April 2002 -- One would think that liberal screenwriters could concoct a fantasy about some guy pushed by capitalist oppression into open revolt, without smashing their audiences over the head with a message. John Q., unfortunately, should be declared a hard-hat site. It is truly shocking that so soon after the terrorist attacks on America Hollywood offers up this cliché-ridden and overwrought propaganda that invites morally dumbed-down audiences to cheer hostage-taking and terrorism.
The movie depicts its title character, John Q. Archibald (played by Denzel Washington), as a virtuous John Q. Public everyman. He has a wife who works in a local store and a son in elementary school. He's a black man who attends church with his white friends. But he has begun to have problems with "the system." He's a Chicago factory worker whose schedule has been cut to twenty hours a week because so much work is being shipped out to Mexico (an anti-free trade jab). John Q. tries to get a second job to make ends meet, but it seems he's over qualified. As a result, he has his car repossessed because of missed payments. (As he runs out the door to stop the repo man, we see President Bush on TV in the background.)
Then comes the crisis that pushes him over the brink. At a softball game, his son collapses, and the hospital tells Archibald that the problem is an enlarged heart. There are two options. The first is an immediate transplant, but that will cost $250,000. A hospital administrator (played by Anne Heche) explains that John Q. does not seem to have insurance to cover the procedure. The second option, then, is to send his son home and make him as comfortable as possible as he lives out the remaining months, weeks, or days of his life.
John Q. is certain he has insurance, but his HMO tells him that because his work hours were cut, so was his insurance. He's covered for only $20,000. But, he explains, he has an insurance contract. "Too bad," says the HMO guy, this sort of thing is done all the time. At the local government social services office, John Q. learns that because he and his wife still work, they're not poor enough for public assistance. His friends chip in, and he sells as many of his possessions as possible, but he still can't raise enough money.
When the hospital is about to throw his dying son out onto the street, John Q. pulls a gun. With a cry of "Free health care for everyone," he takes hostage the heart surgeon (James Woods) and an emergency room full of movie stereotypes. His demand, of course, is that his son be put on the list for a heart transplant. The rest of the film depicts John Q.'s standoff with police and his attempts to save his son.
It's too bad so many good actors are wasted in this film. The plot is obvious, manipulative, and lacking in subtlety. John Q. is such a reasonable and virtuous man, in such a terrible situation, that movie audiences are invited to feel that of course he's justified in taking hostages and threatening to shoot them. Who wouldn't? (And we're meant to believe he probably wouldn't kill anyone anyway.) The hospital administrator who denies treatment to John Q.'s son is portrayed as a truly loathsome person, given to explaining (in essence) that they are running a business and if you can't pay, you're dead. Oh yes, her name is Rebecca Payne. (Get it? Pain! Pass me that hard hat.) And in case any members of the audience still have doubts about John Q.'s actions, a crowd outside of the hospital cheers him on.
The police chief (Ray Liotta) is such a parody that he has four shining stars on each collar and four on each shoulder, making Patton look low-key. He would rather have a sniper take out John Q. than wait for the negotiator (Robert Duvall) to resolve the situation. And the heart that the son might receive is from a beautiful young white woman whom we see at the beginning of the movie, driving recklessly in her German luxury car before being hit by a truck. So we learn that the irresponsible rich might be able to serve the poor—by dying. For the most part, John Q. is as obvious as a comic book.
The film does raise one interesting moral dilemma: Should Archibald commit suicide so that the surgeon he is holding hostage will have a heart for his son? That could have been an intriguing issue to pursue. If John Q. chooses not to impose altruism (read: self-sacrifice) on himself, shouldn't he allow others the same choice? Alas, the implications of this issue are explored only superficially.
But John Q.'s major flaws are political and moral. Showing an individual struggling to navigate America's Kafka-esque health-care system could be a fine premise for a movie—a desperate man discovers how an utterly dysfunctional bureaucracy came to be. Unfortunately, John Q. confuses HMOs with the free market and uses the former to denounce the latter. The hostages in the emergency room wonder if the heart condition of John Q.'s son was not discovered sooner because HMO doctors simply didn't want to add costs to the system. The implication is that, for HMOs, it's better to let patients die than to waste money treating them.
Proliferating HMOs certainly have serious problems, but it is not because of market failures; it is because of a failure to have markets. Specifically, the current situation can be tied to three government policies. First, in the 1940s, in order to allow workers to receive higher compensation in spite of government-imposed wage controls, Congress allowed money paid by employers for purchasing workers' health insurance to be tax-deductible, although money spent by individuals on their own health insurance was not. Thus, there arose an incentive for individuals to rely on employers rather than themselves for health insurance. As a result, individuals are in the position of a dog at the vet, watching as the guys with the money and the guys with the medicine decide what to do with them. What's worse, many people now expect health insurance, as opposed to auto or life insurance, to be provided by employers.
