“Critical Care”

I just watched this today and thought it was an effective allegory on *nationalized/socialized* healthcare (such as Great Britain, Canada, Cuba), which often has to ration its limited resources when it claims to be "free" (aka taxpayers) for everyone.

The acting was good, as were the special effects shots. I also loved the scene with Janeway and Tuvok and the captain explaining she "already has a man." The reactions in that shot were priceless.

Interesting: I felt the episode being an allegory on the United States health care system as percieved here in Austria: Highest medical standard in the world - but not available for a large group of the population.

I watched this for the first time the other day. It was clearly intended as an allegory against the US system, but I also saw that it would work very well against socialism, where the government decides priorities. Really, when you don't have Star Trek replicators, all resources (including medical resources) are finite and need to be rationed somehow.

The bit where the kid says he was assigned to work in the mines and would never get a chance to train as a doctor adds to the socialist feel; it sounds just like a communist government deciding where each individual can best serve *society*.

It would have been interesting if the Doctor's decision had some negative trade-offs...if the doctor over-allocating medical supplies lead to real difficulties for the people (perhaps they end up without enough medication when a plague hits the planet later on). Of course, this would have likely required a follow-up episode, something Voyager is ill-equipped to do.

It's easy to argue using more resources *right now* when you're going off in a starship, never to see the planet again. Those that stay behind have to deal with long term issues that have been conveniently ignored.

My favorite part of this episode had nothing to do with the main story...the sequence where Janeway and Tuvok go through a chain of people to try to find the Doctor was standout, and not just because of the part where Janeway pretends she's dating Tuvok. Instead of the "urgent search" angle that usually comes up in these episodes, Janeway is portrayed as completely bored and annoyed with all of the people she's having to deal with. That's perfect, a nice changeup.

I agree with methane.
Here in the States, the overriding factor in whether you receive adequate care (if you don't have insurance) is your ability to pay. Suppose you're a garbageman (or "waste processor," like in the episode) who has cancer and no insurance. In this episode, the centrally-planned, socialist/communist/utilitarian "Allocator" would have deemed you unworthy based upon occupation. In real life, your wealthy brother gives you money and you, the garbageman, get the care you need.

I just finished watching this episode and it seems especially relevant given the current debate in Congress about health care legislation. It's amazing how Star Trek stories stand the test of time.

I agree with Daniel. I felt that the search sequence had some very entertaining scenes. Especially the crew's reaction to Janeway's impromptu relationship with Tuvok.

Say what you will about the Nhs (british system), it works a hell of a lot better than what you get in the states. I hope for your sakes that Obama gets his way.

After reading some of the comments, I was taken aback at how differently I can interpret an episode from others. As an allegory on healthcare, the Doctor was upholding, to me, the noblest principles when he argued for the life of Tebbis, and against the inhumanity of giving treatment for "arterial aging" on the one hand, when this medicine was essential to Tebbis.

I suppose, as a citizen, if you are priviledged in money or ability, you can always access Level Blue. To me, the ultimate inhumanity is not even to think about those less fortunate - to be as blithley indifferent (to making things better) as was Dr. Dysek in the beginning.

The similarity to the US healthcare debate is striking. It is telling that during Obama`s speech to the Joint Congress, there was not universal moral outrage that currently US insurance companies can kick people off coverage when they are dying, because they are no longer profitable as customers. If you are rich, you get Level Blue treatment, or can sue if you don`t, if you lack money, you`re stuck in Level Red.

A large insurance company in a capitalist economy can be as unaccountable, and bureaucratic, as the old Soviet Union. Socialism, to me, is about from each according to their abilities, to each according to their needs - it means moving toward Star Trek`s utopia. I can`t speak for all Canadians, but putting tax dollars towards universal healthcare or education makes more sense than having a huge military or using the technicalities of legal agreements, as some large US companies do, to exploit the weak.

Perfectly good episode. Not amazing, but quite liked it all around. The B-plot with the thief was a little lacking, but the Doctor's A-plot was very good all around.

If only Voyager could string together 2 episodes of such quality in a row. Somehow that doesn't seem likely ;)

On to the next episode... wish me luck...

HI Jammer and everyone,

Does anyone remember a VOY episode when the ship docks for repairs at an apparently abandoned station and the stations computer starts to do bad things?
I am going through all VOY episodes and reached S7 so far and I have not seen it. I would have sworn I saw that when I was younger.
Does anyone know what episode that is?
Thanks

Are you sure you're not thinking of the Enterprise episode "Dead Stop"?

http://www.jammersreviews.com/st-ent/s2/deadstop.php

Thanks, that episode looks like the one. Would have sworn it was VOY

Prime Directive. Violation of. Check and mate.

Not content with turning every other episode of Voyager into a soap-operette and/or Dr. Phil, there has to be a pervading theme of political correctness interwoven thru the entire series. This time: Universal health care.

Now, I'm all for saving people's lives. Providing medical treatment to everybody should come ahead of spending on defense or supporting the long-term unemployed. But this episode is a very thinly-veiled attempt at socialist indoctrination. ("Reallocation" of Who the hell is The Doc to be pontificating to other races how to organize their health care system? Not only that, but he (it?) takes concrete steps to subvert that system and that is portrayed as laudable! Whatever happened to cultural sensitivity, inclusivity and relativism? Isn't that a hallowed pinnacle of political correctness?

Oh, and screw the Prime Directive!

*barf*

Loved the scene of Janeway grabbing a hold of Tuvok's hand and his reaction! :)))))))

The episode is fun to watch but it's sanctimonious and its instigation is execrable. Two stars and a letter to the scriptwriters to keep their schnozzles out of politics.

Just as the Vulcan nerve pinch seems unfailingly to work on every alien species to which it is applied -- and even to a horselike creature in "STV: The One That Sucked" -- here the Doctor is activated in a facility populated by members of species we have no reason to think he's even ever seen before and immediately starts treating them, even prescribing medicine for them. Bad. One throwaway line of dialogue could have fixed this.

All that medical story unfolding and all that starhopping looking for Garr and the entirety of the episode was the span of four days?

This episode can be viewed as a critique of free market health care, especially HMOs, or as a critique of government run health care. The episode never reveals which was intended by the writers and producers, assuming they had a preference. Notice how Chellick never said who hired him (government or business). Also, the reference to paperwork being in triplicate could apply to an HMO (as Jammer inferred) or to a government bureaucracy.

So when watching this episode decide what you DON'T want running this nation's health care (HMO or government) and imagine that the Doctor is fighting that organization. That way, everybody can enjoy this episode.

"...there has to be a pervading theme of political correctness interwoven thru the entire series."

Are you kidding? One assumes you're a big enough fan of Star Trek to not only bother reading amateur reviews but commenting on them, and you're still amazed at the PC thread to the series?? This is one of the DEFINING aspects of Trek, and has been ever since the very beginning. If you hate this, then seriously - why on earth watch it? It can't be for the hard-core SF factor, as Trek science is notoriously wobbly.

Fascinating that this episode should follow the huge debate in the comments for the previous episode, where a flame war is raging about communism vs. capitalism.

As I suggested there, I think extremes either side are where it all goes wonky, and this episode illustrates that thought quite nicely: it works for either system when taken to extremes.

It works for capitalism - which in itself could also be seen as a merit system particularly in America where wealth is highly respected. If you don't have the money, you die. If you do and are considered valuable to your society (let's say Steve Jobs, CEO of Apple), you survive when 99.9% of others wouldn't have had a chance.

It also works for communism which ironically (for Trek) is what I think was being aimed at here. When taken to extremes, only those valuable to society are treated. Less valuable, you die. Too much of a drain on resources, you are terminated (though there seems to be safeguards in place to try and prevent people being a drain on resources in the first place. Gee.)

Just shows that it's not all black and white.

I think the UK system is fine - basic healthcare is provided for all and they do what they can. It's not perfect - it can be disturbingly similar in some cases (3 patients need a liver transplant... one runs the country, one is a normal guy and one is an alcoholic. Guess which one gets it) but I suppose they are doing the best they can with limited resources without stooping quite to the evils depicted here.
If you want better healthcare (more comfortable, quicker response, better prevention etc) there are still private plans and insurance policies just like the US. The NHS is a baseline, some would call it a bare minimum. Seems like a balance to me, I like those. I just hope Cameron doesn't kill it.

As for the episode, an excellent commentary on a very tough debate, and when delivered by Picardo you can't really lose. I agree that the ending leaves a lot to be desired though (if the Doc thinks for one second that guy will have changed his ways instead of just seeking further vengeance against the innocent, he must be more naive than I thought). For that it definitely loses a star - if finished properly it could've been 4.

My biggest issue with this episode is the lack of urgency. One of the crew has been abducted and the crew seem to be somewhat bored, looking for him.
When you compare with how the crew was when B'Lanna and Harry were lost in The Muse, it only highlights how little is thought of The Doctor.

