In preparation for a Bloggingheads episode, I caught up on A Gifted Man yesterday. I want to like the show — as I wrote when it premiered, I really do think there’s a compassion problem in this country when it comes to health care, and I think it’s really worthwhile to illustrate all the little ways that a lack of insurance, an uneven distribution of quality facilities and doctors, and even difficulties like a patient who can’t get to an appropriate treatment on the bus but doesn’t have access to a car or cab fare. But I’m starting to get frustrated by the show’s insistence that these are problems that can be fixed by the miraculous appearance of a dedicated doctor who swoops in just when a patient who has been denied care or can’t afford it desperately needs an intervention. Plainly put, for A Gifted Man to be a genuinely dramatic show and a genuinely compelling explication of health care inequality, Michael, the main character, needs to start losing some patients.
I’m not quite at the place that Katie Welsh is in thinking that the show should divide its time not between Michael’s practice and the clinic he’s drawn to, but between the clinic and a legislative fight. But I do think that the show needs to make Michael start paying some real costs for refusing to really commit to Anna’s clinic, and to demonstrate that his fantasy of swooping in occasionally to make everything all right is unsustainable, even dangerous. The show makes a ridiculous amount of Michael’s talent — when one patient asks if he’s as good as everyone says, one of Michael’s colleagues insists, “No, he’s better.” And he has a House-like ability to diagnose things on the spot, without the leavening of House’s unpleasantness to suggests there are actual costs to that kind of skill, that the emotional energy it takes to be a medical genius trades off with putting time into being decent to other people. And in an era of vaccine denialism and HPV vaccine hysteria, it’s not a bad thing to convince audiences that it’s good to trust doctors.
But what’s important about health care reform is larger structures, not the ability of individual doctors to make diagnoses and perform surgery. It’s not a matter of 10 volunteer hours a week. It’s a matter of billions of dollars. And if the show is committed to that reality, a patient should die or end up with a long-term condition because Michael isn’t giving enough time to him or her (the latter, I know from personal experience, can happen even when you have fantastic health care and relatives in the industry). He should lose a fight with an insurance company. The investors in his private clinic should ask questions about the amount of free care he’s giving away. I say these not because it pleases me to watch people suffer on screen, but because these are the things that happen in our health care system, and they’re a source of terrific narrative drama. Staying away from these kinds of choices isn’t just a sacrifice of a certain kind of truth-telling. It’s sacrificing a commitment to telling the best, most compelling story possible within the setting the show’s picked to work in.