st voyager critical care

Critical Care (episode)

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The Doctor's program is taken from Voyager , and he is put to work on a vast hospital ship, where the twisted medical system is based on social status, rather than medical condition.

• 1.2 Act One
• 1.3 Act Two
• 1.4 Act Three
• 1.5 Act Four
• 1.6 Act Five
• 2 Memorable quotes
• 3.1 Video and DVD releases
• 4.1 Starring
• 4.2 Also starring
• 4.3 Guest Stars
• 4.4 Co-Stars
• 4.5 Uncredited Co-Stars
• 4.6 Stand-ins
• 4.7 References
• 4.8 External links

Summary [ ]

On board a large vessel , a crowded hospital ship , a trader named Gar is trying to sell medical supplies to Chellick , an administrator . Gar suggests this time he does not have any substandard merchandise, but rather an amazing little gadget, The Doctor 's mobile emitter . He activates it, and the bewildered Doctor appears.

Act One [ ]

The Doctor demands to know why he was kidnapped as Chellick negotiates a price. Then, according to an announcement, another batch of injured comes in. With some threats from Gar, and seeing all of these wounded here, The Doctor starts to help them. He finds their primitive technology almost unworkable, but does the best he can.

Meanwhile, Kim and Paris return from a holographic hockey game on the USS Voyager , and go to The Doctor for some minor bumps and bruises. However, the hologram who responds simply asks them to state the nature of the medical emergency, scans them, and tells them to take an analgesic . He does not even listen to the long story Paris starts to tell.

The hospital ship

When the hologram's program is examined, it turns out to be a fake from one of his old training files. The real Doctor is missing. Captain Janeway demands to know how Gar got away with him. Neelix explains Gar spent the night in sickbay otherwise unattended, claiming to have gotten food poisoning at dinner. Lieutenant B'Elanna Torres identifies when the training program was activated: just before Gar left Voyager . The captain starts the search for Gar. Neelix later explains it was his fault. Gar said his dinner was bland, so Neelix added a few spices to add flavor, not taking his physiology into account. He may have actually been ill instead of simply faking it. If he had never gone to sickbay, he would never have developed a plan to kidnap The Doctor. Janeway reassures Neelix with her experience: men like Gar will find an opportunity like that without anyone's help.

Aboard the medical ship, The Doctor's abilities impress many of the medical staff, including Voje , a doctor. The Doctor offers to contact his ship for more supplies, but Voje says that establishing communications would take a lot of paperwork; The Doctor will have to work with what he's given.

As The Doctor continues down a line of patients waiting for proton imaging , he makes small talk with Tebbis , a mine worker who can diagnose himself correctly. The scanning device also picks up a chronic condition, however, for which Tebbis hasn't been treated. When The Doctor asks why, Voje tells him it's because Tebbis doesn't have a high enough TC .

Chellick then shows up and informs The Doctor he has negotiated with Gar, and acquired his program. The Doctor refuses his instruction to follow him, since he is being illegally detained. The administrator explains that the allocator – their main computer – indicates his talents would be best used on Level Blue, which is a high-priority ward. The Doctor reluctantly follows, expecting to find Level Blue to be an intensive care ward… but instead, he finds that is luxurious compared to where he came from... cleaner, more spacious and there is a doctor per person instead of a doctor per dozen.

Act Two [ ]

These patients, the administrator explains, have a higher treatment coefficient, and it determines the level of care they receive. It is derived through a complex formula based on the individual's value to society, a prioritizing system for limited resources. The Doctor doesn't like it at all, but that is what the Dinaali do, says Doctor Dysek , the chief of medicine. They used to be a race dying from ecological disasters. Once introduced, The Doctor wants to know what is going on in Level Red, the level above, but the administrator and the chief talk about what The Doctor will do in the third person, and ignore his complaints.

Meanwhile, Voyager drops out of warp to find a probe emitting a false warp signature which they have followed. At this dead end, Tuvok comes up with a suggestion: Gar traded them some iridium ore with a short half-life, so he probably got it from within a three light year radius . Cross referencing sensor logs and long range scans quickly finds an asteroid which appears to be a mining colony .

Voyager visits the asteroid

When they arrive, they are hailed, and informed by an angry alien that he wants his iridium back. When Janeway says they traded it, he insists it was stolen from him. She agrees to give the iridium back – which is only half the amount Gar stole – and he in return tells her where induction units he also stole came from: a planetoid called Velos . That's where they look next.

The Doctor, meanwhile, admires the surgical technique of Doctor Dysek, and tries to get him to allow contact with Voyager . Dysek dryly repeats that Chellick authorizes all communications. The Doctor watches a nurse give a cytoglobin injection to a patient. She asks a console for it, it is authorized, and she administers it quickly. The Doctor asks if this patient also has the chromoviral disease , but Dysek says no, it is used to prevent arterial aging. The Doctor notes her arteries are in perfect health, and Dysek indicates it is a preventative regimen. That makes The Doctor coldly angry, because Tebbis, the boy on Level Red, would die if left untreated and yet was denied one. Dysek repeats that their society is far better off since following the allocator's protocols, and if Tebbis' TC rises, he will get good treatment as well.