Holy cow-- anyone who thinks that socialized medicine is the same thing as having a socialist economy or the same thing as having a communist government is a GRADE A IDIOT! Read a book, people. Open your brains up, and let the information in. Do you also think that Facebook is trying to turn the US into the USSR because it's "social" media?!?! Take off the tin foil hats, people. I can't fathom how you are even smart enough to turn on a computer and type words.

Sean wrote above : "it was an effective allegory on *nationalized/socialized* healthcare (such as Great Britain, Canada, Cuba), which often has to ration its limited resources when it claims to be "free" (aka taxpayers) for everyone"

Nothing could be further from the truth! I live in Canada and our health care system is good -- much better than the U.S. Everyone gets good treatment when they need it. It is free, and it is universal, for everyone. In contrast the system in the U.S. is just like that portrayed in the episode Critical Care: the rich get treatment while the poor die. See Michael Moore's Sicko. That represents what's really going on. I am glad that Star Trek producers had the courage to do this episode. Social commentary is what elevates much of ST above other television shows. It has consistently advocated human rights and the rights of all sentient beings. Universal health care is one of those basic rights. It's always amazing to me how ideologues can twist and misrepresent such ideals for the sake of advancing parochial interests of the elite -- just as Chellick does in the episode.

Paul York said, "I live in Canada and our health care system is good -- much better than the U.S. Everyone gets good treatment when they need it. It is free, and it is universal, for everyone. In contrast the system in the U.S. is just like that portrayed in the episode Critical Care: the rich get treatment while the poor die."

Hmm, if the Canadian system is so much better, why do Canadians keep coming to the US for treatment? Oh, that's right, because by the time they receive it in Canada, it might be too late for them.

And if you really think poor people are just allowed to die here, you really are as clueless as you sound.

Yes, in the US there is preferential healthcare treatment based on what you can pay BUT in this episode there is an "allocator" arbitrarily assigning "worth" to individuals based on their, age, skills, education etc. This may have shades of the US healthcare system and maybe the writers were even trying to take a shot at the US healthcare system but if so, they missed the mark. The presence of the allocator puts this in the field of socialized medicine. NOT today's socialized medicine as practised in Britain and Canada etc but a very extreme form of it. This whole episode came off as some grad-student's back-handed attempt to be "deep."

And the Doctor was no more ethical than he claimed the administrators were. His actions in Act 4 completely kicked the soap box he was standing on the rest of the episode right out from under him.

"And the Doctor was no more ethical than he claimed the administrators were. His actions in Act 4 completely kicked the soap box he was standing on the rest of the episode right out from under him."

You're actually completely wrong here.
We know The Doctor, we have seen him grow up over the series but 1 thing has remained constant - his actions have always resulted him doing the right thing.
Yes, he may have pushed the limits of his ethical subroutines at that point, however there was no chance that his actions were going to result in anyones death. If the administrator had called The Doctors bluff, he would have won.

As for the soapbox for the rest of the episode - again, his actions in the end are because of that. He makes a very human decision in his way to make a stand to try and incite change into a very shortsighted system.


As for you interpretation of the story, well, I think you're trying to be too literal and dismiss it - I can think of a few reasons you might do that.
But the simple point of the story is that the people who have worth(and in a captitalist society, it is often deemed by those in charge are the ones who have money are the ones of worth) have access to the best and the brightest while the poorly skilled labourers(the poor) have nothing.
This episode was a commentary on the the US Heslth Care system and did a reasonable job, for a show like Star Trek: Voyager.

As a nurse in the United States, this episode rang very true for me. For those interpreting this episode's hospital as socialized medicine, should reconsider. This is definitely an allegory to American healthcare. If your wealthy or otherwise have clout then you dont have much to worry about (We have great health care...if you can afford it) If you dont...dont get sick. If your illnesses costs more than your insurer is willing to cover...they do have legal ways of denying coverage that would disgust you.

On the other hand this was a great episode....a great laugh with Tuvok and Janeway holding hands. Jammer thinks that this episode ended anticlimactically with no real resolution...guess what ? Its the logical place an allegory to the US system would end to...The Supreme Court will rule in a few days on the legality of Obamacare, 11 years after this episode aired...

There's an unfortunate truth to what Jelendra says there. As I said earlier I'm British myself and we like to whine about waiting times or whatever else but when you sit back and compare it.. the NHS is a wonderful institution. At least they try.

I'm good friends with a guy from over there in the States whose mother is dying, precisely because of that same issue (and yes, it disgusts me): their insurers decided it was too expensive to save her, and terminated the insurance.. including his, as the two were tied to the same contract. There is now not only nothing anyone is willing to do for her, but he himself has come close to suicide on a number of occasions, because he cannot afford the Depression medication that he needs (the depression being made worse, naturally, because of this kind of BS - not even in his 20s yet and already bearing some of the worst that life and society have to offer with both his mother and himself being abandoned). The state of affairs with healthcare over there is nothing short of tragic, from my perspective.

This episode may be 12 years old, but still very relevant. The more these issues are examined, be it through debate or entertainment, the better really.

I didn't think much of this episode when I first saw it, but on rewatching it last night I was actually quite stunned by how prophetic it seemed. If the US healthcare issue wasn't one of the foremost problems in the US when it aired, it certainly is now. Great example of a classic Trek allegory.

It's interesting how much of a Rorschach test this episode is. Yes, this is a very heavy handed critique of the medical system in the United States where failure to propser means you don't live long. Yet many see it as revealing the evils of the imaginary and wholly fictional terror of socialized medicine. I suppose antisocial medicine would be better.

Simple fact is that some services don't lend themselves well to profit driven businesses. Yet perhaps the most fascinating social phenomenon of our age has been the ability of specific vested interests to convince vast numbers of good and intelligent people to support with great vigor policies that contradict both their self interest and fundamental morals.

Key to this is the illusion a zero sum game. This aspect is beyond the capable scope of a 40 minute episode of minor network television science fiction. Was this "cytoplasm" a genuine drain on resources or just a device to illuminate an appalling value system in a manner as subtle as a Louisville Slugger to the side of the viewer's head?

Fortunately, as noted above, this can be heavy stuff and was mixed with the comic take of tracking down the cat-man con artist to lighten the weight.

I think the thing that really got on my nerves was that most of these people looked completely human. No nose or forehead prosthetic, not even any skin differentiation. The only people who got make-up jobs at all were the thief (who looked like a Dr. Seuss character), the aliens that voyager had to talk to in order to track him down, and the Administrator.

I guess they don't bother actually trying to make the extras look like aliens if there are more than a handful that will be on-screen. As it's been proven that they're capable of a much higher standard of production, this is inexcusable. I know make-up takes time but at least slap a few lines or spots on them or something! This was the epitome of lazy!

That aside, a very poignant episode and I really liked it for what it was.

1. great episode! intriguing
2. the captain looking annoyed during the search was great.
3. holding hands with tuvok was great.
4. i noticed the aliens who looked like earthlings (chief of medicine) and thought, "really?"
5. i was fully entertained.

4 stars!

Good episode, but it's hilarious that farming is used as an example of a more valuable contribution - a decade later and so much farm land is being abandoned or sold just to build shopping malls.

"Critical Care" was a daring episode, but nothing's changed much since then.

Star Trek seems to every so often turn out a great medical story, something beyond the standard Trek plague clichés.

This was one of the great stories, in no small part due to the brilliant character of the Doctor and the tense yet fascinatingly multi-layered drama which you can't help but get really submerged in along with our favourite hologram.

The gravity of the horror and disgust the Doctor feels is matched only by the ferocity of his compassion and moral conviction. And the fact it mirrors what we see in the world today only adds to the emotional ride you're taken on.

I applaud the writers for rising to the challenge so well. They could have easily spoiled everything by taking the simple un-provocative route or turning it into a mashup of meaningless action and hallow plot manoeuvres.

Instead they gave their story heart. I imagine the subtext found here was something they cared about. Even the standard search from Voyager was played on differently and made fun for once!

Easily a 3.5 from me!

I find it interesting (yet not overly surprising) that this episode spawned a discussion whether it is about "capitalistic" or "socialistic" medical treatment.

I think it is rather simple: It's about neither of them, but it targets a deeper level: The prioritizing of treatment based on social status, rather than medical need. No matter whether this happens in a free market (using money), or in a planned economy (based on function), it is always the wron approach.

I agree with Thomas, this episode was more complex than just a veiled criticism of privatized medical care vs. socialized medical care. (BTW, as a Canadian, our medical system is not rationed, but allocated dependent on need, there is a difference; everyone receives treatment, you just might have to be patient.)

Anyway, on one level, we saw a society clearly suffering (economic and ecological catastrophes) - in their desperation they hired an outside alien 'consultant' and invested in a sophisticated 'allocation computer system'.

The sci-fi trope of letting a super-computer efficiently run a society is a well trodden road in Trek lore. The computer was a benevolent evil, rather than an overt one with a personality or larger motive. The system of allocating medical treatment was based completely on algorithms and databases.

