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Star Trek: Voyager – Critical Care (Review)

Critical Care is the seventh season of Star Trek: Voyager attempting to be archetypal Star Trek.

To be fair, Voyager had done this before. When Jeri Taylor took over the show during its third season, she steered it away from the disaster of the Kazon arc and towards a more conventional style of Star Trek storytelling. Many of the episodes of the later seasons could easily have been repurposed for Star Trek: The Next Generation or Star Trek: Deep Space Nine or Star Trek: Enterprise without changing much beyond the characters’ names; think of Warlord, Scientific Method, Random Thoughts, Waking Moments.

What’s up, Doc?

This isn’t inherently a bad thing. Indeed, many of the best episodes of Voyager had this broad and generic quality to them, offering something resembling an archetypal distillation of Star Trek for audiences. Remember and Memorial were both stunning explorations of cultural memory and Holocaust denial that could arguably have worked with any Star Trek cast. Blink of an Eye was a beautiful science-fiction parable that was more about Star Trek itself than Voyager. Even Nemesis could have easily worked with Riker or O’Brien or Tucker as easily as it did with Chakotay.

However, there are also points when these attempts to create “archetypal Star Trek” feels cynical and exploitative, the writing staff very cynically offering audiences something that is designed to meet as many of the vaguely defined aesthetic qualities of Star Trek, but without any substance underneath it. This happens repeatedly during the seventh season of Voyager, when it seems like the production team understand what Star Trek looks and feels like enough to offer a passable approximation, but don’t understand the underlying mechanics enough to replicate that ineffable feeling.

“Don’t worry, we’re almost home.”

Like a lot of seventh season episodes, Critical Care is couched in the trappings of Star Trek but without any substance to group it. On the surface, Critical Care is classic “social commentary” storytelling, the type of allegorical narrative exemplified by stories like Let That Be Your Last Battlefield or The High Ground. It is an episode about the horrors of contemporary healthcare, transposed to a distant alien world where Voyager can draw some very broad parallels for the audience watching at home. This is, on a very superficial level, what Star Trek is to a large number of fans.

Unfortunately, these touches do not add up to anything particularly insightful or compelling, Critical Care providing observations on contemporary American healthcare that amount to “this is pretty bad, isn’t it?” without anything resembling actual engagement. The result is a shell of an episode, a missed opportunity, and a pale imitation of the franchise’s best social commentary.

“What is up, Doc?”

The seventh season of Voyager very strongly fetishises the idea of Star Trek. The seventh season treats Star Trek as little more than a costume, a collection of familiar tropes and iconography in which it might drape itself to disguise its own lack of identity. Repeatedly over the course of the seventh season, the writers on Voyager come back to ideas that might be described as “archetypal Star Trek” in nature, constructing stories that build outward from premises that are recognisably “Star-Trek-ian.”

There are any number of examples. Repentance is essentially an extended Star Trek metaphor that deals with the idea of the death penalty as a moral dilemma to be explored. Both Friendship One and Natural Law are the kind of classic vanilla “Prime Directive” stories that can trace their roots back to memorable sixties episodes like The Apple or A Private Little War. The season even makes a point to repeatedly introduce the crew to pseudo-Federations within the Delta Quadrant, reinforcing the franchise’s themes about the benefits of cooperation in episodes like Drive and The Void.

Playing hookey, while they play hockey.

The issue with all of these episodes is that they never explore these ideas in any meaningful way. Repentance is a story about prison life and the use of state power to punish individuals, but it does not offer any greater insight than Chain of Command, Part I and Chain of Command, Part II or any greater humanity than Hard Time. The idea of a region struggling to recover from a horrific conflict is an important plot point in Drive, but there’s never anything resembling the tangible sense of trauma that informed episodes like Duet or Necessary Evil.

Instead, the seventh season of Voyager seems to believe that merely presenting these ideas, simply checking these boxes, is enough to make it good Star Trek. There is something condescending in all of this, with the underlying assumption that it is enough for Voyager to merely look like audiences expect Star Trek to look, instead of being good on its own terms. Voyager merely has to approximate Star Trek, adopt the trappings of Star Trek, offer a superficial resemblance to some vaguely defined abstract ideal of Star Trek.

Talk about a medical emergency.

To be fair to Voyager, there is a sense that this approach has worked, to a certain extent. In the time since Voyager retired, its relative popularity has dramatically increased among both Star Trek fans and casual audiences. When Netflix announced the most popular Star Trek episodes on the streaming service, six of the top ten were given over to Voyager. When Star Trek runs audience polls ranking favourite Star Trek series, Voyager performs relatively well. Even when it doesn’t win, it tends to place second; second most-watched series, the series most deserving of a feature film, the second best musical theme (twice).

This might be contextualised as part of a broader effort to rehabilitate Voyager after the series went off the air. There were arguments made that it was “the under-appreciated black sheep of the Star Trek family” or was “underrated or under-appreciated during its run.” Critics like Ian Grey at RogerEbert.com and Liam Macleod at Den of Geek have made arguments for the series deserving a reevaluation. Indeed, perhaps the best thing to be said about the addition of JJ Abrams’ Star Trek movies and Star Trek: Discovery to the canon is that it seems to have cooled a lot of the anger towards Voyager and Enterprise.

Holo men.

At the same time, there is something about Voyager that consciously lends itself to nostalgic reappraisal. The series is itself essentially about nostalgia; even leaving aside the narrative elements consciously lifted from fifties science-fiction or Tom Paris’ affection for twentieth century pop culture, it is fundamentally a story about journeying backwards towards an idealised idea of “home.” It is a series that consciously yearns for the comfortable and the familiar. Indeed, it makes a great deal of sense that Enterprise would follow this vague sense of nostalgia by literalising the journey backwards to an even greater degree.

The archetypal trappings of Voyager arguably play a part in this. Voyager is the Star Trek series with the weakest individual identity, but it is also the Star Trek series that feels most like Star Trek. The original Star Trek, The Next Generation, Deep Space Nine and even Enterprise all have their own unique flavours, but Voyager has nothing distinctive that would distract from the pure hit of Star Trek that it delivers. Voyager stripped out a lot of what might have given it an original voice in early episodes like Parallax, abandoning the idea of conflict with the Maquis or challenges to Starfleet authority.