The Doctor returns to Level Red and looks at Tebbis again. His condition has deteriorated further. Voje says it's because his coenzyme allotment has been reduced; his TC is too low. The Doctor suggests they raise it; if it is a statistical function, he can just input more data. Voje doesn't like it, but The Doctor talks to him about the moral imperative in medicine, and he is willing to go along. They settle on an expertise in neutronics. But when Voje inputs it, the data is rejected. Even Tebbis is willing to let The Doctor off with a clean conscience.

Instead, The Doctor returns to Level Blue, and informs the nurse that one of the patients requires an additional cytoglobin injection, which he will administer himself. He instead takes it back to Level Red and, after passing dozens of dying patients, gives it to Tebbis.

Act Three [ ]

Meanwhile, Voyager is still following Gar's trail. Kipp , a merchant at Velos, informs them Gar took the induction units on consignment. He was persuaded to do so by a buyer he has known for years. The buyer now knows it was a mistake. It was a suggestion from his wife, who has now left him. She says that she ran off with Gar, and is surprised to see Janeway looking for him, perhaps to steal him from her. To talk her out of this, she says Tuvok is her husband, a most unpleasant situation for Tuvok and amusing for the bridge crew . Tuvok explains that they have a business opportunity for Gar, and she says he is on his way to the gambling tournament on Selek IV .

Meanwhile, Tebbis feels better. He asks why he got the cytoglobin, if The Doctor has done something wrong, and The Doctor lies. He says that he convinced Chellick to recalculate his TC, and he is now authorized for cytoglobin.

The Doctor returns with more cytoglobin and asks Voje to distribute it. Voje refuses, but Tebbis volunteers. The Doctor is pleased and explains where to administer the injections. Voje helps so they will finish before they are caught.

It isn't very long before Dysek asks The Doctor why he is prescribing unnecessary medications for his patients. The Doctor tries to explain to Dysek that the allocator distributes supplies based on the hospital's efficiency – in other words, if any supplies are left over in a given month, the next month's shipment will be correspondingly smaller. Dysek is intrigued, and when Chellick asks if there is a problem, Dysek says no; The Doctor is learning the system well.

Voje is amazed that so many of the patients here are doing well. The Doctor takes it in stride, and tells him he will arrange for other medications to also be funneled here. Tebbis is doing much better now, and he wants The Doctor to say he is still sick so he can help. If he is declared well, he will be sent back down to the mines like his father, and will never get medical training. The Doctor says he doesn't plan to be here long enough to teach him what he needs to know about medicine, but will see what he can do.

Voyager finds Gar

Voyager finds Gar's ship – and bio-signs – and drops out of warp right on top of him, latching on a tractor beam . Gar hails them, and when they demand The Doctor, he claims to know nothing. When he tries to break their tractor beam with a feedback pulse, Janeway just beams him to the brig .

Meanwhile, The Doctor finds much to his dismay that Tebbis has been transferred to Level White – the morgue .

Act Four [ ]

The Doctor talks to Chellick who, after requiring his patient number to find him, explains that Tebbis died of untreated secondary infection. He should have died from the chromo-virus, but someone gave him unauthorized cytoglobin injections. He knows what The Doctor has been up to. After a hot debate about medical ethics, Chellick informs The Doctor that he is restricted to Level Blue, and directly connected to the allocator, who will monitor him down to the second.

" Mr. Neelix… have you deliberately poisoned this man? " " Relax, he's just having gas pains. "

Tuvok is interrogating Gar, and it is not going well. He is attempting to threaten a mind meld – " an invasive, disturbing procedure " – when Neelix walks in with dinner. Gar starts eating it enthusiastically. Neelix is glad that it wasn't his cooking that made Gar sick before, and that Gar was faking his food poisoning. Then Neelix tells Gar that the dinner is based upon Talaxian wormroot . Some people react badly. He hopes Gar won't feel any symptoms from it, like painful abdominal spasms . He does, and when Tuvok calls sickbay, Neelix tells him there is an antidote, but only The Doctor is allowed to administer it. This makes Gar more cooperative. When Tuvok takes Neelix aside and asks him about ethics, Neelix says there is no physiological damage – just as there isn't during a mind meld.

Doctor Voje is working hard on a patient when one of the nurses informs him to he must prepare the patient for discharge. Voje very angrily informs him that he discharges patients at the end of the shift and that's not over yet. The allocator immediately orders him to Level Blue to assist Doctor Dysek in surgery.

Voje arrives to find The Doctor working quickly from patient to patient. It was he who sent for Voje. He says he needs Voje to smuggle his mobile emitter away, despite the fact the twelve patients they treated are being sent home (and will probably die). He manages to persuade him seconds before the allocator deactivates him.

Shortly after The Doctor begins working on Level Red, Chellick considers him too much trouble and attempts to deactivate him. The Doctor swings Chellick around and injects him with the chromo-virus and blood factors from Tebbis. The Doctor plans a new lesson in empathy by making Chellick a patient on Level Red.

Act Five [ ]

When the allocator scans Chellick, it reads Tebbis, to whom it begins denying medication. The Doctor demands the supply of cytoglobin being used as a preventative treatment be used instead to treat every patient on this level.

Meanwhile, Voyager finally finds the ship and The Doctor's program. Unfortunately, Torres can't get a lock, because The Doctor's program has been interfaced with the hospital ship's computer. When the ship is hailed, the allocator answers and states that Administrator Chellick is unavailable, and he is the only one authorized to speak with alien species.