We, the viewer grew attached to the sick boy and his mini-story, and to find out he suddenly and so tragically ended up in the morgue drove home the inhumanity of running an 'allocation' system by a cold-calculating computer.

An unusually thought-provoking episode of Voyager. -- Parting thought, the alien cityscapes in this episode were marvelous, complete with floating medical facility.

"Critical Care" was the last episode of televised Trek that I actually I was blown away by. It is not perfect by any means, but it is well told, it is about *something* and features characters that I'm invested in. Those are the requisites of dynamite Trek for me.

Enterprise was such a "dental office experience" of a series (with the exception of "In a Mirror Darkly", which was just fanfic come to life.) that I had no investment in the characters, so that even a thoughtful episode like "Cogenitor" (that I saw in re-runs) didn't do much for me.

I'm saddened that the last time I was truly invested in first run Trek for the right reasons was 14 years ago. That's truly depressing.

More loading of the dice here, I'm afraid (despite being a good episode). The kid who is being refused care just happens to be a promising talent. Come on. The vast majority of people in the US that can't afford care are useless, lazy bums.

Okay, dlpb, you've just turned in your sanity card. Please show up on time for your straight-jacket fitting.

@dlpb

Are you sure you're a Star Trek fan? It sounds like you've learned very little from the shows.

The kid is a promising medical talent not so that his worth is increased in OUR eyes (the fact that he's a person should be enough to do that), but so that he bonds with the Doctor.

They put them in a quasi mentor relationship so that in the end the Doctor is willing to murder the one he sees responsible. That part of the episode has nothing to do with the healthcare metaphor, it's all done to bring the Doc to a darker place.

And I thought it really paid off. It's probably the part of the episode that works the best.

Soviet style healthcare was excellent. Even Maoism had a pretty radical and laudable health plan, sending hundreds of thousands of free docs off into the countryside. Sharing is caring.

Of course such things are unsustainable under capitalism, in which all money is nonsensically issued as debt at interest, but then capitalism itself is.

"Tebbis ends up as the episode's thematic equivalent of the proverbial drowned kittens." Best sentence of the review. That is all.

I thought the situations presented in this episode were to extreme to be effective criticism of America’s healthcare (or any other system for that matter). Much too convenient that the same medicine can cure one disease on Level Red and extend lifespans of the healthy on Level Blue. The supposed « moral dilemma » of the Doc deciding to poison the administrator falls flat, because there is no way anyone could defend such an absurdly extreme system.

My two cents on the health care "debate":
What some of you may not know is that the U.S. government spends as much on health care per capita as Canada does. The problem with U.S. health care has nothing to do with socialism or capitalism, it is the influence that large corporations have over the government’s decisions. They finance election campaigns and get very generous subsidies in return, which they use not to help patients but to maximize their profits (by, among other things, finding very complicated ways to avoid paying for treatments, thus increasing the bureaucracy tenfold). To be blunt, a completely free-market system OR a Canada-style system would both be much better than what you have now.

Rosario said, "And the Doctor was no more ethical than he claimed the administrators were. His actions in Act 4 completely kicked the soap box he was standing on the rest of the episode right out from under him."

I'm surprised more people haven't commented on this. I thought the Doctor's decision to poison the administrator was clearly unethical with respect to his profession. I appreciated the final scene with Seven. Being willing to sacrifice an individual (the "bad" administrator) for the sake of a collective (the sick Level Red patients) does fit with a certain type of ethics. It's interesting to note that this was essentially the logic of Chellick. One subgroup was being sacrificed for another subgroup of society.

I initially saw this episode as an allegory for the U.S. health care system, and an indictment against allowing principles of capitalism to apply to health care. I'm also persuaded by Thomas, above. The episode does seem to assert that rationing of health care based on socioeconomic status is wrong. It also made the same point about rationing of education based on socioeconomic status - another problem in the U.S. 15 years after the air date.

Was Larry Drake cast as the "evil doctor" in this episode because of his prior role as the deranged doctor in "Dr. Giggles"? ;-)

I know people who have put off medical care because they can't afford it or wait until the pain is so bad they can't stand it. Interestingly in two cases this has been for dental care. Something is seriously wrong when medical care is the number one cause of personal bankruptcy in a country. I'm not holding my breath waiting for the private sector to handle this problem.

@Sonya,

Pleased to meet a fellow trekkie. I wanted say you make an excellent point regarding education and socioeconomic status. This has been one way to keep the uneducated underprivileged classes in check for almost as long as civilization has existed.
This was partly accomplished by simply restricting access to information, books, scholars and gurus.

I would say that the rise of the internet and its global reach will quickly do away with lack of education, since there is a wealth of information readily available for free to anyone with access to it. Anything from scientific studies to advanced calculus to the even the most basic interactive language learning. You can even view foreign countries (mostly) at street level. Planning vacations and seeing the landscape has never been easier. I can choose a location I want to travel to and stay at, view the street address on google map, and from there view the surrounding area!

I believe also that there is discussion in the works for providing Wi-Fi for free to low income households in the US. I can't remember which state implemented this but if successful it won't be long before it spreads across the other states.

I've always loved the idea of information being readily available at one's fingertips. The handheld ipods/iphones and ipads are the manifestation of the handheld devices holding terabytes (or quads, can't remember which) of data in the Star Trek mythos. One no longer have to be in the dark about anything unless they simply choose to be. It doesn't get much simpler with Google. You can either type or speak your query and Google does the rest.

Not that the internet does not have its dark side as well. But I like this site because it invites enlightened (usually)debate and positive forward thinking so I won't delve into that territory.

And it did allow me to respond in kind to and meet a fellow trekkie :)

Amazing that no one really predicted the rise of the internet. It just turned out that way. I feel as if this may be the one thing that may unify minds across the globe. I'm just happy to be alive to experience it!

The Doctor is a computer program, so why couldn't the thief just make a copy? Why doesn't Voyager have a backup copy? It makes no sense that there can only be one of him.

The Doc had a training program now too. Where did this come from? Where was this every time the Doc was away from Voyager? Heck, in Message In A Bottle, Harry Kim was trying to make another Doc from scratch. And NOW, Janeway says to secure his program from being stolen. Why didn't Janeway secure the Doc's program when the Doctor's Backup Program was stolen in Living Witness or even after his emitter was stolen in Concerning Flight or even after his program was stolen in Future's End. Tuvok - Do Some Work!!!

Yes, in Canada, the wait times for some things are ridiculous, even if it is free. Getting an MRI Scan appointment can take 6-12 months. By then, its too late for some patients. Yes, some Canadians would rather pay in the U.S. to get faster treatment. When it comes to organ transplants, it's the same thing. For those needing a new organ for example, you have to wait on a list for one that is compatible. If you know you're chances of getting a new organ in time are slim, people will come up with the money and go to Mexico. Being an organ donor is a choice, that more people should choose to do. If we can receive free healthcare, then the healthy should give blood and sign their Organ Donor cards in return.

Almost a throwback to a different era - a straightforward morality tale with a definite 70s sci-fi vibe to my mind. Yes it's all fairly formulaic but it gives the Doctor a good platform to do what the Doctor does, and it's a strong vehicle. I thought it was tied together very nicely by the concluding scene.

The B-story was the standard chase, but also handled in a novel and fairly fresh style - Janeways "I have a man" being something of an unexpected highlight.

And it's noticeable the FX work has taken another leap forward again. It's a real shame that the technology now available hadn't been there for the previous 20 series in the nu-Trek run. 3 stars.

Oh goody, a message show. I so love it when Hollywood feels the need to preach to me... Where should I begin?

First of all, let's point out the complete and total lack of subtlety here. Chellick was evil with a capital E, and the proles were all goody two shoes. There is no doubt that the Doctor is in the right, or at least that the writers wanted the Doctor to be in the right. Heck, just look at their faces. Chellick is fat and ugly with ugly tumor-like bumps all over his face. He might as well be a Vogon. The other doctor on Blue level was stern faced, not quite as evil but still kinda harsh. And the Doctor and patient at Red level? Cute wide-eyed baby faces. They might as well have given everyone white and black hats. Heck, look at that opening shot. Drab gray buildings surrounding the gleaming hospital. You know you're in for a class warfare episode as soon as it opens. Like I said, no subtlety.

Now, how about the message itself? It seems clear that it was meant to criticize the US health care system, or at least the insurance system as Jammer alluded to. But as Sean said, it doesn't really fit the actual US system. It's barely even a straw man! There was no money involved, no way to try to get more medicine if you might need it, just a harsh allocation system imposed from on high. I'd say that makes it sound more like a centralized socialized health care system, except European health care isn't run like this either. In fact, the closest real life analogue to this system is the Cuban system, with resources allocated for the ruling elite (and to show to visitors) while the proles get the dregs. But, well, surely that's not what the writers were preaching against, right? And if they weren't meant to be preaching, why was it such a blatant black and white, good vs evil dichotomy? So in the end, the writers were beating up a straw... something. Because normally straw men bear a passing resemblance to the actual thing they're criticizing, but this doesn't.