Brought to heal.

This decision effectively distilled Voyager to the purest possible form of Star Trek: a crew on the frontier, encountering “new lifeforms and new civilisations” on an almost weekly basis. The series’ rigid episodic structure hindered long-term plotting or character development, but it offered the illusion of momentum. Watching Voyager, the ship seemed to move so fast that it could always escape the consequences of the previous week’s episode. There were aliens, there was techno-babble, there were uniforms, there were profound moral speeches; there were even nods towards big philosophical ideas from time to time.

At the same time, all of this was very superficial. Voyager looked like archetypal Star Trek, but only in a very simplistic and straightforward manner. Voyager was Star Trek for the kinds of Star Trek fans who complained that Deep Space Nine could not be Star Trek because it was too dark or because the crew didn’t actually go anywhere or because it adopted “soap opera” elements like character development. It was Star Trek for those fans who had difficulty accepting The Next Generation because Jean-Luc Picard was a radically different leading man than James Tiberius Kirk.

“I mean, at least we’re boldly going! Backwards, sure! But still!”

Perhaps it makes sense that Voyager would benefit from a nostalgic reappraisal, removed from its original context. When it was originally broadcast Voyager‘s awkward nostalgia was seen as something that held the franchise back while television (and even Deep Space Nine) moved on ahead of it. In hindsight, certain types of Star Trek fans are more accepting of the comfort and familiarity that Voyager affords. More than two decades after it launched, Voyager is no longer measured against the realities of a rapidly evolving television landscape, and can instead be assessed with the same nostalgia that it runs through its veins.

This may explain why this reassessment of Voyager has overlapped with the decidedly less warm reception for other more modern iterations of the franchise like the JJ Abrams Star Trek movies and the launch of Discovery. It is quite impressive the amount of vitriol that exists among the established Star Trek fandom for the latest iterations of the franchises. Then again, it should be noted that Deep Space Nine, Voyager and Enterprise were each subjected to very vocal detractors while they were on the air.

“Tastes like vindication. But not syndication. Because they don’t really do that anymore.”

It should be noted that these new iterations of the franchise are hits by just about any measure outside of the vocal fandom; the three most recent Star Trek films are the most financially successful in the franchise, they are among the best-reviewed in the franchise by multiple measures, and the two Abrams films made the IMDb‘s list of the Top 250 Movies of All-Time, a populist measure if ever there was one. Similarly, Discovery is one of the most popular shows on Netflix for family audiences, the second most popular show on Netflix outside the United States in late summer, and the most popular show on social media.

However, Star Trek fans have reacted with hostility towards these modern iterations of the franchise. The JJ Abrams movies were perceived as being “not really Star Trek.” Fans famously ranked Star Trek Into Darkness as the worst film in the franchise in a convention poll, apparently forgetting that Star Trek V: The Final Frontier and Star Trek: Nemesis exist. Fandom reacted viscerally and vocally to Discovery, arguably long before the first episode of the series was actually broadcast.

“Yeah, but the way in which the science in Into Darkness was ridiculous was entirely different to how the science in The Wrath of Khan was ridiculous.”

A lot of the more visceral reactions to the Abrams movies and to Discovery are anchored in the implication that they are not “really Star Trek” and so, logically, are not good. As Geoffrey Bunting argued in response to this vocal fan backlash:

It’s hard to see what exactly Discovery has done to deserve this kind of reaction. For some reason, after five separate series in which we have seen warp travel, time travel, wormholes, transcendental species (including a seemingly all-powerful continuum and godlike aliens that live inside a wormhole), and all manner of creatures and aliens, suddenly how radiation is treated and how binary stars look are deal-breakers.

Whatever the reasoning, the consensus among “fans” is clear: Discovery is not Star Trek.

What exactly defines Star Trek in this case is unclear, but it appears to be an arbitrary and, at times, deeply personal concept, based on the perceived vision of Gene Roddenberry. This is easy to understand, especially as someone with their own personal connection to Star Trek. The problem is, this movable definition is no longer welcoming to new ideas, rather now it is being used to insulate the fan-base from the change that they feel Discovery represents.

To be fair, this has always been the case. The Next Generation and Deep Space Nine did not look like Star Trek when they were released, and so generated considerable backlash. Star Trek II: The Wrath of Khan was similarly polarising on its release, treated as an affront to everything that Star Trek was.

Star Trek without Spock? Kill it. Kill it now.”

Of course, it goes without saying that change is good and necessary, particularly over long periods of time. The Wrath of Khan, The Next Generation and Deep Space Nine all radically changed the idea of what Star Trek could be, and modern fandom’s idea of Star Trek is shaped by what were once radical departures rejected by earlier generations of fans. In its own weird way, it is revealing that Voyager seems to be undergoing a miniature reevaluation at a point in time when more recent Star Trek productions are a source of such controversy; Voyager being reappraised as quintessential Star Trek in a way that they are not.

This is ironic on a number of levels. After all, Voyager consciously paved the way for a lot of what fans were reacting against in the JJ Abrams Star Trek movies or in Discovery. The later seasons of Voyager saw the series attempted to embrace a more consciously effects-driven blockbuster style of storytelling with effects-driven episodes like Macrocosm or Thirty Days and television movies like Dark Frontier, Part I and Dark Frontier, Part II. Some of these epic action-driven stories are among the most beloved episodes of Voyager; Scorpion, Part I, Scorpion, Part II, Year of Hell, Part I, Year of Hell, Part II, Timeless.

Healthcare budgets are sky high.

As nostalgic as these fans might be for the late Berman era, those years consciously paved the way for a more bombastic and action-driven Star Trek storytelling aesthetic. Nemesis was very consciously an attempt to build an action movie around the Star Trek brand, while the DNA of the Abrams movies (and of Discovery) can clearly be seen in episodes like The Killing Game, Part I and The Killing Game, Part II. If anything, a large amount of fandom’s outrage towards the Abrams movies and towards Discovery is rooted in the fact that they are doing a much better job of what Voyager tried to do.