As The Doctor continues to examine Chellick, Dysek shows up. Chellick orders him to administer cytoglobin, but Dysek cannot do that, because it is not authorized for Level Red patients. Dysek is not in league with The Doctor, but his insights into the system are something he finds profound, such as resource allocations for Level Blue. One way to increase those allocations, The Doctor suggests, would be to move several of the Level Red patients – including Chellick – to Level Blue. Chellick agrees, just as Chakotay and Torres beam inside.

Once back on Voyager , The Doctor tries to come to terms with his actions at the hospital. He gives Seven of Nine a clean bill of health during a routine scan but, before she leaves, he asks her to perform a check-up on his own program. Seven asks if there is something wrong and The Doctor replies that there is not – he only wants a routine check given that he has been off the ship for an extended period of time and interfaced with an alien computer. Seven reports that all of his systems are within acceptable parameters. The Doctor then requests that she specifically examine his ethical subroutines and admits his ulterior motive for the check-up. He explains that he intentionally poisoned a man in the interest of saving dozens of patients, an action that Seven appreciates and likens to the Borg philosophy of sacrificing individual concerns for those of a collective. The Doctor expresses that he does not wish to aspire to Borg ideals. Seven examines his ethical subroutines one last time but advises him that, unfortunately, she must also give him a clean bill of health.

Memorable quotes [ ]

" I'm not about to perform medical services for a pair of common thieves! "

" I thought you were withholding your services… " " Fortunately for these patients, I am programmed with the Hippocratic Oath. "

" Everyone's assuming he faked his illness – but I might've really made him sick! " " It's not as if your cooking turned him into a thief. " " No… but if he hadn't gone to sickbay, he may never have come up with a plan to kidnap The Doctor – much less had the opportunity to do it. " " In my experience, Neelix, men like Gar have no trouble finding opportunities to take advantage of other people. "

" Level Blue is your critical care area, I presume… " " Level Blue is the area where it's most critical that we provide excellent care. "

" When you got sick last time, I thought my food was to blame – until I realized it was just a… ruse for you to get close to The Doctor. I used Talaxian wormroot as the base… I'm glad you like it. Some people react badly… " (Obviously beginning to) " React how?!?!" " Oh, dear, I hope you're not getting sick… if it's the wormroot, it's… gonna get a lot worse " " What've you done to me?!?! " (Mockingly) " The usual symptoms, are… abdominal spasms, which increase in severity for thirty hours… forty at the most… It's not fatal – horribly unpleasant, but… there's an antidote. " (In agony) " Then give it to me!!! " " Unfortunately, our doctor is the only one authorized to administer it. "

" Your actions are not only against regulations… " " Didn't I hear someone threaten a mind-meld? " " I was merely trying to encourage the suspect to be more forthcoming. " (Looking over at Gar) " I think he's getting all the encouragement he needs! "

" I'm making you a patient in your own hospital! "

" I want enough cytoglobin to cure every infected patient on this level! " " We don't have an adequate supply… " " There's plenty on Level Blue! " " Where it's being used to prevent arterial aging. " (Furiously) " Those people will survive without it. But a dozen people on this level won't – I will NOT let them die! "

" That feeling you get from healing someone – infectious, isn't it? "

" It's not that , it's just… I already have a man. "

" You were hoping your behavior was the result of a malfunction. I'm sorry, Doctor, but I must give you a clean bill of health. "

Background information [ ]

• Filming for this episode began on 25 July 2000 [1] (X) and was finished by 3 August 2000 . [2] (X)
• Debi A. Monahan , Gregory Itzin , and John Durbin all guest-starred in Star Trek: Deep Space Nine . Monahan played Melissa in " His Way ", Itzin played Ilon Tandro in " Dax " and Hain in " Who Mourns for Morn? ", and Durbin played Traidy in " A Simple Investigation ".
• Gar is trading in iridium, which is claimed to have a very short half-life, allowing Tuvok to deduce how far away Gar could have gotten with it. This would have been a (synthetic) radioactive isotope of iridium, with a half-life ranging somewhere from 2.5 hours ( 195 Ir) to 73.83 days ( 192 Ir).
• Among the costumes and prop items from this episode which were sold off on the It's A Wrap! sale and auction on eBay was the costume of Paul Holmquist . [3]
• The prop for the allocator seen in level blue in this episode later became the drink dispenser in Enterprise NX-01 's mess hall on Star Trek: Enterprise .

Video and DVD releases [ ]

• UK VHS release (two-episode tapes, Paramount Home Entertainment ): Volume 7.3, 4 June 2001
• As part of the VOY Season 7 DVD collection

Links and references [ ]

Starring [ ].

