Sometimes it is necessary to revisit the past in order to see whether mankind has actually progressed. Lost in the day-to-day struggles, we lose sight of the long view. Especially with regard to American health care, which I view with more than a modicum of cynicism these days because as a Medicare patient I am the target of every doctor and hospital under the sun trying to sell me something that will prevent something I do not yet have, treat something I don’t think needs treatment, or test me for something I haven’t even conceptualized.
Why? Because they can. Because the technology exists and Medicare will pay for it, and doctors and hospitals need to survive. The business of medicine is big business. In the last week, I have narrowly escaped spending $8500 for dental work on teeth that don’t yet hurt, and whatever Medicare will allow for a colonoscopy I do not need. This despite the fact that I can’t get a blood test that might actually tell me something I want to know. It’s the reimbursement, stupid.
So I watched the first episode of “The Knick” tonight, and found it therapeutic for exactly the reasons described above. American health care might be bad now, but at the turn of the 20th century it was probably worse. Or maybe not.
If you haven’t seen “The Knick” yet, it’s a ten-part series about a New York city hospital and its chief surgeon just at a moment of great change. Electrification is coming to the city, along with boatloads of immigrants with tuberculosis and other diseases. “The Knick” stars Clive Owen as a man who, besides being an incredible surgeon, is a cocaine addict with collapsed veins. Every episode is directed by Stephen Soderberg, so we’re in for a real thrill.
For reasons known only to me, I found “The Knick’s” revelations comforting. After all, many doctors are addicted to painkillers today, and it’s good to know that’s part of a long time-honored tradition. It’s also good to know that hospitals were running deficits because of uncompensated care as early as a century ago. I would hate to think my own generations fucked up something that used to work by overlaying insurance and its accompanying cost structure over an idyllic relationship between patient and doctor.
The first episode begins with a Caesarean section performed publicly, with much fanfare, for other physicians. It fails miserably; both the patient and the baby die. But we are meant to feel good, because we know that now Caesarean sections are so routine they can be performed purely for the convenience of either the mother or the doctor. Just think! Only a century since something once worthy of witnessing in an amphitheatre has devolved to simply a scheduling issue. Surely this is progress.
I’ll not ruin your enjoyment with spoilers, but the stage is set for contemplation of where we’ve come from and where we are now. Some things are obvious: the horse-drawn carriage is on its last legs, so to speak, and the hospital is being electrified. But others are not so obviously changed for the better: do our doctors still take their professions so seriously that failure to save a life is grounds for hara-kiri? Do we still have hospitals supported by wealthy families who want to help people? And what of the competition among physicians for honors at the hospital?
To me, “The Knick” is a complex meditation on health care, technology and progress, if such a concept really exists. Have we truly graduated from the dark ages in medicine to somewhere better? Or have we merely replaced one form of ignorant barbarism for another? The first episode of this series was so good that I intend to stay tuned.