The issues is somewhat compounded by the fact that Voyager is a much uglier piece of work, politically, than either the Abrams movies or Discovery. For all that fans claim that the Abrams films or Discovery are “not really Star Trek” and do not represent the alleged values of the franchise, it is hard to square that with fandom’s embrace of Voyager. In many ways, Voyager was the most reactionary and radically right-wing of Star Trek series, arguing that immigrants were plotting to replace indigenous populations in Displaced or that refugees were untrustworthy freeloaders in Day of Honour.

“What about Threshold?”
“We don’t talk about Threshold.”

Voyager emerged in the wake of the Los Angeles riots and in the midst of a broader cultural anxiety about gang violence involving young minority men; and the series reflected this. As introduced in Caretaker, the Kazon were presented as archetypal savages reimagined as modern gang members, the series doubling down on that in stories like Initiations. In Alliances, Janeway discovered that she got on a lot better with the “civilised” white Trabe who had enslaved the Kazon. This is to say nothing of the handling of Chakotay, especially rooting his cultural beliefs in ancient (white) alien visitors to Earth in Tattoo.

This makes Voyager hard to reconcile as an exemplar of what is “really Star Trek” in contrast to the more modern iterations of the franchise. The franchise’s engagement with the legacy of the War on Terror in Into Darkness was admittedly muddled and clumsy, and arguably already explored in a much more raw and powerful fashion in the third season of Enterprise, but it at least represented a sincere attempt to wonder whether a liberal utopian future could withstand contemporary anxieties. In contrast, Voyager was a series about how hard it was to be rich travelling through the deep space equivalent of the third world.

Sh!thole planets.

The difference between Voyager and these later iterations of the franchise was that Voyager was much better at looking like Star Trek, of approximating the appearance and the trappings of Star Trek than the JJ Abrams Star Trek films of the Discovery television series. It was capable of rather cynically offering audience members something that had all the superficial markers that they associated with Star Trek, but with very little of substance underneath it. This is true across the length and breadth of Voyager, but it is especially true in the seventh season of the series.

The seventh season of Voyager often feels like a cardboard model of what a Star Trek series should look like, painted in familiar colours and populated with familiar shapes, but lacking any real weight or material behind it. There is a repeated sense of obligation around the season, a sense that it exists because it has to and that many of its individual episodes exist because they have to. This is obvious even in the character-driven episodes focusing on long-neglected characters. Repression is an obligatory Tuvok-centric story that says nothing about Tuvok. Nightgale and Lineage repeat familiar plots for Kim and Torres.

“I want someone to tell me how this snake oil salesman managed to evade every security protocol on the ship.”
“I take full responsibility.”
“I’m not interested in fault. Besides, this wouldn’t even be your biggest screw-up this month.”

However, it is most obvious in the seventh season’s “social commentary” episodes like Critical Care and Repentance. These episodes exist because these are the kinds of episodes that Star Trek makes, stories that offer a reflection of contemporary American life through a science-fiction prism. Indeed, there are any number of great examples of these kinds of stories in Star Trek history; A Taste of Armageddon, Errand of Mercy, The Hunted. Indeed, even Voyager itself a few episodes that deserve to rank among the best in the franchise; Distant Origin and Living Witness both deal with the challenges of history in a postmodern era.

The issue with seventh season episodes like Critical Care is how cynical and calculated they feel, how hard they work to appear to be saying something provocative and profound while also working equally hard to avoid actually saying anything that might potentially upset or frustrate viewers. In the lead-up to the broadcast of Critical Care, much was made of how overtly political the episode was supposed to be. In interviews, including one that aired on UPN’s news, actor Robert Picardo described the episode as “the Doctor vs. the HMO” and “the Doctor’s abduction by an alien HMO.”

“Here, ‘HMO’ stands for ‘horrible metaphor overload’.”

These specific references anchor Voyager in the late nineties in the same way as the fixation on gang violence with the Kazon or the recurring anxiety about the end of history in episodes like 11:59 or Relativity. For non-American readers, it is worth briefly outlining what a HMO is, and why it was such a big deal in the late nineties. Scott Holleran offers a very brief introduction to the concept:

The new year begins as employees begin a process called open enrollment–when many employees designate a health plan through their employer. Unfortunately, most are forced to enroll in a managed care plan, i.e., an HMO or PPO. That’s right: force actually lies at the core of today’s health care system.

From their beginnings, HMOs were designed–by Democrats and Republicans–to eliminate individual health insurance. The result is a vast network of health care collectives (HMOs, PPOs, Point-of-Service plans) created by government that are destined to do harm to individuals.

The individual was first discouraged from buying insurance in 1942 when employee health premiums were made tax deductible to employers–not to individuals. Congress created Medicare in 1965, making individual insurance for those over 65 obsolete. Subsidized, unrestricted health care for seniors lead to an unprecedented frenzy of spending by patients and doctors.

For many Americans, the biggest issue with HMOs was a perceived lack of choice. Under indemnity insurance cover that had been popular in the early seventies, Americans could visit any doctor or any hospital and receive treatment. In contrast, the restructured schemes that placed an emphasis on HMOs severely restricted the avenues open to Americans suffering with health concerns.

“I’m a doctor, not a social commentator!”

Star Trek has a long history of building episodes around healthcare, in large part because healthcare tends to offer interesting abstract moral dilemmas that are frequently tied to life-and-death stakes. Ethics touched on the theme of medical ethics and informed consent to radical treatment, Nothing Human wondered about the morality of using information collected in an immoral fashion, and even Imperfection was effectively an extended allegory for kidney transplantation. As such, it makes a certain amount of sense that Star Trek would confront the horrors of HMOs.

Even beyond that, the franchise had a recurring fascination with the challenges in balancing an individual’s well-being with that of a larger culture. The Measure of a Man might be the best example, an episode in which Data fights to assert his own autonomy against Starfleet’s desire to pick him apart for the greater good. Episodes like Tribunal and even Tinker, Tenor, Doctor, Spy play out the absurd comedy of individuals trying to navigate byzantine, unfeeling and even actively hostile systems.

Administering aid.