Which is sad, because the idea was at least worth investigating. Throwing the Doctor out of his element like this was a worthwhile approach to a plot, and seeing how he would respond to less than ideal working conditions. And his story was decent enough, how he tried to work around the evil administrator. If there were more shades of gray here, if there was a more relatable adversary for him, then we could have had a lot more fun with it.

For example, early on, they said this planet was DYING. The people were absolutely desperate. What if the situation was so desperate that one might be able to justify this situation? For example, what if those water engineers were so rare that they had to have their lives extended? What if society would collapse without them? Then we would have a reason for this situation, and force the Doctor to justify his immediate need to treat patients with society's need to survive. Or maybe have those treatments in Blue be for the actual plague as well, so that it's a matter of triage. Give something there for him to work with instead of it being a morality play.

And then there's the ending... Look, I've been harping on the inconsistent writing on the Doc's sentience since the first season. And they even brought up his Hippocratic Oath at the very beginning of the show, that this is something that he CAN'T ignore. Which makes sense to me. I've always assumed that Zimmerman would have been smart enough to program this learning machine to always have medicine as the top priority, something akin to Asimov's Three Laws. And there's been many instances throughout the show's run where this idea is backed up. When he tried being a therapist to Seven which ended up with someone else dying in Retrospect, he felt so guilty he wanted to excise all of his additional programming. In Latent Image, even the thought that he might have used some other criteria for triage than his medical programming made him go insane.

But then in Equinox, he could get a flipped switch to evil. In Virtuoso, he was willing to quit being a Doctor to become a singer. So what gives?

To complicate matters further, it's been strongly suggested that he needs other people to program in some of his other interests. Or at least needs help to program in his interests. Seven could excise some of his extraneous interests in Life Line. He asked Torres for help on at least one occasion. Which suggests that, if he was really evolving to move past his Hippocratic Oath programming, it had to be a conscious decision, and possibly one that involved other members of the crew. And given his final conversation with Seven, that clearly didn't happen.

So was this a subconscious evolution, something akin to the Zeroth Law in Asimov's books? Maybe, but, well, the Hippocratic Oath is much simpler. First do no harm. There's not much wiggle room in that. Deliberately poisoning one person to save others is well outside the norm of medical ethics. It just doesn't seem to fly with everything else we've seen. This is supposed to be a deep character issue, perhaps, but it comes out of the blue. I much prefer Latent Image.

So, all in all, a very frustrating episode to me. On the bright side, the hunt for the Doc was fairly humorous, a better run than the usual routine we see in these sorts of episodes. Of course, I wonder if Janeway would be so cavalier if it had been Tuvok kidnapped instead of the EMH. Then again, maybe Janeway has become self aware that she is a mere character and everyone has plot armor. If the Borg couldn't kill anyone, they weren't gonna be defeated by this lame guy.

This episode depicts whatever Healthcare System you don't like. It's clearly not American or Canadian or European. So pick one and complain. It seems more Socialist to me. the "state" seems to be at the heart of things because the level of H/C apportioned is basically based on one's contributions to society.

Of course the ACA was to fix all America's healthcare woes... chuckle... ho many are uninsured now? How many are still exempt?

I like the English version as long as "basic" health care doesn't include add-a-dick or breast augmentation or abortion etc.

This episode if fine. It did seem to drag a bit I thought. Janeway taking Tuvok's hand was frellin hilarious!!!

3 star episode for me.

A good allegory works on multiple levels. A bad one protests specific things the author dislikes.
Here we have a good one. Any bureaucracy that puts "efficiency" over patients is a bad one. This reminds you of various systems without calling out any specific one.

Trying to find a direct correlation is a useless exercise. It isn't meant to be a direct correlation, it's meant to make you think about various things that get in the way of patient care. And everyone has a story such as the wrist story in Jammer's review or know someone who has a similar story, because big bureaucracies aren't the same as caring individuals.

Great stuff!!!1 Whodda thunk the best character on the show would be a hologram. (****)

A very enjoyable episode, as the Doctor's usually are. For once the B plot meshed well with the main story and I appreciated the comic relief provided by The Search for the EMH. I agree with the comments about Tebbis' character being as pathetic as a drowned kitten, but I still think it was good that the writers didn't cave in and provide him with a miracle cure. I didn't find the ending anticlimactic. It wasn't the EMH's business to single-handedly change that society, but he seemed to have planted seeds of rebellion in the minds of Dr Dysek and Dr Voje, which might or might not have resulted in changes.

I'd love to know what propaganda was being employed to convince Americans that universal free health care is an evil communist plot - it seems to have been very effective. I wonder if some of the above comments might be changed with Obamacare now under way. By the way, here in Australia, Medicare will cover part of the cost of an abortion which, it might surprise Yanks to learn, is not a cosmetic procedure.

@Polly - The propaganda is very easy to explain. There are a lot of Americans that have a strange affliction where.

a) They see themselves as hard working
b) They see people who get more government assistance as they do as lazy
c) Whenever government assistance helps them they view it as normal, whenever government assistance hurts them they view it as theft
d) Because most of us know more poor people than ultra rich people, many people fixate on the poor stealing from the government instead of the rich

So to provide 2 examples... most people in my socio-economic class are bitching that their premiums have gone up since Obamacare. I personally shell out about $20 ($30 up from $10) more per co-pay and more in my check each month without any increase in service. I was on one of those "cadillac plans" that were heavily hit with higher costs. In theory I can afford to pay this, in practice it can be tight. People with more money have higher living costs. That said though.... Democrats in power have also brought free universal pre-k to my area. I currently am paying thousands less on childcare for pre-k this year than nursery school. And in 3 years my second kid will be in pre-k. The truth is that until all my kids are in school my very decent salary makes me feel poor because I bought a house and have to pay very expensive child care. So this break is when/where I need it the most in a lot of ways. But my peers don't see the connection between socialism in A and B. They see UPK as a needed service and socialized medicine as theft. Because in one case we're fitting the bill for other people's stuff and in the other we're recipients. So that's how my c) works.

One could argue both cases are good for people and society. Certainly giving people childcare a year earlier brings more spending money to families when they really need it and gets more people back in the workforce earlier. It's good for everything. But so is having poor people with healthcare. Because when people who can't afford healthcare get checkups they don't end up in a hospital (that cannot legally refuse service) for something more serious 5 years later racking up tens of thousands of dollars in bills that... yes.... SOMEBODY has to pay anyway. And it keeps them healthy and working, which is also a good thing for the economy big picture.

But that brings me to d). I've seen people rage about people showing up with their hair and nails done to supermarket and pay in food stamps (nevermind the possibility that these people are working a job where they need to look nice). This happens a lot that people worry about what other people are getting free when 1) the cost to police who's cheating what might actually cost more than the cheating... because are we going to pay PIs to follow people on disability around to see how disabled they really are? 2) because we all know more poor people than we do ultra rich nobody sits there and fixates on the fact that rich people pay half the taxes on capital gains that you do on income. And that you could pay for all those poor "thieves" if you did, in fact, fix that.

So the propaganda is largely a "look over there at that poor person who is not the same color as you and is stealing your money" (see Ronald Reagan and the welfare queen speech and Mitt Romney's 47% "speech") way to misdirect people and make them distrust socialism in all forms where in fact most people would benefit from socialist policies and those who wouldn't could probably live without that 3rd vacation house. And the last piece of the puzzle in the American dream. People don't want to gut rich people because they think that if they work hard enough and pull themselves up by their bootstraps that they too will be rich. I've got news for those people though, most rich people have a trust fund. Most of them are not wunderkinds like Zuckerman that just happened to have made the most successful damned product on the planet and gotten magically rich. Most money is old money, very old money.

Now after reading all that one might say I'm against capitalism. I'm not entirely sure that I am. Obviously capitalism has done some good things. But the older I get the more I'm convinced the true solution is somewhere in between, and we have to stop viewing socialist ideas as though they are poison. And lastly... it might also sound like I think all conservatives are like this. I don't. I think many conservative politicians have fanned the flames of American dream propaganda alongside people's inherent need for things to be fair and distrust of minorities (especially in communities where there aren't many) and big cities in order to achieve wins against socialist policies. And that those politicians aren't being honest because they seek wealth distribution where they want it (see farm subsidies for a random example) and try not to call it that. There are truly conservatives that think if we all just paid nearly zero taxes and spent all of our money how we saw fit that most of us would be better off. For them it's an ideology, the principle that if you work for a dollar you should keep a dollar. There were actually founding fathers who didn't think the federal government should have taxes at all. Some who would be aghast that a dollar you gave to federal income tax could be used to fund a farm or a school that's a 6 hour plane flight away from you. I don't know that I have anything to say on that ideology except that I don't think it's realistic at this point.... but the majority of "conservatives" who have poisoned people against "socialism" think nothing of having laws on the books that can cause you to pay no taxes for 20 years because you had a billion dollar loss. Think nothing of letting people write off losses on buildings that they won't rent because they want to charge more rent than any store is willing to pay to occupy that space. Think nothing of cutting taxes to the 1% because they want to pretend that "trickle down" works. Well it doesn't. After the recession when businesses were making money again they didn't hire more workers or pay their existing workers more. They paid their CEOs bigger bonuses because those guys were getting the same work out of less employees. Good job!!!

