Thursday , February 22 2024

Book Review: ‘Samaritans’ by Jonathan Lynn

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.

About Tim Gebhart

After 30 years of practicing law to provide shelter for his family, books and dogs. Tim Gebhart is now perfecting the art of doing little more than reading, writing and sleeping.

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One comment

  1. Dr Joseph S Maresca

    Our healthcare system has to reward strategies which lead to wellness not disease management. In the past few decades, childhood diabetes has grown to alarming heights because legislators haven’t screened out excess sugar from the dietary choices.

    For instance, many sodas have upwards of 40 grams of sugar when the dietary limits for sugar are 35 grams/day. Some physical trainers really prefer a 25 gram limit for sugar intake. Former Mayor Bloomberg tried to stem the tide of soda sales by instituting a soda tax. The industry reaction was predictable. “Give me a break” was the familiar cry from numerous soda commercials on TV.

    The challenge is to give the public a break by producing higher quality food and drinks aimed at achieving nutrition rather than incremental pleasure for the taste buds. To its credit, Pepsi removed aspartame from its sodas. Hopefully, other popular brands will follow.

    We do have health care models outside the profit center concept. For instance, the Federal Hill Burton Program of 1946 provides free health care to the poor and sliding scale fees for the middle class.

    Hill Burton swaps facility services to the poor for federal mortgage forgiveness of debts incurred in building medical schools and neighborhood health clinics. Since 1946, the US population has nearly doubled but the Hill Burton Program has been cut. We need to dramatically increase the funding for the Hill Burton Program because it has served the poor well for decades.

    Health Care delivery needs to be a composite of public and private sector participation and not an oligopoly of a few private sector behemoths! The current debates over Obamacare and Repeal/Replace need to include incremental funding for the Hill Burton Program of 1946. In addition, our nation’s Governors Association needs to take up the taxation of junk food as an incremental revenue source to fund Medicaid and other programs for the poor.

    Our Congress and the governors of the 50 states need to address the health care delivery systems in this country jointly before real progress can be made in moving forward.