At the same time, HMOs represented the easiest (and softest) possible target for Voyager. It was arguably astounding that it took the series so long to produce an episode dealing with these organisations, even allegorically. As Ellen Goodman outlined, the HMOs seemed like comic book villains to the American public:

HMOs have become the new expletive undeleted. Managed care companies are rapidly replacing tobacco companies as corporate demons. Indeed if you watch The Rainmaker, the HMOs are taking the place of the Russkies as the bad guys. As Ronald Glasser, a Minneapolis pediatrician, HMO critic and moviegoer who was downing popcorn when the audience roared at Ms. Hunt, exclaims, “I looked around and said, ‘My God, the people are way ahead of the politicians on this.’ “

A few years ago, the public saw doctors as rich professionals who overcharged on Tuesday and played golf on Wednesday. The weakness in the system was cost control, or cost out of control.

Now doctors and consumers are becoming allies on the same side, fighting the HMOs, hassling the 800 numbers, trapped in a medical system we suspect is being run by accountants. The weakness in the system is trust. Or rather, mistrust.

As such, Voyager is arguably picking the lowest hanging fruit, calling out something that the public already hate in a very cartoonish and exaggerated fashion without anything particularly insightful or clever to say, beyond pointing at a problem that broader culture had already identified.

The EMH is very sick of this.

To be fair, Voyager has form. The fifth season had introduced the Malon in Night and Extreme Risk as a commentary on industrial pollution, but these recurring aliens were drawn so broadly that they may as well have been villains from Captain Planet. Industrial pollution was not presented as a process inexorably tied to modern conventional notions of industrialisation and profit, but something that could be fixed with magic technology of which the Malon simply chose not to make use, because they were eeeevil. To be fair, Juggernaut added a bit more nuance to the Malon, but it was too little too late.

The commentary on the American healthcare industry in Critical Care is similarly toothless, very much in the same style as the commentary on industrial pollution in Night and Extreme Risk. There is no nuance or insight to be found, no exploration of why things are the way that they are and how these obviously harmful policies are enabled by the political classes and public opinion. Much like Night feels content to declare that pollution is bad and that people should probably fix that somehow, Critical Care acknowledges that the system is broken without talking about why it is or how to fix it.

“Boy, this medical care is As Bad As It Gets…”

It should be noted that there was nothing particularly daring or striking about going after HMOs. After all, both George W. Bush and Al Gore could agree that HMOs were bad, even if they disagreed on the reasons and the solution. Similarly, a throwaway expletive-filled line about HMOs in the Oscar-winning As Good As It Gets turned into something of a viral sensation three years before Critical Care made it to screen, as David S. Hilzenrath explains:

Audiences in the Washington area have been erupting in whoops, whistles and applause when actress Helen Hunt, playing the single mother of a chronically ill child, denounces HMOs with a string of unprintable epithets.

Hunt’s character quickly apologizes for the outburst, but actor Harold Ramis, playing a physician, assures her that the apology is unwarranted.

“Actually, I think that’s their technical name,” he says.

It’s the managed-care industry’s reward for playing the heavy in the nation’s war on rising health-care costs, and it helps explain why many lawmakers view proposed restraints on the industry’s cost-cutting powers as a sure way to win votes.

Some analysts say it would be a mistake to dismiss the applause line — and similar references in television dramas — as mere Tinseltown frivolity.

“I think it has real implications for the managed-care industry’s image and what they’re going to need to do about it,” said Mollyann Brodie, director of special projects for the Henry J. Kaiser Family Foundation in California, which sponsors public opinion research on health care.

“HMOs have become sort of the villain in our society,” Brodie said. “Whether it’s fair or not, they have become the easy target.”

It should be noted that while Critical Care was taking broad swipes at a system that everybody agreed was broken, the Star Trek franchise had yet to properly engage with any of the actually controversial crises of the late nineties. Deep Space Nine often had to struggle LGBTQ ideas under the radar in episodes like Rejoined or Chimera, the franchise reluctant to take a meaningful stand on something that might actually have generated some controversy.

Not an impatient hologram.

Indeed, the big issue with Critical Care is that it is not especially critical. Like so much of Voyager, it studiously and carefully adopts the trappings of a liberal and socially-engaged Star Trek without actually putting the work in. Critical Care cannot decide what the actual problem is with HMOs, which is a major problem for an episode that claims to be social commentary. Critical Care correctly suggests that no decent society should allow innocent young people like Tebbis to die before their time. However, it never bothers to explain how or why American healthcare became so messed up.

There is a very obvious reason for this. The reason that American healthcare is so messed up is because of pure and unchecked capitalism. The rigid belief in free enterprise as a guiding force in healthcare explains why the system is so fundamentally broken, accounting for the reduction of individuals to simple metrics of worth and treating them as cogs inside a gigantic anonymous, profit-generating machine. This is not a profound or novel insight. It is, however, one that could be considered vaguely controversial or provocative. Which may explain why Critical Care steers well clear of the implication.

Industrious healthcare practices.

Christopher Hitchens offered an exploration of how these capitalistic impulses were the root of the crisis in contemporary American healthcare:

A gluttonous appetite for more and more customers (to be treated on an assembly line with fewer and fewer professionals and facilities) does not by any means extend to all patients. A few years earlier, a homeless man named Adolpho Anguiano was brought to the Sunrise emergency room in an ambulance. He complained of severe chest and abdominal pain. The emergency-room staff declined to take his vital signs or run any tests. To Marc Gardner’s later incredulity, a physician wrote the words “chronic homelessness” in the medical-record space for diagnosis. Mr. Anguiano “became upset.” Security men were called, and escorted him out of the emergency room. Ten minutes later, he fell on the grass outside, looking up at the vertical beauties of a billion-dollar hospital, and died from acute pneumonia.

The general comment of Richard Scott, former C.E.O. of Columbia/HCA, on denials of treatment was as follows: “Do we have an obligation to provide health care for everybody? Is any fastfood restaurant obligated to feed everyone who shows up?” His answer was a revealing one, about the McHospital mentality. Mr. Scott, of course, has only a tenuous connection to the world of medicine and medical ethics. He is an expert in corporate raids and acquisitions. (And I refer to him as the “former C.E.O.” because he has since, as a result of the Medicare scandal, been “let go.” Having drawn a $900,000 salary and a $720,000 bonus in 1996, he received a $5 million parachute and a $950,000 annual “consulting fee” for five years. He also got to keep his stockholding in the company for 90 days, though I suspect that this may have depreciated.) Actually, he was wrong anyway on the simple matter of the law. Federal legislation requires hospitals at least to assess and stabilize an emergency patient before making a decision on transfer or discharge. Mr. Anguiano did not throw his unwelcome and disheveled self into the arms of the Columbia Sunrise staff. He was brought, having no say in the matter, in an ambulance. Even at the most profit-conscious and understaffed hospital, he should have been examined and stabilized before being discharged, or sent to a public hospital, or asked to sign a promissory note.