This turned out longer than I thought it would. But for those who don't live her who are curious... that's how the propaganda works. You make people furious that the poor people are stealing your tax dollars so that you don't notice that the rich people are doing it.

Robert Picardo's performance in this episode is beyond anything voyager has shown before.

@Mephyve: excuse me, but did you just give 4 stars to a hospital episode??

I must admit I also enjoyed this one, but the ending didn't ringing true. So Chellick gets his come-uppance, but what happens after he gets the treatment? Does he honour the agreement? I know I wouldn't if someone extorted a promise from me in those circumstances.

3 stars

I must confess I don't remember watching this particular episode when it first aired. This year I have made it a point to watch each episode of Voyager in order. It is such a treat to have "rediscovered" gems like this episode this year.

So, I'm with those who say this is a great allegory. Not one representing or criticizing any specific government or bureaucracy: each of us as individuals will make a judgement based on our experiences and the institutions we live in.

Personally, I think this episode brought several concepts together rather well. The Hippocratic Oath dictates to do no harm, but to whom? Individuals, or entire societies? The needs of the many outweigh the needs of the few, but which many? Not to mention the Prime Directive, which the doctors we've seen in Trek have wrestled with time and again.

The Doc and the administrator each are operating within their bounds of their institutions. We may never know the ultimate intent from the writers. Only they know their true intent. Finally, I personally like that this episode ends rather open ended.

Voyager reminds me a lot of the Original Series and I think it captures the TOS spirit well. This episode is an emotional roller coaster. I love to see Trek comment on society, and Critical Care is a wonderful example of Trek at its best.

Great episode... I read through the comments and people arguing about it. I saw some points on Canada I would like to correct.

1 - it is not "free" in that sense. We pay a higher tax rate in most cases than the US (as do the Euro countries that have universal single payer systems). In the province of BC, everyone also pays a monthly fee (75 bucks these days for most). Due to the overwhelming costs of this, it does affect other areas of spending that is for sure, which has an opportunity cost attached to it. And, it makes it more likely to run deficits because it is not easy to cut back expenses in the medical system. So, it is not "free" for our society or for taxpayers. You could argue it is free to those who are disadvantaged and don't have income. If unemployed person A gets cancer, they will get treatment without question.

2 - People do not die due to long wait lists. Yes, there can be found rare examples here and there out of a system serving 33 million that will have other factors involved. People go down to the US for expediency (If they can afford it). If your life is in danger, you get to the front of the line. If you need a knee operation, maybe you wait 12 months . If that knee is infected and you may die, you get it the next day. While a system like the US allows quick access for those who pay and are insured, a universal system is strapped for cash and is slow. It is a trade off. For most people, they can not afford to pay for it themselves. So, I think it's better to have wait lists than 10% of our citizens with zero health care available

3 - There are plenty of people in Canada (usually Conservative voters) who like the US system and hate the idea than everyone gets health care and that causes their taxes to go up. The irony is, they are rather silent when a loved one needs a quarter million dollars worth of cancer treatments, and they are happy to accept the health care at that point.

For me, this episode is not about access to health care as compared to our real world systems. it is about a society selecting who lives and who dies via some sort of social engineering. This whole thing that planet set up was to selectively treat people based on education, job, social status, etc. I wish they would have had some dialoge about "who does the waste extraction if they all die". Yeah, it's nice to think that only educated elites should live...... society needs the drivers, and miners, and clerks, and laborers, and whatever else makes them a low TC score. I would have loved if this system had bene in place for a 100 years and they were screwed over because nobody had skills for the things that make society actually run every day.

Just to add some additional perspective on the Canadian system: yes, basic emergency, diagnostic and necessary surgical care is covered by the Provincial health plans (there is no universal care in Canada - each Province has its own health plan).

But the idea that this eliminates the need for private health plans or that it covers all necessary healthcare is something of a fiction.

In Ontario, for example, medications (outside of what is administered in the hospital as part of surgical or emergency care) are not covered. Dental care is not covered. Physio and psycho therapies and rehab treatments (outside of perhaps a narrow very limited hospital based treatment for very serious injuries - and only at the outset) are not covered. Basic assistive devices are not covered. So for instance, my daughter's club foot brace (about $500 at the outset and then again as we get larger braces as she grows) was not covered, despite it being necessary for her not to be crippled. Her emergency anti seizure medication would not be covered. If you got into an accident and needed physio for an injury, most of that would not be covered.

People in Canada do have private health insurance. And you can still end up paying thousands of dollars for healthcare expenses notwithstanding "free" care.

That said I am conservative and I would not take the US system. When I travel to the US the first call is to my health insurer to verify coverage - I am not interested in having to pay a $500,000 bill if God forbid my daughter has a seizure in Florida or my wife needs her appendix out.

The price for healthcare in the US is ludicrous.

Actually, what the Doctor did at the end was highly ethical. He was kidnapped. His kidnapper's co-conspirator (don't say he wasn't every bit as guilty as the thieving kidnapper, as soon as the Doc told him he was kidnapped the Administrator became an accessory after the fact and as soon as he continued to prevent the Doc from contacting Voyager and tied his program to the Allocator he added a whole host of other crimes) was actively preventing him from performing his main function saving lives. The Administrator was never the Doc's patient. Hippocratic oath didn't even apply. He was a criminal engaged in actively violating the Doc's rights. He is also at least implied to have murdered the Doc's young protege. His explanation of sudden onset infection makes absolutely no sense.

In any case, this silly "unethical" assertion reminds me of this verbal exchange from Doctor Strange (2016). ****SPOILER ALERT! SPOILER ALERT! AVERT EYES!****

Doctor Strange: "It is Dr. Strange. Not Master Strange, not Mr. Strange, Doctor Strange. When I became a doctor, I swore an oath to do no harm. And I have just killed a man! I'm not doing that again. I became a doctor to save lives, not take them."

*snip, snip, irrelevant dialog*

Baron Mordo: "You're a coward."

Doctor Strange: "Because I'm not a killer?

Baron Mordo: "These zealots will snuff us all out, and you can't muster the strength to snuff them out first?"

Doctor Strange: "What do you think I just did?"

Baron Mordo: "You saved your own life! And then whined about it like a wounded dog."

Doctor Strange: "When you would have done it so easily?"

Baron Mordo: "You have no idea. The things I've done... And the answer is yes. Without hesitation."

Doctor Strange: "Even if there's another way?"

Baron Mordo: "There is no other way."

Doctor Strange: "You lack imagination."

Baron Mordo: "No, Stephen. You lack... a spine."

The Doctor did what he needed to do under the circumstances. If he were to take up a phaser and vaporize the Administrator, beat him over the head with a lead pipe, kick him down a disposal chute, whatever, it would ALL be morally and ethically correct, because this individual was actively engaged in multiple crimes against the Doc AND preventing the Doctor from performing his primary task, saving lives. While it's good for his own mental health that the Doctor had misgivings about it, enough to ask 7 for a checkup, he really didn't have a reason to be worried at all.

Also, the exchange between the Administrator and the Doctor at the end was made gold by Picardo's delivery:

Chellick: "You're only making things worse for yourself."
The Doctor: "As a matter of fact, I'm making things worse for you; I'm going to make you a patient in your own hospital."

The way Picardo leans in and says the last sentence with such vehemence plus the intense expression on his face held so much awesome. It was almost as good as Doctor McCoy in "This Side of Paradise":

Sandoval: "We don't need you, not as a doctor"
Dr. McCoy: "Oh, really? You want to see how fast I can put you in a hospital?"

Sorry Quincy, I disagree.

Oh sure, perhaps you have a point that an ethical person, seeing a situation like that, would do whatever to escape. Heck, we just had a lengthy discussion on that various topic over with The Most Toys. I'm not arguing that part. There are two specific aspects I argue: that this is a doctor doing harm under medical conditions and that this is an AI doctor doing those things.