• Kate Mulgrew as Captain Kathryn Janeway

Also starring [ ]

• Robert Beltran as Chakotay
• Roxann Dawson as B'Elanna Torres
• Robert Duncan McNeill as Tom Paris
• Ethan Phillips as Neelix
• Robert Picardo as The Doctor
• Tim Russ as Tuvok
• Jeri Ryan as Seven of Nine
• Garrett Wang as Harry Kim

Guest Stars [ ]

• John Kassir as Gar
• Gregory Itzin as Dysek
• Paul Scherrer as Voje
• Dublin James as Tebbis
• Larry Drake as Chellick

Co-Stars [ ]

• Christinna Chauncey as Level Blue Nurse
• Stephen O'Mahoney as Med Tech
• Jim O'Heir as Husband
• John Durbin as Alien Miner
• Debi A. Monahan as Adulteress
• John Franklin as Kipp

Uncredited Co-Stars [ ]

• Pam Blackwell as Dinaali patient
• Bill Blair as Jye administrator
• Brooks Bonstin as Dinaali miner
• William Daniels as Allocation Alpha (voice)
• Tarik Ergin as Ayala
• Paul Holmquist as Level Blue nurse
• Stephen Pisani as operations division officer ( unconfirmed )
• Lisa Vanasco as Dinaali patient
• Dinaali chief engineer
• Dinaali patients

Stand-ins [ ]

• Brita Nowak – stand-in for Jeri Ryan
• Stuart Wong – stand-in for Garrett Wang and Paul Scherrer

References [ ]

ability ; abdominal spasm ; agricultural engineer ; allocator ; amendment ; analgesic ; anesthizine ; antigen ; arterial aging ; asteroid ; brig ; buyer ; career ; Chief of Medicine ; chromovirus ; class T nebula ; " clean bill of health "; coenzyme ; consignment ; cooking ; cortical bypass ; cytogenic ; cytoglobin ; dilithium ; dilution ; Dinaali ; dozen ; Dralian ; Dralian vessel ; dysplasia ; eco-disaster ; ethical subroutine ; ethics (aka ethical standards ); expired ; faking illness ; famine ; Federation ; feedback pulse ; food poisoning ; Gammadan Mining Facility ( mining facility ); gas pains ; gesture ; half-life ; healer ; health care (aka medical service ); high stick ; Hippocratic Oath ; hockey ; hockey stick ; Hospital Ship 4-2 ; hypospray ; ice skates ; induction unit ; ion trail ; iridium ; irrigation ; jersey ; Jye ; kidnapper ; kilo ; lateral artery ; leech ; level ( Level Blue / Level Green / Level Red / Level White / Level Yellow ); leverage ; logic ; lot ; medical staff ; music ; Nausicaan ; Nausicaan guard ; necrobiosis ; neural blocker ; neural monitor ; neutronics ; osteal extravasation ; poison ; power generator ; proto-humanoid ; proton imaging ; radius ; red alert ; rule of law ; sample ; second opinion ; security protocol ; Selek IV ; selenide ; snake oil salesman ; statistics ; Talaxian wormroot ; Tebbis' father ; Telsian ; third person ; tractor beam ; Trauma Team Four ; treatment coefficient ; Velos ; viremia ; mind meld ; warp signature ; waste processor ; working conditions

External links [ ]

• " Critical Care " at Memory Beta , the wiki for licensed Star Trek works
• " Critical Care " at Wikipedia
• " Critical Care " at the Internet Movie Database
• 1 Daniels (Crewman)
• 3 Calypso (episode)

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Star Trek: Voyager

“Critical Care”

Air date: 11/1/2000 Teleplay by James Kahn Story by Kenneth Biller & Robert Doherty Directed by Terry Windell

Review by Jamahl Epsicokhan

"I'm going to expose you!" "To whom? The people who employ me? They brought me here to make the hard choices they don't want to make." — The Doctor and Chellick

Review Text

In brief: An effective but not fully realized allegory on the bureaucracy of medical care.

In "Critical Care," Doc wakes up one morning (figuratively speaking, of course) and finds himself in the most chaotic wing of an alien hospital. He's thrust into an extreme situation which is written very consciously by the Voyager writers to be extreme. In the spirit of shows like last season's " Memorial " and " One Small Step ," this outing goes down as another effective Voyager "message show" — the story emerges from a premise that is telling a story specifically to make a point.

Is the story's message in your face? Well, not to a point that makes it remotely unpalatable. But like "Memorial" and "One Small Step," the point is not going to escape you, because it's right there, front-and-center. It's just as well. "Critical Care" is an allegory that works on its story terms and also as something that wants to be a Classic Trekkian Commentary. After last week's awful " Repression ," which wasn't about anything at all, "Critical Care" is a relief in that it turns out to be about something. And it's about it well. It plays like a good, substantive episode of The Original Series .

The allegory targets the bureaucratic corporate-ness of HMOs (Health Maintenance Organizations), which too frequently seem more interested in the bottom line than in serving their customers (patients) efficiently. No, HMOs aren't The Devil, and they aren't anything remotely approaching what's depicted in "Critical Care," but there are points here that echo the bureaucratic nonsense that patients (customers) must sit through in dealing with some HMOs, as when Dr. Voje (Paul Scherrer) tells Doc that his request must be made by filling out and submitting a form in triplicate.

Quick story. One of my coworkers injured her wrist on the job last December. That was nearly a year ago, yet today she still suffers from significant pain that interferes with simple daily activities. She probably should've had surgery long ago. The case is long and complicated, but I can assure you that the insurance companies and medical providers haven't been particularly helpful in resolving the case in any way that would avoid her stress. Perhaps the biggest kick in the head came when she got a letter saying she was suspected of making the whole thing up. Very infuriating.

In "Critical Care," the writers turn up the heat and make the consequences more dire. Reducing patients to impersonal numbers isn't simply a side effect of inefficient corporate operation; it's an intentional means to reach a rather cynical end that has been deemed necessary by the societal Powers That Be. And the consequences extend far beyond the mere decomposition of one's patience and peace of mind, and instead lead straight into death.

