If you have not read The Hunger Games, do yourself a favor and give it a go (note: I’ve yet to see the movie so I can’t comment on how well it tracks the book). You may not like the fantasy genre, you may think YA (“Young Adult”, ages 13 + up, for those who don’t know the parlance of the book business) fiction is too unsophisticated for your tastes. Or maybe you don’t like to read. Whatever. Read it anyway, because whether you like it or not you’ll find yourself wondering how the hell did these fictional people end up in that level of misery. And that, my dears, is one of the points of the story.
Collins gives some hints of the back story throughout all three books of the trilogy, but she does not necessarily draw a bright line. She shows us the end result, hints at the conflicts that gave rise to Panem, but in the end leaves it to the reader to infer the connection between real life and the fiction.
As well she should have in the tradition of dystopian fiction in both written and visual media. The dramatic tension is in the unveiling of the fictional world and the struggles of the characters to overcome the burdens of dystopian life. The final resolution of the trilogy in Mockingjay is the thing we live for as readers; like the destruction of Parliament in V for Vendetta, we find satisfaction when we see the characters we care about tear the dystopia down. But it’s the realization that a society can more easily fall down a rat hole than it can preserve democratic and social justice principles that drives writers to imagine dystopia, and both fascinates and horrifies readers (or listeners/viewers in non-text media).
We are very much on the road to Panem right now. Leaving aside for the moment the most obvious contemporary parallel to the Games – reality TV and its occasional flirtation with snuff genre (ever watched Deadliest Catch?) – many aspects of our social fabric as showing signs of devolving in something we never intended. This the first of an occasional series wherein I hope to try to detect the telltale signs showing where our path is taking us and talk about why we should be afraid if we cannot find the way or the will to change course.
In the town of Seam, in District 12 of the country of Panem, formerly the United States of America at some point at least 75 years before, Katniss Everdeen’s’ mother is an herbal healer, providing care for any and all who come to her no matter who it is or the nature of the problem. It is quite clear that she is not part of any medical system most of us would recognize; indeed there is no indication that District 12 has any form of medical care for most people other than Katniss’ mother. Metaphorically, this is a way to graphically trace the descent of a culture from a technological high point to primitivism. The perniciousness of the divide in Panem is illustrated by contrasting life in the Districts to life in the Capitol, the segment of society that dominates all others. In the Capitol medicine is so advanced and available that nearly any horrific injury in the Games can be mended if it is expedient, and people can choose to dramatically alter their appearance on a whim. Herbal Medicine vs. Plastic Surgery; is any more illustration of the divide between the haves and have nots really necessary?
The divide in medical care between the haves and have nots already exists in this country, and it is more that the proclivity of the rich to keep plastic surgeons in chips. Already, it is fueling the emergence of underground medicine. Don’t believe me? Check this recent story about the arrest of an unlicensed dentist in Florida, whose patients were driven to him as the only affordable solution for a medical need. And this is not an isolated case; stories of unlicensed clinics dispensing medicine and even performing surgery are on the increase, especially among disadvantaged communities. PBS did a report in 2004 on another unlicensed dentist - and talked more broadly about the phenomenon of unlicensed medicine. The full extent of the underground medical system is not known. If the message of articles on this subject is to be believed, the trends and pressures leading to the emergence of underground medicine are even stronger today then they were when journalists first broke these stories.
The issue of affordable, available medical care is one of the issues of our time, and how it plays out speaks volumes about motives, power and the direction our society is choosing. Take the American Medical Association on the subject of the Affordable Care Act. One would think, naively, that the medical profession would be delighted to bring more patients into the system; if you genuinely care about people, that’s an easy call; and even if you don’t the added volume is good for business. Yet their support for the ACA has been lukewarm at best; their list of dissatisfactions is far longer than the short list of ACA provisions they claim to support. You can see their positioning here: http://www.ama-assn.org/...
Properly analyzed, the AMA position is entirely about money and devoid of any discernable concern for the patient. Here’s part of the list:
1. Medical Liability reform. Embedded in this is the naked assertion that “low cost timely health care” is only possible by severely limiting malpractice liability. This is an old chestnut. But at least you would expect the AMA to give lip service to the underlying patient care problem: how to fix the damage when someone has been injured or killed by medical malpractice. Who cares?
2. Repeal the Independent Payment Advisory Board. God forbid anyone try reform Medicare while preserving coverage and quality. Probably it is the word "independent" that scares them here since it implies removal of the issues from the political sphere. Obviously that would impact physician income. The AMA has no interest in the welfare of Medicare patients if it is going to impact income.
3. Medical Education. Sure, there are issues there; but the main concern seems to be to preserve graduate medical education subsidies from Medicare. They don’t want government interference unless there is a check involved.
4. They don’t like the Cost/Quality index scheduled for implementation in 2015. There is no articulate explanation for their position. Presumably, since the cost of and quality of medical care is only relevant as it impacts the income of the physician population, how dare anyone attempt to measure it.
5. Antidiscrimination provisions are unacceptable because they might “allow expansion of the scope of practice for nonphysician allied health practitioners.” Translation: our policies have created an underclass and we’ll be damned if we’ll allow them legal access to alternative care. Its bad for business.
6. Restrictions on hospital ownership. We don’t believe in conflicts of interest. Stay away from our profits.
7. For this one, fasten your seatbelt. They take an astonishing position relative to Health Savings Accounts and the upcoming exchanges: “The ACA is silent on whether health savings accounts (HSA) will be deemed acceptable coverage under the individual insurance mandate. The AMA continues to advocate to the Administration that implementing regulations, including those governing health exchanges and minimum acceptable coverage, ensure that high deductible plans coupled with health savings accounts (HSAs) can be offered as acceptable options in the exchanges.”
Really? A savings account as an acceptable coverage option? Their concern for the well being of the well-to-do is touching if unnecessary. The real agenda here, though, is to sell this pig-in-a-poke to the middle class who don’t have tens of thousands of dollars sitting in savings accounts awaiting a cancer diagnosis or a heart attack. Sure, the premium for the minimal high deductible plan is dirt cheap: that’s because it doesn’t pay for much (which, by the way, is the insurance industry’s preferred business model).
Frankly, if you are middle class (I mean with an income at or near the median) and that is your only choice, then you may be better off without insurance at all. Uninsured people of modest means can get charitable help in most communities, often in the form of deep cash discounts; having any insurance usually destroys your personal bargaining power - you pay what your insurance plan says you have to pay and that is that. So, really, the AMA’s interest here is to position people so that they cannot bargain over the cost of care. AMA’s conspicuous silence on the realities tells it all.
The list goes on, but you get the flavor. At every juncture, the income of medical practitioners trumps all concern for patients. One thing is certain: the AMA does not indulge itself in the notion that good medical care ought to be a basic incident of life in a healthy society; its vision of the future seems sadly wedded to lives of privilege. At least the AMA has the decency not to pretend that patient care is their primary concern. We are, in the final analysis, on our own.
If the AMA has its way, the transformation of medicine from an art practiced by caring individuals motived by a desire to do good to another parochial business whose primary motive is to extract the maximum amount of resources out of its customers will be one of the milestones on the road to Panem. The wealthy and privileged will never suffer because the availability and quality of care depends only the depth of their bank account or credit lines. For the rest of us? Maybe they will create a system where you can get the best care by volunteering to risk death on TV in the Hunger Games. It’s a far shorter step to that place now then ever before in history.