Let's deal with the first one. You gave an example from Dr Strange. Note that he struggled mightily with simply using violence as self defense completely outside of his medical ethics. And eventually, he became more used to it. Whatever. Again, it's outside of the medical sphere. No one is saying a doctor can't engage in self defense, and no one would expect that. Dr Crusher had no qualms with firing phasers at various Borg or at a bug-controlled admiral, for example. But that's because it's not in her professional realm. The Hippocratic Oath is applied to the medical realm. If Hitler gets wheeled in on an operating table, you do your best to heal him. It doesn't matter that it's Hitler. Again, using Crusher as an example, I believe she still did her best to help the terrorists who kidnapped her in The High Ground. Bashir worked to help the Jem'Hadar. It doesn't matter what outside ethics means once you have a medical kit in your hand; you do no harm. The Doctor violated that. So if the Doc wanted to take a pipe and smack the evil guy upside the head, that makes more sense than deliberately poisoning him and then withholding medication.

Secondly, this isn't a person. Maybe the Hippocratic Oath says that you give Hitler the best treatment you can, but it's certainly possible that a human doctor would "accidentally" mess up a surgery there. This was a plot point in a MASH episode, for example. But the important thing, the thing the Voyager writers forgot about so often, is that the Doctor is not human. In fact, he's not even Data. Data was programmed to be like a human, to emulate humans. Thus, Soong programmed him to be able to make his own choices and his own ethical decisions. Obviously this backfired horribly with Lore, but it was still the way Soong programmed them. But the Doc? He was not programmed to emulate humanity, he was programmed to be a tool. A highly complex tool, but a tool nonetheless. His sentience is accidental in nature rather than designed like Data's. So why would Zimmerman program the Doc to be able to make ethical decisions outside the standard accepted medical practices? It shouldn't happen. The episode even lampshades the fact that it shouldn't happen, yet did it anyway! Why? How?

Keep in mind that less than 2 years ago, it was revealed that a simple triage decision outside standard medical standards caused catastrophic errors the likes of which we haven't seen since a good old fashioned Kirk Logic Bomb! How could he have evolved so fast such that he couldn't make that decision then, but could violate his own personal Prime Directive just a few years later? And again, all without a conscience decision on his part to overwrite his programming, which again is at odds with multiple other Voyager episodes.

So the idea violated continuity, and violated common sense. And it failed to use the Doctor's unique position of being an AI creatively, preferring instead to have him act like yet another boring human. Tis a waste.

If only there were a way for society to determine the value of an individual and allocate resources accordingly. Oh, yeah. It's money. When society values a person more, they pay them more. Professional athletes, who provide a lot of value for their teams and TV networks make more money. COEs, who provide growth and value for their companies make a lot of money. Doctors, who suck in a lot of money from insurance companies and medicare/medicaid make a little. Teachers, who pull in crap from government make crap. And homeless/mentally ill people, who drain societal resources, make less than zero. This is how our society allocates value in a bottom-up manner, and this is how we pay for healthcare, housing, schooling, etc. This is how this supposed dystopian society works, and this is how it ***should*** be. If you provide ZERO value to society, you get ZERO value from society. If we have to ration resources, this is the best way to do it. Otherwise we all lose.If the society fails to account for the potential of youth, as in the wide-eyed viral-kid, then they're doing a crap job of accounting for value. No society is going to pay for arterial health of an old agricultural engineer at the expense of a bright student. This episode is a great screed against socialist bureaucracy that fails to identify value and places a top-down number on human life and potential and fails to allow for human flourishing.

Watching this episode in 2017 as Congress works on repealing Obamacare is just painful. It's barely allegory. Good ep, though -- the doctor's distress at the end, finding that he actually chose of his own free will (!) to poison Chellick, was a great coda. As is the idea that a programmed being might have free will ...

As for the convenient Janeway/Tuvok "relationship" -- loved Janeway's facepalm at the end. I laughed out loud. :)

I can see this episode being an allegory for either of the two most common assumptions: the US health care system or socialized medicine. It's actually quite telling that this is possible. But if we look at the pattern of ideology (and let's be honest, the Star Trek universe is a socialist utopia) that the writers and stories have shown us over the years, it's most likely meant to be critical of the US system. Fair enough. It's their show and they can say what they want on it, and I was fine taking the story as it is (I despise socialism, btw).

But it wasn't until I watched the SF Debris review of the episode that I noticed what was missing from the allegory that makes it crumble under the weight of logic. Money is never mentioned once. Only value to society. Chuck does a great job of pointing out that the criticism towards the US system makes sense if you are talking about money (in terms of how the Allocator determined where care was to go), but if there is no money involved, then the allegory makes no sense. It's the kind of messy mixing of metaphors/similes that happens all too often when one is too eager to promote an argument in a message show. If the Allocator was programmed to distribute care based on value to society, the result would not look like the socialist wet dream (by which I mean a representation that is so obviously meant to show the results of evil capitalism) that we have in 'Critical Care'. I understand where they wanted to go, and on the surface it looks like they got there, but in truth the message is muddied by sloppy allegory whose logic fails to holdup under scrutiny. It's like taking a plane to France and ending up in Paris, California (and trying to convince everyone that the chapparal in the your pictures is standard plumage in the French capital).

Pretty interesting episode about healthcare (of all things) and the discrimination for different segments of society given their different treatment coefficients on some alien world. Picardo is really good in this episode (again).

That the alien society runs on giving medical treatments based on different TCs is a good take on how a non-Earth society would/could administer medical treatment. All about treating those who are bigger contributors to society -- analogous to our planet (in a way) with the rich (1st world countries) being able to afford better treatment.

Doc's plan of poisoning Chellick reminded me of Kirk in "The Cloud Minders" beaming the administrator into the mines to prove the effectiveness of the gas masks. Kirk was trying to get a poorly treated class of society equality. I liked how Doc resorts to this extreme act to prove a point not long after the shock he sees at the unscrupulous medical ethics.

Also some decent humorous moments with Janeway trying to track down Gar - bit of a wild goose chase and then the interrogation with Tuvok and Neelix was well-done to get the thief to confess. This must have been a plan between these 2, although it seemed like Neelix took matters into his own hands (with the feeding of Gar) - much like Doc has to do on the alien world.

3 stars for "Critical Care" -- a really good take on medical care, though we don't know if that alien world changes its ways (in terms of one of the possible conclusions to the episode -- not a big deal). Doc is proven to be in fine condition by 7 when he was concerned his poisoning of Chellick was a malfunction -- that was a nice touch to end the episode.

The episode makes a direct reference to the public health care system and compares two cases of prioritization based on merit or prioritization based on problem severity and life expectancy.

There is middle ground. It is a complex calculation, I admit, and after setup, best left to computer algorithms instead of people. You have to calculate how the allocation of resources will maximize the usefulness of health services individually without compromising future resources socially.

Idiots, in general, tend to entrench themselves behind ideological extremes and avoid the task of synthetic solutions.

This is an interesting episode, at any rate; Picardo is good as always and the atmospheric direction contrasting the blue and red regions of the hospital works pretty well. It's a message show so it's about something. And it also does something relatively new with the Doctor's character. I'm not really sure about the results.

So: the episode's taking on medical bureaucracy. I think that it's specifically a criticism of the American system having to do with HMO's (which I don't know much about, not being American) and insurance generally, because it's an American show and so it's attempting to be topical in some field where it can maybe have an impact on its viewers. But I think it also generalizes to any kind of bureaucratic system which allocates resources according to some notion of merit (be it economic/wealth, a sense of a person's value to society as a whole, etc.) rather than according to need, and it does so to an extreme extent, and so can also apply to totalitarian communist regimes or whatever in addition to capitalist ones. The big point is anti-bureaucracy. In any case, I agree with the central idea here that it's a bad and immoral system which prioritizes unnecessary treatments for a few "worthier" persons over urgent care for a larger group of people. It's also a society in which there seems to be no real mode of advancement -- the kid has his father's job, and that's that, so it's stratified and also lacks much opportunity for personal choice to influence one's position in the stratum. The episode also has a TOS feel, both in the Explicit Allegory element and of course in the "computer controls all society, and it's up to Our Hero to destroy it" plot element.

That said, the episode stacks the deck too hard for me to take it too seriously in some senses; that the kid the Doctor attempts to save is a budding medical prodigy and ALSO has a heart of gold, bravely letting the Doctor know he doesn't blame him for not treating him, pushes him out of the realm of character and into pure symbol. The bureaucratic Chellick is fat and ugly, and even is identified as a different species than the rest of the people around, as if to further isolate him from being considered a person. The other doctor, Voje, at the red level, was a more convincing character, someone who wants to do more good for his patients but is stymied by a recognition of the probable consequences and the hopelessness of any attempt at change; and I thought that the other blue level doctor was relatively convincing as well, as someone who prioritizes his own career but is willing to make an end-run around the rules for that.