The plot point used to drop Doc into this situation is that he has been stolen by a scheming opportunist named Gar (John Kassir) and sold to a medical facility on a troubled world. This facility — indeed the entire society — is lacking in resources when it comes to medical treatment. This particular area of the hospital is depicted as an understaffed, overwhelmed, dim, dank, chaotic ER. With the priority of the Hippocratic Oath taking over, Doc puts aside the fact he has been abducted and quickly lends his medical talents.

The hospital administrator, Chellick (Larry Drake), witnesses Doc's abilities firsthand and decides he would be better utilized in another section of the hospital known as Level Blue. Doc is moved out of the chaotic Level Red wing up to Level Blue ... which looks to be about as advanced as Voyager 's sickbay.

It's here where the story unleashes its allegory-via-absurdity approach. Level Blue treats patients who, quite simply, do not require the treatment they're getting. Crucial medicine that would save lives on Level Red is wasted on Level Blue to proactively treat possible medical conditions that do not yet exist in these patients, and may never exist. "It increases life expectancy" is about the best justification Doc is supplied by Chellick and Level Blue Dr. Dysek (Gregory Itzin). Medicine is rationed by "The Allocator," the pre-programmed hospital computer, which was supplied its inflexible directives by Administrator Chellick. Doc is outraged. His outrage is irrelevant. Chellick tells him in no uncertain terms that This Is The Way It Is.

Why are patients on Level Blue afforded such better treatment than those on Level Red? Simple: It comes down to something called the "TC" — "Treatment Coefficient" — a formula essentially derived from a patient's current value to society (engineers who work on projects important to society have a higher TC than, say, expendable mine laborers). Patients with a higher TC get the priority for medical resources, even if they don't really need them.

What's amazing is how close to plausible Chellick is able to make his reasoning seem. There's a potent scene where Doc confronts Chellick's cold, numeric approach to patient treatment, to which Chellick responds that this once-dying society has improved dramatically under such measures. I liked that Larry Drake's performance wasn't one of a villain so much as a cold, inflexible pragmatist who has been given a job to do and is determined to do it ("They brought me here to make the hard choices they don't want to make") even if it means the lower tiers of society may be paying with their lives.

This doesn't for one second wash with Doc, however, who makes it his new mission to save the lives on Level Red, which he does by stealing medicine from Level Blue and taking it to Level Red. While on this mission he recruits reluctant Level Red Dr. Voje, who is a wonderful example of a decent guy trying to do his job within the confines of a system much bigger than him. Doc pushes at Voje to bend and eventually break the rules to give better treatment to the patients of Level Red (manipulating the TC of patients and later administering them stolen medicine). Voje is understandably reluctant and annoyed; when you've been brought up on an ethics system as screwed up as this one, turning around and risking your career to oppose it isn't necessarily the first thing to come to mind.

The Level Red situation is reduced via microcosm to a teenager named Tebbis, who is played fetchingly — almost to a fault — by Dublin James. He's a Sick Boy and a Nice Kid, and thus might as well have "Dead Meat" scrawled across his forehead in a story like this. I liked the doctor/patient relationship established between Tebbis and Doc, even if Tebbis ends up as the episode's thematic equivalent of the proverbial drowned kittens.

Indeed, one of the real strengths of "Critical Care" is the way it portrays Doc completely in the role of a healer. He takes pleasure in his work, where the highest reward is in making the sick get well. And when Tebbis unexpectedly dies and Doc learns that Chellick sat by and let it happen because the rules said so, there's a scene where Doc stares at Chellick with a look of disbelief that is conveyed about as well as surprised disgust can be. (Picardo, as usual, puts in stellar work.)

There are other really good moments here, like when Doc cleverly uses the backwardness of the system against itself, convincing Dysek that using more resources on Level Blue will lead to getting more resources (which Doc then steals and routes straight into Level Red). I also liked the riff on automated bureaucracy in the recorded message that greets Janeway when she tries to hail the medical facility.

What only worked kinda-sorta for me, however, was the ending. It seemed kind of ... anticlimactic. The idea of making Chellick a patient in his own hospital is appropriate enough, but what happens in the final act lacks a certain follow-through and ends up being pretty simple. And it doesn't really come to any resolution: By having Chellick cave in to Doc's demands at the last moment, we're not really solving any problems. Perhaps we're not supposed to be solving anything, but the story's mistake, I think, is that it doesn't really commit to a larger picture for the ending, one way or the other. Do things get better after Doc's intervention, or worse? Is any change effected? Should there be?

I also didn't quite understand Dysek's motives in going along with Doc's use of this "leverage" over Chellick. Early in the episode Dysek seems to buy completely into Chellick's way of doing things as a matter of necessity, but by the end he flip-flops without much in terms of motivation.

I guess it doesn't much matter, because the episode is about this isolated case involving Doc, and it keeps the focus on him. By the end, it indicates a certain growth on Doc's part, permitting him to infect a man with a disease in order to save a dozen others. It's an ironic situation, and it's good that the episode — and Doc himself — realizes this is the case. For Doc it's a conflict that shouldn't be permitted by his programming, because his ethics are clear: Do no harm. But something else — call it necessity — takes over in him by the end of "Critical Care." Interesting.

