If Jonathan Lynn’s Samaritans takes off, he should send thank you notes to Congress, particularly Rep. Paul Ryan and Sen. Mitch McConnell. The ongoing Congressional spectacle with the Affordable Care Act provides a near perfect backdrop for Lynn’s a biting takeoff on healthcare in America.
Lynn is perhaps best known as a television writer and film director (including one of my all-time favorites, My Cousin Vinny. Satire becomes a scalpel in his story of Max Green, head of hotel operations at a Las Vegas casino, who sees becoming CEO of a large hospital as the path to wealth. Evincing many of the ideas at the heart of ACA debate and weaving in real facts about the American healthcare system, few elements of the healthcare debate are spared.
Green becomes head of Samaritans Medical Center in the Columbia Heights area of the nation’s capital. Obsessed with the bottom line, Green insists his contract include him getting “a fair slice of the profits” when he turns the hospital’s red ink into black. The hospital board, chaired by the billionaire owner of a company that makes electronic components for weapons systems sold worldwide, decides to give Green a chance.
Green’s efforts include fairly common strategies — trying to build high profile practices by hiring renowned doctors, eliminating costly elements (even nurses, here many are replaced by janitors) to create profit centers, and buying outside service providers, such as temporary nursing and billing and collection agencies. These aren’t enough for Green. He implements numerous “innovations,” including cutting a deal with a celebrity lawyer who frequently sues Samaritans, that bring profit but also have dire ramifications for both he and the hospital.
It’s what motivates Green and his data-driven deputy, Blanche Nunn, that sharpens the book’s focus. They expound the free market and evangelical ideologies underlying much of today’s healthcare debate. Green tends to make Paul Ryan-like pronouncements, such as, “People can’t have what they can’t afford. That’s what got America into this economic mess — everybody wanting something for nothing.” If someone can’t afford health care, Green says it’s “TP,” their problem.
Green’s philosophy also lays out the Catch-22 in leaving people uninsured. “Prevention’s not profitable,” he observes. It’s better to shutter a diabetes center because treating the consequences of the disease is far more profitable. And when Andrew Sharp, the star cardiothoracic surgeon Green hired, suggests not everything can be decided by the marketplace, the CEO says that “sounds like communism.”
Blanche’s devotion to the free market is rooted in what she’s learned from her evangelical ministers, Pastors Spittle and Wallow. (The hospital’s Roman Catholic chaplain doesn’t express opinions he “can safely leave my theological thinking to my superiors.”) “Capitalism is God’s ordained economic system,” Blanche maintains, and because the free market is “divinely inspired,” government should not interfere. When it comes to medical needs, Spittle taught her that “God had prescribed the answer: unregulated, free-market corporate health care.” Thus, Medicare’s problem, she says, is that it was “set up to help patients, not profits.”
In lampooning these ideas, Samaritans shows how they are at work in the politics of healthcare. Dr. Sharp and other Samaritans physicians and employees provide the counterpoint, observing and experiencing the impact of Green’s and Nunn’s machinations. Ultimately, Green goes a step (or three) too far, resulting in inventive denouement. Lynn’s one page epilogue contains some of the book’s best humor but it would require an inexcusable spoiler to show why.
Samaritans is more insightful farce than laugh-out-loud funny and generally succinct and well written. It does, though, have its flaws. A couple characters seem unnecessary to advancing the story and feel more like walk-on extras. More disquieting is a tendency for some of the female characters to use sex as a tactic to achieve success. While Lynn uses this to further distinguish between the good guy and the bad guy, the frequency with which it appears collapses toward hackneyed trope.
Still, these blemishes are comparatively negligible compared to the book’s truth telling. In looking at America’s healthcare system, Samaritans both entertains and educates.