It honestly seems like the Ferengi would be a better fit for Critical Care than for Inside Man.

“A collector’s item.”

To be fair, there are moments when it seems like Critical Care might acknowledge that capitalism is at the root of the healthcare crisis facing the Denaali. This is most obvious in the early scenes with Chellick, who is essentially introduced as a healthcare consultant on the hospital ship. He explains the seeming inequity of the system as a result of attempted optimisation. “It may seem impersonal, but it’s what the Dinaali have contracted us to do,” Chellick tells the EMH. Dysek elaborates, “Chellick’s people are known throughout the sector for their administrative skills. Before they came here, we were a dying race. Eco-disasters, famine.”

The unspoken implication here is that Chellick is a cynical predator, exploiting a society that desperately needs help for his own gain; the idea of being “contracted” immediately suggests that the gain is financial in nature. As a result, Chellick’s attempts to limit the resources available to certain patients immediately seems like a cynical effort to inflate his bottom line. “Can’t you give him a neural blocker?” the EMH demands of one patient with a horrific injury. Voje responds, “He’s already had his allocation.” It seems like this chaos may be driven by profit motive.

Chell(ick) out.

There is a wonderful scene between the EMH and Dysek which plays into this idea, and which may seem familiar to anybody who has ever worked for a large profit-driven enterprise. “I did some checking,” the EMH explains. “Last month, Level Blue’s total medication requests were down by six percent.” Dysek confirms, “Because our cure rate was higher.” The EMH elaborates, “Exactly. Because you performed so efficiently last month, the Allocator will determine you’re able to do with less next month. If we don’t order more medication now, we may not get it when we need it.”

This is one of the paradoxes of capitalism, how the drive for profits leads organisations (including governments) to keep cutting costs and cutting cuts until they lead to a crisis. “Think about it, Doctor,” the EMH warns Dysek. “If you don’t have the proper resources, your cure rate could go down. If that happens, the Allocator may assign you to a lower level.” The conversation is interrupted by Chellick’s arrival. “Are we having a problem with our newest piece of technology?” he asks. Dysek responds, “Actually, he seems to be learning the system quite well.”

The EMH has the (level) blues…

However, the episode very quickly shies away from any perceived criticism of capitalism in how it sketches the finer details of the hospital ship’s internal dynamics. This is most obvious in the reveal of the nature of “the Allocator”, the brilliant mind directing the treatment plan on the ship. However, the Allocator is not a person. As Voje warns the EMH, “The Allocator isn’t a him. It’s our main computer.” This is a pretty big red flag, because these sorts of society-governing computers in Star Trek have always been a stand-in for totalitarian unfeeling communist regimes.

The original Star Trek frequently used unfeeling machines as a metaphor for the horrors that the Soviet Union inflicted on its citizens. Star Trek was anchored in Cold War politics, and it was no coincidence that episodes like Return of the Archons, The Apple and For the World is Hollow and I Have Touched the Sky would find Kirk liberating primitive societies from cruel and unfeeling robot overlords. The problem with machines in the world of Star Trek is that they are too cold and too rational, too unfeeling. Even Data can only be accepted so long as he pursues emotional engagement.

Gar’s my destination.

Once it is revealed that the important decisions are being made by a machine, Critical Care very quickly becomes a pointed criticism of socialist medicine. Patients are prioritised by their “TC”, which is used as a metric to determine how much care and attention they can receive from the overworked medical staff. When the EMH asks what a “TC” is, Chellick explains, “Treatment Coefficient. The Allocator assigns one to every patient. It determines the level of care they receive.” The EMH inquires, “How is this coefficient derived?” Chellick responds, “Through a complex formula that involves profession, skills, accomplishments.”

This is interesting, because it pointedly leaves out the biggest factor in determining a patient’s priority within the American healthcare system: their money. Indeed, the American healthcare debate often circles back around to the question of income and insurance, with the unspoken assumption that those who have the money to pay for private insurance receive a higher standard of care than those who don’t. In the United States, a patient’s worth is frequently measured by the thickness of their wallets.

Clouding the issue.

This has led to a number of shocking moral judgements from prominent politicians; Mo Brooks argued that poor people do not deserve healthcare because they do not lead “good lives”, whereas Jason Chaffetz shamed poor people for wanting to purchase mobile phones. The United States medical service operates for profit rather than for people. Almost half of the country’s healthcare budget is spent on a mere five percent of patients. Having money opens up new avenues of treatment and better classes of service to the wealthiest patients.

However, Critical Care pointedly steers clear of any of this. The patients who receive better treatment on “Level Blue” are not elevated because of their family connections or their material wealth. They are elevated based purely on their social value. “An agricultural engineer is obviously more important than a waste processor,” Chellick explains, which seems a rather dubious assertion; a society would very quickly notice if their toilets stopped working. The EMH demands, “Important to whom?” Chellick responds, “Society. When your resources are limited, you have to prioritise.”

The Voje of reason.

It goes without saying that this in no way reflects the issues with HMOs and the American healthcare system. The issue with the American healthcare system is not that “socially useful” individuals like teachers or engineers or police officers are getting preferential treatment. The issue with the American healthcare system is that it has come to reflect the massively inequitable distribution of wealth, with so much power and influence siloed away from regular Americans. For an episode nominally about HMOs, Critical Care is very careful not to touch on the role that capitalism plays in the crisis.

In fact, Critical Care makes a point to portray this as nightmare as in a style very similar to critiques of socialism and communism, as an extension of the fears articulated in The Measure of a Man about the sacrifice of an individual for society’s greater good.  “So you base treatment on whether patients have particular abilities?” the EMH challenges. “It’s much more complicated than that,” Chellick responds. “The Allocator assesses the entire individual.” The EMH counters, “And reduces his life to a number.”