Next week: Lt. Barclay as a pawn to ... Ferengi?

Previous episode: Repression Next episode: Inside Man

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Comment Section

92 comments on this post.

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.

Jakob M. Mokoru

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.

Ken Egervari

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.

Overthinker

"...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.

BlightedSight

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.

Captain Jim

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.

Jonathan Baron

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.

Jo Jo Meastro

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.

cawimmer430

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.

Diamond Dave

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.

dave johnson

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.

Sleeper Agent

"--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.

MusicalTurtle

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.

Sarjenka's Brother

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.

TheRealTrent

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.

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Recap / Star Trek Voyager S 7 E 5 Critical Care

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This episode provides examples of:

• In response to there being only limited supplies of a critical drug, that drug is withheld from critical patients and diverted to non- critical patients for what's essentially off-label use based on the algorithm valuing those individuals more highly.
• Quite aside from the horrifying humanitarian implications, the system promotes all kinds of perverse incentives. For instance, doctors who use fewer resources risk having their rations cut, making them less effective at their jobs, and risking their positions and careers. It's therefore in their best interest to requisition more supplies than they actually need (remember, the system is supposed to address a lack of resources).
• Badass Bureaucrat : Chellick is surprisingly astute. He catches on to the Doctor's attempts to subvert the system very quickly. This seems to be his species' hat , as they are known for their talent in administration.
• Beleaguered Bureaucrat : The doctors on the planet of the episode are forced to work in the unhelpful and obtrusive healthcare system put in place by Chellick. All important decisions about patient care, from who gets what medicine to what ward the patients are sent to, to where the doctors themselves will be working, is decided for them by a non-sentient artificial intelligence that decides everything by a vaguely defined algorithm. Interestingly, both doctors we see on the planet are less than happy with the bureaucratic system they're forced to operate in despite doing so at different levels, and both are very receptive when the EMH provides insight in how to exploit loopholes.
• Beware the Nice Ones : The Doctor demonstrates what happens when you put a healer in a situation where he has to cause harm to save lives.
• Beware the Silly Ones : Neelix, of all people, is the one to get Gar to talk, by giving him food chock full of Talaxian spices, much to the surprise of Tuvok who was threatening Gar with a Mind Meld .
• Bittersweet Ending : The Doctor's plan to poison Chellick and put the proverbial shoe on the other foot goes off without a hitch. But afterward, all the Doctor can think about is the fact that he just poisoned a man. It goes against everything he was made for, and he's deflated to find that this decision was not a malfunction, but his own free will.
• Borrowed Biometric Bypass : The Doctor uses this in reverse on Chellick, poisoning him in such a way that the computer reads him as the deceased Tebbis, disease included. Stripped of his authority, Chellick has little choice but to comply with the Doctor's demands if he wants to be treated, much less have the Doctor undo his sabotage.
• Boyfriend Bluff : Captain Janeway and Lt. Cmdr. Tuvok pretend to be romantically involved as they talk to one of the people that Gar came in contact with.
• Chekhov's Gun : Neelix remembered about the spices that gave Gar indigestion and decided to use them again.
• Cold Equation : Chellick sees this as the essence of his job. He was hired to make the hard decisions others can't or won't.
• Colour-Coded for Your Convenience : Each level of the facility has a different color designation depending on T.C. score. In descending order: blue, green, yellow, red, white. The highest T.C. scores are at Level Blue with the best care, while the lowest T.C. scores get Level Red which is strapped for resources. White is the morgue.
• Con Man : Gar is a serial huckster. As Voyager tries to retrace his steps, each person they talk to gives a different tale of being swindled. His lover's request that they ask him to come home implies that he probably ran out on her too.
• Continuity Nod : The Doctor mentions the algorithms Seven promised to create to secure his Morality Chip in "Equinox".
• Crisis Point Hospital : Level Red, which is for the common rabble, fits the trope description — overcrowded, insufficient resources, people dying left and right. Level Green is implied to be even worse, and Level White is a euphemism for the morgue.
• Doctor Jerk : Chellick is a medical administrator, rather than a doctor, but otherwise fulfills this trope. His entire job is denying medical care to those who he deems unworthy of it, and shows zero concern for how it impacts anyone. Chellick eventually gets his comeuppance when the Doctor decides to poison him with Tebbis's illness, putting Chellick in the Level Red and forcing him to change his thinking .
• Does This Remind You of Anything? : People with treatable illnesses going without vital medicine because they aren't "valuable" to society. Dinaali society just makes the denial of care official rather than letting it happen by economic default.
• Dramatic Pause : In The Doctor's Catchphrase when he realizes that he is no longer on board Voyager . "Please state the nature...of the medical emergency?"
• Foreshadowing : The back of the elevator in the care facility shows the different levels by color. Given Level Blue with the best medical care is at the top and Level Red with the worst medical care is second from the bottom, it's easy to infer that Level White, the very bottom level, would be the morgue.
• From a Certain Point of View : The Doctor assumes that Level Blue is the critical care unit. Chellick says that it's critical that these patients get the best care.
• Get Out! : For the nurses on Level Blue, a simple "You may go" is sufficient.
• Good Cop/Bad Cop : Subverted with Tuvok and Neelix. Tuvok threatens a Mind Meld while Neelix brings a homecooked meal to Gar. Neelix turns out to be the bad cop in this scenario .
• He Had a Name : The Doctor is pissed at Chellick for referring to the deceased Tebbis as "Patient R-12", since he sees all patients as worthy of care, not statistics.