The second governmental contribution to our current health-care mess was Congress's creation in 1965 of two public programs: Medicare, to cover health-care costs for the elderly; and Medicaid, to cover health-care costs for poorer Americans, like John Q. With the government paying for such care, health insurance for the elderly disappeared, while self-help and subscription organizations (a major source of funding early in the twentieth century, before Social Security) declined even further. Naturally, government spending on health care started to skyrocket. With the government paying, price was no object. So what did the government do to control costs? It introduced another policy.
The third problem policy was the HMO Act of 1973, which provided government subsidies to HMOs and mandated that all businesses with more than twenty-five employees offer the HMO option. Further, during the 1980s, Congress allowed many states to force Medicaid recipients into HMOs. And whose idea was it to herd people into HMOs?
On March 3, 1978, Leftist icon Senator Edward Kennedy bragged, "As the author of the first HMO bill ever to pass the Senate, I find this spreading support for HMOs truly gratifying. Just a few years ago, proponents of health maintenance organizations faced bitter opposition from organized medicine." He added, "HMOs have proven themselves again and again to be effective and efficient mechanisms for delivering health care of the highest quality. HMOs cut hospital utilization by an average of 20 to 25 percent compared to the fee-for-service sector." Yes, by kicking out people like John Q.'s son.
Now Kennedy poses as an enemy of HMOs. On May 15, 2001, he said: "Today, if your child has a rare congenital heart defect…your [HMO] plan can condemn your child to second-rate care…" Right, Teddy! A good movie might be made, following the story of a posturing, hypocritical senator: He creates a system that increases costs and reduces services for health care; he tries to pretend that he had nothing to do with that system; he blames the system's problems on the free market; and he advocates a nationalized system to take care of all our health-care problems. But since few voters see the deceit in the real world, many movie-goers might miss the message as well.
Health-care professionals who argue that John Q. is just a Hollywood action movie that got some facts wrong cannot explain its forthright endorsement of national health care. The message is so clear that I was expecting to see Hillary Clinton listed in the credits as a script consultant. I didn't have to wait that long. A clip of her commenting on health care actually appeared in the film.
In one way, the film John Q. is very honest. The essence of the political Left is openly on display. If people fail to meet your demand that they sacrifice their goods and services, pull a gun, take hostages, and threaten to kill the innocent. It is remarkable that such a theme has appeared in a film only six months after the September 11 terrorist attacks, but it has. Such is the grip of altruism on the liberal mind.
John Q. also gives us the essence of the Left in its message that health care is a "right." To be paid for by whom? The government, of course. If there were "free health care for everyone," as John Q. demands, he wouldn't have to do what he does—because government-sponsored health care does in another form what John Q. does for himself. It pulls a gun and forces taxpayers to hand over their money, and it forces physicians, who have devoted years to acquiring their life-saving skills, to do its bidding. If one accepts the premise that all of us are morally obliged to take care of others, the John Q. solution is what you get, one way or another.
Because John Q. is so blatant about the coercive essence of its altruist-collectivist premises, it is disturbing that audiences find any appeal in it. The conclusion must be that, though most people would prefer to have private health insurance, many will opt for a government-run or government-supported system if they are convinced it is necessary to head off the sort of situation depicted in John Q. They believe that, if health care is a matter of life and death, then the medical profession owes them services. Freedom—particularly other people's freedom—becomes a dispensable luxury.
If this is indeed the meaning of John Q.'s moderate success at the theaters, then supporters of freedom clearly have their work cut out for them in educating the public about the problems with the health-care system. Much more important, though, supporters of freedom need to pay more attention to strengthening the ethical infrastructure of a free society, so that individuals will understand it is their responsibility to secure all of the essentials of life—food, housing, a career, and, yes, health care.
But the most significant task is to teach people how to respond when their freedom is threatened in the name of altruism. Consider this statement from Rick Wade, a senior vice president at the American Hospital Association: "No hospital that can do a transplant would fail to do it because the patient can't pay." That sounds a lot like, "We would never assert our rights in the face of a person's need." To show benevolence and to defend freedom, what the association should have said is: "No hospital that can do a transplant would fail to do it because the patient can't pay, but we will absolutely refuse to offer such charity the moment any citizen or government demands that we provide it." Or, in the words that Ayn Rand once quoted from an earlier era of movies: "Gentlemen, leave your guns outside."
This article was originally published in the April 2002 issue Navigator magazine, The Atlas Society precursor to The New Individualist.
Edward Hudgins is research director at the Heartland Institute and former director of advocacy and senior scholar at The Atlas Society.