It should be noted that this panic exists in a broader cultural context, with many in the United States particularly anxious about what they see as socialist healthcare. As David Greenberg argued, “socialised medicine” was deployed as a smear during various health reform debates:

In 1994 the term socialised medicine was heard less often than in previous battles. One of the few who used it was Clinton, when he donned Truman’s mantle to deride those critics of the former president who had stooped to use what Clinton implied was a shrill and overwroughtcharge. (“What did they say? ‘Harry Truman’s a radical liberal. He’s for socialised medicine.’ … Well, the truth is, Harry Truman … had this old-fashioned notion … that people who work hard and play by the rules ought to help one another.”) To be sure, Republicans made hay with less archaic-sounding phrases such as the “government takeover of the health care system” (even though Clinton’s plan relied more on market mechanisms than on government ukases). Newt Gingrich, then House minority whip, blasted Clinton’s plan as a throwback to the kind of “centralised, command bureaucracies” that were dying across Eastern Europe.

But if these attacks ginned up some hostility to Clinton’s plan, the real problem was more fundamental. As political scientist Jacob Hacker has argued, the basic obstacle was nothing less than the government’s failure to have adopted a comprehensive health insurance plan decades earlier. As a result, the system that emerged by 1994 entailed such a crazy quilt of private interests—corporations, small firms, insurers, doctors, unions, HMOs, and so on—that moving all Americans into a new framework without worsening anyone’s situation had become virtually impossible.

It should be noted that during the heated election between Al Gore and George Bush, Bush even used the spectre of socialised medicine to attack his opponent’s proposed solutions, warning, “Al Gore’s prescription plan forces seniors into a government-run HMO.”

Facing up to the flaws in the system.

The medical system in Critical Care is not presented as monstrous because it preferences those with material wealth, or because it victimises the poor and the needy. Explaining one of the patients that he is favouring over Tebbis, Dysek explains, “This woman is a chief engineer of an irrigation facility which provides water to half the subcontinent.” It is still monstrous and inhuman, but the idea of saving the life of somebody who provides an important function is a different argument than prioritising somebody because they happen to have been born into wealth.

The healthcare in Critical Care is suggested to be monstrous and inhuman because it prioritises the health of the community over the individual. “I was trying to save lives,” the EMH insists. “And I am trying to save a society,” Chellick responds. “Do you really think Patient R-12 is going to help me do that?” He elaborates, “He wasn’t contributing. He was a drain on resources.” This is monstrous, but it plays into deeply engrained cultural fears about totalitarianism and communism rather than about the HMO system.

“Hey, maybe it also stands for ‘Humongous Muddling Observations’, am I right?”

In particular, and perhaps in keeping with Voyager‘s ideological outlook, Critical Care is much more in line with right-wing criticisms of government provided healthcare. It fits perfectly with Sarah Palin’s alarmist rhetoric about “Obamacare”, which became a major moral panic in twenty-first century America:

“The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society.'”

By the way, this is absolute nonsense. However, the prevalence of the myth demonstrates just how terrified the United States is of the idea of socialised healthcare. This is part of the reason why “Obamacare” became such a heated issue, even among those who would be affected by its repeal.

When you’re setting up a healthcare system, you have to planet carefully.

This is absurd. Critical Care is an episode that looks like it is going to engage with an important social issue, and then botches the execution in a profound and unsettling way. It is a movie that somehow presents the excesses of a profit-driven hyper-capitalist healthcare system as a stark moral about the dangers of an uncaring communist regime, never once even properly acknowledging the issues at stake or framing its analogy in anything but the most superficial manner. Critical Care either doesn’t understand the issues with HMOs, doesn’t care, or is worried about potentially upsetting audience members.

To be fair, this isn’t much of a surprise. Voyager is a surprisingly conservative series in outlook, particularly by the standards of the larger Star Trek franchise. When the EMH created a holographic family in Real Life, it was just as steeped in fifties nostalgia as any of the series’ pulpy sci-fi trappings. Tom Paris and B’Elanna Torres had to get married in Drive before they could conceive in Lineage. Even in pon farr in Body and Soul, Tuvok would not compromise his marriage. (There are exceptions; Child’s Play rather brutally subverted the show’s insistence that the traditional family unit was by default the best caregiver for a child.)

The conservatism in Critical Care is so striking because it seems so out of place to non-American audiences who accept socialised medicine as a simple (and commendable) fact of life. As Frank Llewellyn noted:

In other developed democracies, national health care systems are so popular that once they have been established it is politically impossible to eliminate them. In a recent Gallup poll, while only fifty-seven percent of United States residents said they were satisfied with their health care, over seventy-five percent of Canadians and Western Europeans said they would not trade their health care system for the current U. S. model. That is the real reason that Republicans are trying to sow doubt and prevent passage of a national health care bill: they want to protect the for-profit health care and pharmaceutical industries.

There is a reason that the United States ranks so low on global comparisons of healthcare, despite its status as a first world nation. There is a reason why the United Kingdom is horrified at the idea of selling the NHS to American interests.

To be fair, this is a recurring anxiety for the Star Trek franchise. The Star Trek franchise has generally been quite reluctant to articulate exactly what political and economic models drive the utopia featured in the series. The franchise obviously unfolds in a post-scarcity world, but Star Trek has always been reluctant to explain the sorts of political compromises that were necessary to create this idealistic future. Then again, there is good reason for this. Since Star Trek: The Motion Picture, it has been suggested that the Federation is at least a little socialist; and that is still a highly-charged word for American audiences.

To be fair, there have been moments where the franchise has explored the question of how exactly these systems are supposed to operate. The first season of The Next Generation was perhaps a little over-zealous and over-eager to trumpet the value of socialism over capitalism, introducing the Ferengi as villains in The Last Outpost and having Picard thaw out some twenty-first century humans to lecture them about their primitive beliefs in The Neutral Zone. In fact, it could be argued that episodes like The Measure of a Man were necessary in large part as a corrective to this heavy-handed approach to the Federation’s values.

Fair trader.