• Hoist by His Own Petard : After spending the entire episode trying to get the Doctor to follow the rules, Chellick is not happy when Dysek does exactly that. Dysek : I don't want to break the rules . Chellick : I MAKE THE RULES ! Dysek : Then you should be pleased I hold them in such high regard .
• Hope Spot : Tebbis starts recovering nicely with the help of cytoglobin injections—and then he dies when his medicine is cut off and his infection worsens.
• Hospital Paradiso : Level Blue. The Doctor rejects it in favor of Level Red, where he feels he's more needed.
• Human Aliens : The Dinaali have no alien makeup whatsoever. The only difference demonstrated between them and humans are internal scans.
• Hyperspeed Ambush : Voyager pulls one on Gar to keep him from escaping, downwarping right above his ship and grabbing it with a Tractor Beam .
• Hypocrite : When Tuvok tells Neelix that poisoning a prisoner is a violation of Starfleet rules regarding the treatment of prisoners, Neelix points out that Tuvok threatened to use the mind meld on Gar, which is also a violation of those same rules.
• I'm a Doctor, Not a Placeholder : Chellick: We're healers, not killers.
• Inconvenient Hippocratic Oath : Subverted in one instance where the Doctor purposely poisons the man in charge of the medical facility in order to get better health coverage to those of a lower societal status.
• Jerkass Has a Point : While Chellick 's system is deeply flawed, and his total lack of empathy is disturbing, he points out that he's been hired to fill a difficult but necessary function. In a society with insufficient medical resources, someone has to decide who gets treatment and who doesn't. He was hired to make those hard choices because none of the locals are willing to do so . Both Dysek and Voje tell the Doctor that conditions on their world improved significantly after Chellick’s people took over administrative functions. The Doctor forces him to learn some empathy, but it's not like the circumstances on the planet are really going to change .
• Laser-Guided Karma : After purposely letting Tebbis die, Chellick is injected with Tebbis's illness by the Doctor in a fit of desperation, and he is sent to Level Red, where he is left to die. This forces Chellick to reconsider his ethics and move all surviving Level Red patients to Level Blue so they can live.
• Lethal Chef : Neelix purposely poisons Gar's food with indigestible spices so that he could get his cooperation in retrieving the Doctor's program . He succeeds.
• Medical Drama : An episode that focuses on the Doctor as he struggles to deal with the finicky ethics of the facility he ends up working for (against his will) while trying to heal the patients there.
• Mind Meld : Tuvok was about to attempt doing this to Gar to extract information from him when Neelix shows up with an alternative form of interrogation .
• Misapplied Phlebotinum : The treatment for a deadly disease is also effective as a more mundane wellness medication, and is being predominantly prescribed for the latter use. The Doctor finds this appalling, as they're letting a treatable disease run rampant just so already-healthy people can live a bit longer.
• Mood Whiplash : The episode's A-plot is the Doctor's attempts to treat dying patients, culminating in the death of a boy he'd befriended and deciding to take drastic measures. The B-plot is Voyager trying to find him by giving a man indigestion, arguing with other outraged traders, and Janeway becoming hilariously more exasperated with each passing interview.
• Moral Pragmatist : Dysek accepts a system that allows level red patients to die while the medicine that could save them is used to help level blue patients live slightly longer. The Doctor convinces him to rebel against the system by pointing out that the Allocator will " reward " his efficiency by reducing his resources until he doesn't have enough, at which point his cure rate will go down and the Allocator will downgrade him.
• My God, What Have I Done? : Afterwards, the Doctor is seriously disturbed that he deliberately infected someone with a deadly disease, and can't simply blame it on a malfunction.
• The Needs of the Many : Seven says that the Doctor was merely sacrificing an individual to help the collective. The Doctor doesn't find the Borg philosophy comforting, especially since that was close to the explanation that Chellick gave for denying patients life-saving care.
• This is the flaw in the Allocator's system that convinces Dysek to turn. If a doctor is too efficient, the Allocator will give them fewer resources, and continue to do so until their cure rate goes down, at which point the Allocator will downgrade the doctor.
• No Time to Explain : The Doctor says this when asking Voje to smuggle him back to Level Red, as he's going to be deactivated in less than a minute.
• Oh, Crap! : Gar gets pretty unnerved when Tuvok threatens him with a Mind Meld , and again when the Talaxian spices in his meal start to wreak havoc with his digestive system.
• Reasonable Authority Figure : Dr. Dysek. It's hinted that he's no less unhappy with how the Level Red patients are callously treated, and aids the Doctor's efforts on several occasions, either by turning a blind eye and congratulating the Doctor on how he learns to game the system to benefit them both, and later refusing to treat Chellick while giving the Doc a "consult."
• Screw the Rules, I'm Doing What's Right! : Pretty much everything the Doctor does on the planet, bending or breaking every rule to care for Level Red patients. Even poisoning Chellick with a deadly disease was for the purpose of getting better treatment for the Level Red patients and forcing Chellick to learn more empathy.
• Socially Scored Society : The Doctor has to deal with an alien world where each citizen receives a "T.C." or treatment coefficient from the Allocator , which ruled how useful a person was to society. The higher the T.C., the better healthcare they get.
• Surrounded by Idiots : Tebbis: I've never met a doctor like you. Doctor: Well, it's not hard to stand out when the general level of competence is so low.
• Swiss-Cheese Security : One of the most egregious examples in the series, as the Doctor is stolen from Sickbay. Justified by the fact that the EMH was intended to act as a short-term emergency replacement, and since mobile emitters weren't invented yet, they could only function in a holographic environment. There was really no reason to design an EMH to be difficult to steal.
• Triage Tyrant : Administrator Chellick, whose policies decide who's socially important enough to receive better treatment while leaving the Level Red patients to die.
• Ugly Guy, Hot Wife : The fat schlub and the Ms. Fanservice wife who left him for Gar.
• Wham Line : Voje telling the Doctor that Tebbis has been moved to Level White and what that means: "It's the morgue."
• What the Hell, Hero? : Voje is appalled that the Doctor infected Chellick after having given Voje several lectures on medical ethics and where a doctor's duty lies. The Doctor isn't blind to the hypocrisy, but feels he's been backed into a corner and has no other option.
• Star Trek Voyager S 7 E 4 Repression
• Recap/Star Trek: Voyager
• Star Trek Voyager S 7 E 6 Inside Man