The Doctor's quickly throwing himself into this system and trying to transform it is itself interesting. It's not a fully Prime Directive issue because the species seems warp capable and, besides, they kidnapped the Doctor and forced him to work, so he really is already involved. Additionally, the Doctor seems not to have that much experience with or interest in Starfleet noninterference, though surely he's aware of it, and it certainly *should* be part of his Emergency Command Hologram programming which is presumably underway post-Tinker Tenor Doctor Spy -- but basically I think it's basically believable that he places the Hippocratic Oath, and his interpretation thereof, over other concerns. The Doctor's arrogance, a regular character trait, combines with his concern for patients and so he immediately tries to fix the society at least enough to be able to help the people in his care. The episode seems briefly to be like something out of M*A*S*H where the doctors would do something illegal and a bit below-board to do an end run around the military bureaucracy to help their patients, and usually (not always) succeeded, or at least didn't make things much worse. The Doctor's using bureaucratic logic to convince the blue level doctor to order extra medication is another good scene and one which fits with the idea of turning the system against itself in order to help people -- which also hearkens, in a way, to Kirk destroying those computers which rule societies against each other by tricking them with their own logic. And yet the Doctor's plan backfires spectacularly. A whole bunch of people *die* when The System fights back. Maybe there's a reason no one else has tried what the Doctor tried here, no? The death of the young man and the possible deaths of all the patients thrown out after the Doctor's well-intentioned stunt add a kind of grimness to the story that I had forgotten about and wasn't entirely expecting.

So then the ending. The idea that the Doctor specifically betrays his principles -- poisoning a man and using his potential death as leverage -- is a good one, actually, particularly given how responsible he feels for the care of the patients whose lives were jeopardized (or ended) as an indirect result of his actions. It's extreme, but I basically get where the Doctor is coming from and what the writers were going for here. However, looking beyond "what they were going for" and onto what we see, I feel like the ending makes no sense and undermines itself. The Doctor manages to get *both* the other doctors on his side, and the blue level one even seems to articulate that it's necessary to get more blue level patients for the sake of his career (for the explanation the Doctor provided earlier). But for this we have to assume that Chellick's adding a few extra chairs to level blue is, what, a permanent decision? That they have his word that he won't take it back once he's no longer dying as a result of being drugged, poisoned and having his identity falsified by a rogue computer program and two of his staff? There's no reason for Chellick not to change the number of Blue Level patients back to its previous number once he's no longer being held against his will. And even if there was: look, the Doctor doesn't know he's about to be rescued, but maybe we're meant to recognize that he knows that his program will be decompiled after this stunt (or that he'll be forcibly reprogrammed or something), and is willing to sacrifice himself for the cause. But those other two doctors aided and abetted a pretty major crime against him, and they're going to -- what -- just stay on at the hospital? Not get arrested? I guess we don't know much about this society, but I think most of the time, decisions made under duress because someone is trying to kill you don't have to stand legally once your life is no longer in danger. Anyway, I can maybe see the level red doctor going along with this out of some desperate humanitarian impulse, but the one concerned with his career thinks that participating in this attempted murder and fraud against his boss is going to be worthwhile because they'll get some more meds from the computer after this? It makes no sense on its own terms.

I find that there's a curious low energy in the shipboard scenes, especially early on, where the crew seem to barely be able to stop from yawning when discussing how their chief medical officer and friend was kidnapped by some thief for nefarious reasons. Tuvok and Neelix's interrogation techniques, which involve the threat of a mind meld and then actually "poisoning" him (giving him gas) are played for laughs but tie in with / foreshadow the ending to the Doctor's story.

2.5 stars for ideas and for some of the Doctor character development.

Caustic, funny, and insightful. 3.5 stars. I particularly liked the scene with Neelix, Tubok and Gar.

There are two things I liked about this:
1) They didn't tahe the easy way out with Doctor poisoning Chellick, they didn't use the "ol' switcharoo" at the end with the doc saying: "Ha, that wasn't that sickness, i was bluffing" so that the Doctor would come out pure and innocent at the end.
2) I like the last words of Seven, quoting Spock, to "comfort" Doc: The needs of the many outweigh the needs of the few.
It's a shame the writters didn't give Seven one more line to make Doc's dillema even worse (and thus making it more interesting) - The needs of the many outweigh the needs of the few - isn't this the same "logic" that Chellick was using to justify what he was doing?

"medical bureaucracy"?
You mean "medical inequality", right?
We have an ethical issue here, an ethical choice not just bad organization.
Should the strong and wealthy keep being in favor of the society?
Should healthcare be equal for everyone?
I see it as as an allegory for the US medical system and I am not even American.

I am sorry, but many of the previous commenters got it backwards:

The episode is manly a metaphor for US and similar systems, because if you are more "important" (better job, earn more money and or have better benefits) you have amazing healthcare.

Socialized medicine is EXACTLY what the Doctor (and Star Trek in general) preconizes: priorize the most needed, social position ignored.

I'm going to go out on a limb here @Michael and assume that you're Republican.

Yowza. Had to quit reading after powering through so many, many political comments.

My thoughts:

--Though it can be interpreted differently, when it comes to how best to achieve Nirvana, the ep plainly sends this message: Healthcare should be accessible to those who need it, regardless of their status in society.

--The ep has a main theme though, that is not so political, about ethics and frustration and what's ok to do. Tuvok threatens Gar with a mind meld, Neelix actually poisons him, Janeway lies about her relationship with Tuvok just because she wants to move that conversation along, Gar steals to make a living, the lady left her boring husband to be with the exciting Gar, Doc lies and finagles to get medicine, he subtly threatens the nurse, he poisons a man, and more. It's constant throughout the ep.

What counts as critical? Is it ever ok to lie, cheat, steal, threaten or actually do bodily harm? Do we do it for others, or for ourselves, out of frustration and to make ourselves feel better, to try to solve a problem with minimized effort?

The real theme is getting lost in all the talk about the "in your face" lesson, which, yes, is there, but the preachy message is not, IMO, central.

It's all about the gray, not the black and white.

Some really quite bizarre misconceptions of UK healthcare on here. Things along the lines of if three people had the same health problem "socialised medicine" would help the one with the greatest economic worth. It couldn't be more different. The one in the greatest need would get help first. End of. Those of the highest value to the economy/richest getting the best as shown here is a pure observation of US society.

I've lived in the US, the UK and France. I was studying in the US and not much money, just basic health care. The US system sucks if you don't have money. Anyone who's not rich advocating for the US system is deluded and brain washed. If you have money, you can pay for all the healthcare you want in all 3 countries. You're not forced to use public healthcare. You can pay insurance (cheaper than the US) and get seen privately when you want. This is as a topup. But even in the UK, if you have a crisis, often they'll send you to the public anyway because the NHS is fantastic. And severe cases are prioritised whether public or private.

The difference is what happens when you're poor. I'm being managed in the UK for a health issue that wasn't looked at properly in the US because I had no money at the time. 10 years later! If I had been in the UK , it would have been resolved quickly and cheaply within a matter of days. It wasn't and it became chronic.
Ill people are not good for a society. If say, cancer cases are not looked at properly, they will worsen and become very expensive.

Another issue that those who rail against socialism don't realise is your medical costs in the US are highly inflated. So they think more socialist countries are paying those fees and they will have to pay such high fees if they use a similar model. We are not. It does not cost 600 dollars for a saline drip.

When I watched this episode, it made me think of what healthcare would be like in a a Nazi-controlled government, as depicted in the Man in the High Castle novel.

"--The ep has a main theme though, that is not so political, about ethics and frustration and what's ok to do." -Springy

Well said.

Overall an enjoyable episode with a well thought out script. Still left me a bit unmoved, maybe because the story's main philosophical question was a bit over exposed and lacked certain refinement.

2-2,5 Stars I guess.

@ ANDRE

Except that every implementation of said socialism ends up exactly as shown here: Your political standing determines your care, decided by an unfeeling, uncaring drone of an organization. A person can always find ways to earn more money.

There are definitely things that need fixing in the US healthcare system. Most of those things are a direct result of people saying "Government needs to get in the middle of it".

This childish ignorance of human history in believing that a more powerful government under socialism cares, about anybody, but their own government officials, as shown repeatedly throughout history, is really quite revealing inasmuch as how our schools are actively failing their students.

Oh dear. 20 years later and people are dying in the US because they can't afford vital medication. In the UK there is uncertainty over the future of the NHS - which is overstretched and a bare minimum anyway; they're pretty good at keeping you alive but quality of life is not a priority. Not all of Star Trek's "message shows" are done well, but there are some I wish we could plonk government officials down in front of them and make them watch!

A bit scary that some people seem to think the NHS and similar systems were the subject of this though; the only vague parallel I could see was the difference between public and private healthcare but that's a very tenuous analogy, and people aren't routinely deprived of medical care because of their [financial] status in society. Occasionally individual fatal mistakes are made, but they are not systemic flaws!


Overall, I really rather enjoyed this episode. I agree there is the question of what really would happen in the long term, but I think the implication was that given a new choice to actually treat patients who needed it, the doctors would go with that, even if it meant playing the system to do so. How well that would work on the long term is debatable.

Comment from April 4, 2011: "If you are considered valuable to your society (let's say Steve Jobs, CEO of Apple), you survive when 99.9% of others wouldn't have had a chance."