It should be noted that the economy of Star Trek is not entirely based on socialism, at least not as modern political theorists understand the term. As Rick Webb notes of Star Trek economics, there is still an economy at play, just with a much stronger safety net and minimum standards in place:

I sort of love that Star Trek forces us to think about a society that has no money but still operates with individual freedom and without central planning. I love that democracy is still in place. I love that people can still buy and sell things. It’s real. It’s a more realistic vision of post-capitalism than I have seen anywhere else. Scarcity still exists to some extent, but society produces more than enough to satisfy everyone’s basic needs. The frustrating thing is that we pretty much do that now, we just don’t allocate properly. And allocating properly cannot be done via central planning.

Although there are multiple competing readings of how exactly “the economics of the future” work on Star Trek, it could be argued that they can be read as an extension of European (and especially Scandanavian) social democracy rather than Soviet-style communism. However, this still unsettles American audiences.

In a cramped space.

After Gene Roddenberry stepped away from the franchise, Star Trek became less likely to overtly comment upon how its fictional utopia was designed. On Deep Space Nine, episodes like In the Cards and Treachery, Faith and the Great River were both dedicated to exploring how economies and scarcity might work in the twenty-fourth century. In Star Trek: First Contact, Picard acknowledged that the Federation existed without concepts like money. However, by and large, outside of acknowledging that the characters are lucky to live in a world with replicators and transporters.

In some ways, this hints at what would be a problem with Enterprise when it launched the following season. In a single line in Broken Bow, Charles “Trip” Tucker would boast about how Earth had “pretty much” wiped out “war, disease, hunger” in “less than two generations.” This ignores the fact that this is a much more interesting story than anything told in the first two seasons of Enterprise, but one that would be unpalatable to American audiences because it would (by necessity) involve concepts like redistribution of wealth and the dissolution of nation states.

“Don’t worry, Tuvok. We’ll get through this.”

This cowardice is very much at play within Critical Care, an episode that is very clearly constructed to be an archetypal Star Trek story, but without any weight or bite to it. It is a cynical and reactionary piece of work, one terrified of actually exploring the fundamental issues of contemporary American healthcare and so committed to a bizarre false equivalence that has nothing to do with the issue at hand. It is an example of Voyager superficially approximating the look and feel associated with Star Trek without actually saying anything worth listening to. It is a facsimile of archetypal Star Trek storytelling, an imitation, an empty copy.

Even aside from this fundamental issue with the episode, Critical Care suffers from a number of other problems that plague the final season as a whole. The writing is incredibly sloppy, particularly at the climax. At the end of Critical Care, the EMH plots to give Chellick a literal taste of his own medicine, which isn’t a bad reversal. However, in order to do this, he manages to draw in Doctor Dysek as a co-conspirator. This makes no sense from a character perspective. The EMH was earlier able to manipulate Dysek by appealing to his ego and insecurity, his own selfishness. That motivation gets a bit lost in their climactic team-up.

What a brig-and.

“What are you waiting for?” Chellick pleads to Dysek, lying on the table. “Give me the cytoglobin.” Dysek responds, “I don’t think I can.” He elaborates, “Cytoglobin isn’t authorised for Level Red patients.” He continues, “I don’t want to break the rules.” It is very clear that Dysek is trying to teach Chellick a lesson, the same lesson that the EMH is trying to teach him. “I made the rules!” Chellick protests. “Then you should be pleased I hold them in such high regard,” Dysek observes, with a wry smirk.

Critical Care tries to handwave this out-of-character behaviour. “Don’t tell me you’re allied with this defective hologram,” Chellick gasps. “No,” Dysek observes, “but he has given me insight into some of the intricacies of our system. For example, did you know if I don’t request enough resources for Level Blue this month, I won’t get what I need next month?” As such, the episode tries to root Dysek’s actions in self-interest, but it’s unconvincing. If that were the case, why wouldn’t Dysek simply deactivate the EMH and start ransoming Chellick for his own ends? More to the point, why would the EMH consider him an ally?

Doctoring the numbers.

From a plotting perspective, Critical Care needs Dysek to be part of that final confrontation to suggest that Chellick cannot simply go back to normal once the EMH has left. After all, without Dysek on-side, there’s very little to stop Chellick from firing Voje and returning to business as usual. However, his selfish motivation at the climax doesn’t actually serve that plot purpose. There is nothing in the episode’s resolution to stop Dysek and Chellick from firing Voje and stealing even more resources from Level Red for the patients on Level Blue. This is a fairly significant logical gap.

Similarly, the closing scene of the episode makes a fairly half-hearted attempt to add some moral ambiguity to the EMH’s arc, as he reflects over his torture of Chellick. He asks Seven of Nine to run a diagnostic of his ethical subroutines. She reports, “You were hoping your behaviour was the result of a malfunction. I’m sorry Doctor, but I must give you a clean bill of health.” It’s a very lazy attempt at moral ambiguity, a much less satisfying attempt at pay-off than Data’s attempted murder of Kivas Fajo in The Most Toys, which at least felt like a logical culmination of his arc within the episode.

“Let’s not Dysekt the internal logic too rigourously.”

The EMH’s angst in the final scene of Critical Care is a clumsy attempt to place a cherry atop the episode’s sundae, but it doesn’t work at all. The bulk of the episode is built around the EMH’s clear-cut and unequivocal moral superiority to Chellick, and the manner in which his mere presence inspires people like Dysek and Voje to do the right thing. As such, attempting to undercut that moral authority – especially retroactively – feels clumsy and ill-judged. Like the treatment of Dysek at the climax, it represents a fundamental misunderstanding of how this story needs to work.

Similarly, the subplot focusing on Voyager also feels woefully misguided. There is no reason for the rest of the cast to feature in Critical Care at all. The episode might work better as a story told exclusively from the perspective of the EMH, similar to Honour Among Thieves or Inter Arma Enim Silent Leges on Deep Space Nine. Even just cutting away from the claustrophobic and panicked environment of the hospital ship back to the familiar standing sets robs the episode of a great deal of tension and anxiety.

A subpar subplot.

