphor culture was presented. On the other, that's kind of a Trek thing, and it did make way for the Doctor's mania. Though I was generally disappointed, I think I'd still rather have more allegory, even clunky, shortsighted allegory, in my Voyager episodes, not less. While much of what I had to say about this episode wasn't entirely complimentary, I'd always rather have episodes that I have a lot to say about.
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