Well, that comment sure didn't age well. But who could have known back in April of 2011 that he would be dead in less than a year?

Oh boy, did this episode hit a nerve right now! Perhaps fitting that Jammer didn't even mention the completely extraneous B-plot on the ship, which largely just distracts from the story at hand and is oddly whimsical on the issue of torturing Gar. Surprise Jim O' Heir was at least fun though. Still, good episode. Especially enjoyed the final scene with Seven and the intriguing moral ambiguity it leaves us with. A solid showing for Picardo too.

Its pretty entertaining to me seeing people call this episode an indictment of "socialist" healthcare; as if patients in Canada and the UK are deemed "worthy" for treatment by a "social credit score" or something.

This is very obviously a critique of the US private healthcare system. "TC" is a stand-in for wealth, and social class. The "red" section is the lower class, the poor, the working class. The "blue" section is the upper class; the professionals, the administrators, the wealthy.

The "allocator" is the market. The wealthy, those with "TC" that's high enough, are afforded the chance to get the best healthcare they can get, to the detriment of everyone else. The poor, those with a "TC" that's too low, get the worst standard of care, that's barely serviceable.

This has been how healthcare has worked for most of human history. This is not a new phenomenon. The rich have gotten good treatment, the poor have gotten, well, poor treatment. The private healthcare system in the US just formalizes this arrangement.

I'm not sure how healthcare worked in Communist countries; I'm not even sure that they're relevant, or comparable to countries like Canada or the UK. This is an American television show, they are talking about the American healthcare system.

It's funny, this reminds me a lot of the "Colbert Report" effect; people of whatever political persuasion just believe that the show is agreeing with them, despite what the performer is actually trying to convey. I believe something similar is happening here.

I thought it was a really good episode. I thought it was an indictment of the US healthcare system myself. And remember when this was made, we were still the "good ol' days" of being denied coverage for pre-exisiting conditions and such.

But in the end, heartless allocation is heartless allocation. Does it really matter if a socialist government or the CEO of a capitalist company is the one denying you? Either way, you're without what you need.

Also, have you ever noticed that message shows usually feature very humanoid looking species?

@ Sputnik:
))Soviet style healthcare was excellent.((
I take it that you have never actually been a patient in a Soviet-style healthcare system? I have (on the Crimea). What I experienced there confirmed what my mother-in-law (a neurologist in Moscow ) and both her parents (Red Army surgeons) always said.
When you've had a physician use a carved wooden stethoscope to listen to your heart or been told that you have to routinely empty your sick family member's bedpan into the communal wash basin used by the whole station (i.e., where they also brush their teeth), you get a different perspective on things.

I really enjoy Jammers reviews because they aren't filled with the crap you see in current day reviews. Maybe they would be if they were written today.

Sadly, most people don't seem to understand what they are talking about when they make comparisons to modern healthcare. Especially all the comparisons to the United States system are especially dead-wrong.

Don't get me wrong, it's not because the US system amazing or terrible, it's because the comparison is just plain wrong. This episode actually does a great job of posing a classic Trek sci-fi conundrum: "The leaders of a devastating planet are trying to recover but have limited resources. So they assign medical care based on which people provide the most to the rebuilding of their society."

And this is where almost everyone here doesn't have a clue what they are talking about. This is obviously a government-controlled and government-distributed health care system. The patients in this hospital are not paying for anything, they are being "assigned" and "allotted" care based on their status. Clearly, a government-issued status. It doesn't matter if the "Allocator" is the one assigning value because the Allocator is just fulfilling the contract the planetary government has with the hospital ship.

The story in the episode is quite good. It asks the question "What is moral: to infect one man to save 12? To give care to the important at the cost of the unimportant in order to save society?" Those are actually interesting questions. BUT you have to realize that they involve a very important condition... "to GIVE care" which begs the question, who is the one "giving" the care? And the answer is the planetary government.

Back to Earth-bound reality, in the United States healthcare is not "given" to anyone. It's paid for by the patient, the person receiving it. The patient is the customer, he isn't "given" anything. Now the argument on whether that is good or bad is an entirely different thing, but what isn't accurate is that this episode is about US health care.

The best comparison likely is with an entirely government-controlled healthcare system. In those cases, healthcare still costs something (doctors are still paid, medical still costs money) but the allotment of money is decided by the government (the Allocator). And in all governments that run healthcare, they do indeed establish charts and "values" to patients, exactly like the TC.

When you pay for healthcare yourself, then you are your own "Allocator" when you don't pay anything for healthcare then your government is your "Allocator."

@Springy Nov. 7, 2018 "What counts as critical? Is it ever ok to lie, cheat, steal, threaten or actually do bodily harm? Do we do it for others, or for ourselves, out of frustration and to make ourselves feel better, to try to solve a problem with minimized effort?"

I liked your basic take on what the episode was really about. Picardo portrays a man blocked from practicing medicine with a conscience by the machinations of a disfunctional institution and its heartless administrator. It was insightful.

He violated the Hippocratic Oath for sure, and his direct action against the administrator was punitive, but the needs of the many beckoned. He's way too hard on himself, given that he's faced by extreme circumstances.

Doc's response to a dehumanization of a whole class brought to my mind the actions taken by Kirk against the high councilman in the Xenite mine in "The Cloud Minders" one of my favorite 3rd season TOS episodes. Kirk forces him to dig Xenite by hand--- "Dig!!!"

Come to think of it, the hospital ship floating above the planet surface was a call back to Stratos, the elite city in the clouds in that episode.

The industrial landscape of that alien world was filled with what looked a forest of oil derricks and reminded me of the Galveston coast or Pierce Junction near Houston. Excellent set design and effects. Really captured the grim aspect of industrial output.

Amazing to see this discussion over the course of 10 years and several changes of government. The allegory in the episode is extremely broad, an indictment of prioritizing anything but the health of the patient. The details of the portrayed health system are not a match for any current health care system I know, but they don't need to be. Whether it's health care in the US, Canada, or across Europe, there are plenty of issues that basically boil down to the problem this episode points out - privileged treatment. Even the "socialized" health care system people in the US often point to have different levels with different privileges. In the end, money will by you shorter waiting lists and better treatment everywhere.


On a side note, the b-plot was entertaining though it seemed incredibly strange to me for the crew to basically straight up torturing info out of a prisoner. Deliberately poisoning someone and withholding the antidote isn't exactly up to Starfleet ethics. If they're willing to do that, I can see a lot of other episodes having a much easier and quicker solution.

For me, "Critical Care" works best on a production design level. There's something very strong and stark about the hospital city, and the way different status levels are visually demarcated.

The episode also grants us a couple memorable villains, and offers a reasonably good sketch of an alien culture.

Most of the comments above argue over whether this culture is being offered as a critique of privatized or socialized healthcare, but to me it looked like a deliberate attempt to blur the two. The hospital ship seems managed by an outside, privatized, bureaucratic class, but these guys are doing so at the behest of a national government fixated on national goals.

The class distinctions within the alien health system seem identical to those that arise in contemporary America. Though the episode doesn't mention money at all, the aliens' brand of social Darwinism echoes what we see today, where market metrics are coldly used to justify worth and usefulness, leading to a certain strata (wealthier, older etc) deemed more valuable and so able to hog more resources, and/or use these resources to tackle trivial or even cosmetic ailments (the privileged are obsessed with gerontology in this episode).

Some comments above claim that the episode is critiquing national health services as well, because it resembles the cold calculus of Soviet-styled command economies, but today's socialized systems try to do what the doc advocates at the episode's climax: provide a broad, base-line level of support for the least privileged.

It's probably significant that this episode ends with a Borg analogy. Making individuals - the more privileged aliens - suffer for the wider good of the collective, is deemed by the doctor's subroutines to be ethical. His torturing of the administrator for the good of the wider community is then contrasted with Tuvok/Neelix's "torturing" of the trader, this time for the good of the individual (the Doc, who in turn benefits the Voyager community).

I thought the Janeway subplot was mostly shallow filler, but it was executed briskly and with some style. The Doctor tended to get good episodes on "Voyager", but they also had a myopic quality. This episode, in contrast, stresses his sense of duty and compassion. Give this episode to Bashir or Bones and it would probably work equally well.

It's interesting how increasingly a lot of older comments and reviews reflect a misled American public. The drug companies COULD produce plenty of what is needed and charge reasonable prices. America COULD provide free healthcare without a burdensome cost. However, simple greed prevents them from doing so. This is why the satire is not nuanced because there IS no nuance.

I like how even the rich Level Blue Doctor is disgusted by this to an extent. He undoubtedly prefers being paid better and working in less than terrible conditions but he still doesn't want people to be left to die because they can't afford medicine. My only real regret about this episode is that they use the Allocator and resource scarcity as an excuse versus just saying "money. These people can't afford it." There's no reason not to have it be a paid-for medical society.

B’lanna and Chakotay showing up with phasers drawn at the end didn’t seem to fit Starfleet First Contact protocol.