To be fair, there are parts of the subplot that work. Gar is an interesting creation from both a conceptual perspective and in execution. The Star Trek franchise needs more lovable rogue traders, particularly during the relatively sterile Berman era. There is something inherently alluring about con men, and Gar is an intriguing example. Part of that is down to his design; his costuming is refreshingly casual in the larger context of the Star Trek franchise, effectively wearing a leather jacket. His make-up is suitably alien looking. The character is elevated by the performance of John Kassir, who famously played the Cryptkeeper.

However, outside of Gar himself, the subplot simply isn’t very good. It’s a stock quest narrative, with the crew chasing down a rogue trader across a large sector of space, following a trail of breadcrumbs that brings them into contact with a variety of colourful characters. As a result, the bulk of the subplot feels like it is designed to stall for time, as the characters move up a chain that can be precisely as long as the writers need it to be in order to get Torres on to the hospital ship at just the right moment. It feels like a cynical exercise in wheel-spinning. It’s very much filler designed to pad out the episode.

Gar beyond the stars.

Critical Care is a deeply frustrating episode of Voyager. The problem isn’t necessarily that the episode doesn’t work. There are plenty of episodes of Star Trek that do not entirely work, but which are still interesting on their own merits. The issue is that the episode doesn’t try. More than that, the episode invests considerable effort in not trying, in working hard to project the image of a piece of art with something interesting to say while studiously avoiding actually saying anything that might be considered challenging or confrontational.

Critical Care is another example of the problems with the seventh season of Voyager, a season that isn’t so much accelerating as it approaches the finish line as it is gently coasting on its superficial connections to franchise nostalgia. Critical Care might look like an archetypal and traditional episode of Star Trek, a perfect example of Voyager as the purest distillation of the franchise’s identity uncluttered by anything distinct to the series itself, but it is completely hollow.

9 Responses

  1. Who would have imagined that Voyager would become more relevant decades later? I also submit “The Voyager Conspiracy”.

    “Past Tense” came closest to capturing that angry social commentary, but DS9 was content to focus on politics / war for the most part.

    • The Voyager Conspiracy is fascinating, because it’s basically Voyager arguing that it shouldn’t embrace serialisation for… eh… reasons.

      Past Tense is fantastic. Genuinely underrated. And a much better example of “archetypal Star Trek social commentary” than this more overt example.

  2. You sure do spend a lot of time bitching about a nation you don’t live in. Typical of Euros.

    • You sure do spend a lot of time bitching about reviews written in a nation you don’t live in. Typical of you.

      Also, to be entirely honest, “the United States healthcare system is kinda awful” is hardly the most shocking of revelations. I mean if it’s “b!tching” to complain about something that virtually everybody on every side of the political spectrum agrees, I wonder what “observing” looks like to you.

      • Yes, it’s terrible; famously so. We pay double the price for the same quality as other developed countries. This isn’t a controversial statement.

  3. I worked once in a German hospital and the difference between the unit for normally secured patients on the one floor and the area for privately paying/secured just a few step upwards was almost the same as between the red and blue area in this episode. Immediately this episode jumped to my mind, because I always held this episode in very high esteem. It is an attempt for archetypical storytelling, and for me as a child back then it worked quite well to make me think of those issues. Today I still enjoy it, and despite flaws find it strangely entertaining and thought-provoking at the same time.

    Among the highlights:
    – the dilemma of the Doctor being kidnapped, but forced to cooperate due to his oath, but thereby being confronted with a doubtfully meritocratic, pseudo-rational system that is not so far removed from us (not only US) today
    – Gregory Itzin (that alone is almost enough, as I like his acting a lot), though you are quite right that his sudden turn of character at the end is very difficult to explain with his insight into the absurdity of this allocation system (and if you can easily increase your allocation by ordering more stuff – what is the use of this restriction anyway?)
    – the impressive sets
    – finally, and as a side note, finally the acknowledgement that not all food might be the right one for every species.

    I think the end was not an attempt to say “oh, we forget to remind viewers there is a moral dilemma here”, but to leave it ambiguous, to ask viewers if we would have done the same, to wonder if it is ethical to torture guilty people to gain what you want or what you consider ethical. I liked the parallelism between the hospital ship and Voyager (Tuvok, Neelix), though in the Doctor’s case he has to follow the hippocratic oath and care for individuals, when the whole system appears wrong form another ethical perspective. It is an interesting question to ask when you cannot any longer follow the rules when confronted with grave injustice, in this case a toxic mixture of a minimal care for all and higher care for the well educated elite, like a pseudo-meritocratic socialism. The answer though seems neither sustainable, logical nor in any ways building upon the insight of people. They basically remain convinced of the system’s necessity, despite possible evidence to the contrary.

    What I found interesting was that the Doc’s motivation seemed pretty selfish, when he stated the feeling of joy to heal people. His arrogant trait is kind of interesting, as he remains pretty likeable, but in cases like this his self-importance seems like a dangerous character aspect.

    The only thing that indeed becomes kind of worn out is the stereotypical story of Voyager being deceived by greedy salesmen. The hunt for Gar was pretty reminiscent or even redundant to “Live Fast and Prosper” – granted, there were funny moments, but apart from the parallel dilemma of extracting information via more or less unethical means (a precursor to Enterprise, 3rd season) it was pretty useless.

  4. This is a very American-centric episode in a series deeply invested in US-culture and history. As I age, I become more aware of how American Star Trek is. Canadian media has been colonized by US content to an incredible degree, to the point it is often hard to discern things while growing up. But this episode seems odd as an adult. The utopian norm of Federation egalitarian healthcare is already here, without the advanced tech. Almost every advanced economy has public healthcare. The USA is a weird outlier in this regard. As such, this seems like watching a show about how “one day we’ll eliminate child labour” or something. lol

    I also noted the return to ‘alien’ races that are physically identical to humans, despite being on the other side of the galaxy. I wonder if their budget was being cut.

  5. This was another of Voyager’s extremely rushed and unsatisfying endings. Because, Voyager protected itself and it’s assets/people, and moved on not really caring at all about any sort of reform of the unjust systems it showcased for 40 minutes. Indeed, it’s hard to imagine any lasting change happening, but that isn’t The Doctor’s ending dilemma, instead it’s all about himself. That is indeed Voyager’s conservative ethos at play.

    • Yep. I think the seventh season of Voyager in particular suffers from wanting to look like Star Trek, but without any actual substance to support it.

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