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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 .

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.”

Projecting.

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 ‘ H umongous M uddling O bservations’, 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.

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Filed under: Voyager | Tagged: capitalism , critical care , death panels , emh , healthcare , hmos , nostalgia , obama care , social commentary , socialism , star trek , star trek: voyager , Television , topical |

9 Responses

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.

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.

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.

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.

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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Critical Care

The Doctor is abducted from  Voyager  and forced to work in a hospital where patients are treated based on their social status. He must sidestep the tyrannical hospital administrator to treat patients other than the privileged.

Gregory Itzin

Debi A. Monahan

Larry Drake

John Durbin

John Kassir

Christinna Chauncey

Dublin James

Stephen O'Mahoney

John Franklin

Cast appearances.

Kate Mulgrew

Robert Beltran

Roxann Dawson

Robert Duncan McNeill

Ethan Phillips

Robert Picardo

Garrett Wang

Episode discussion.

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Star Trek: Voyager

Critical Care

Cast & crew.

Larry Drake

Gregory Itzin

John Kassir

Dublin James

Paul Scherrer

Information

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Critical Care Stardate: Unknown Original Airdate: 1 November 2000

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Star Trek ® is copyright of CBS Studios Inc . Copyright © 1966, Present. The Star Trek web pages on this site are for educational and entertainment purposes only. All other copyrights property of their respective holders.

Six Degrees of Star Trek

Ethan Phillips

Kate Mulgrew

Larry Drake

635th Anti-Aircraft Missile Regiment

635-й зенитно-ракетный полк

Military Unit: 86646

Activated 1953 in Stepanshchino, Moscow Oblast - initially as the 1945th Anti-Aircraft Artillery Regiment for Special Use and from 1955 as the 635th Anti-Aircraft Missile Regiment for Special Use.

1953 to 1984 equipped with 60 S-25 (SA-1) launchers:

• Launch area: 55 15 43N, 38 32 13E (US designation: Moscow SAM site E14-1)
• Support area: 55 16 50N, 38 32 28E
• Guidance area: 55 16 31N, 38 30 38E

1984 converted to the S-300PT (SA-10) with three independent battalions:

• 1st independent Anti-Aircraft Missile Battalion (Bessonovo, Moscow Oblast) - 55 09 34N, 38 22 26E
• 2nd independent Anti-Aircraft Missile Battalion and HQ (Stepanshchino, Moscow Oblast) - 55 15 31N, 38 32 23E
• 3rd independent Anti-Aircraft Missile Battalion (Shcherbovo, Moscow Oblast) - 55 22 32N, 38 43 33E

Disbanded 1.5.98.

Subordination:

• 1st Special Air Defence Corps , 1953 - 1.6.88
• 86th Air Defence Division , 1.6.88 - 1.10.94
• 86th Air Defence Brigade , 1.10.94 - 1.10.95
• 86th Air Defence Division , 1.10.95 - 1.5.98

'I’ve been here too long’: Patients feel ransomware attack effects at Ascension

Just four days after Ascension St. Vincent's operations were upended by a ransomware attack earlier this month , Mark Hammond, 74, was admitted to the health system's flagship hospital on 86th Street in Indianapolis for life-threatening symptoms.

Quickly, his family, including his daughter who is trained as a nurse, realized that things were going very wrong. What typically should have been a weeklong treatment for a blood clot and bacteria in his blood has dragged on into an 11-day stay and counting. Throughout Hammond's time in Ascension St. Vincent, he has watched as his health care providers have struggled to determine the best way to help him heal. Doctors and nurses couldn't access his electronic health records, which spell out instructions for imaging tests that are safe since he has a medical device implanted in his heart. His caregivers could not make necessary decisions about what dosage of medicine he needed without rapid lab results, and the lab was delayed due to the hack, his family said.

"I've been here for too long," Hammond said from his hospital room Tuesday. "This is costing me every day for something that's not my fault."

Since the ransomware attack on May 8, doctors, nurses and other staff across Indiana and 18 other states have lost access to important health care technology. In the absence of computer records, they have turned to keeping medical records, prescriptions, vital signs, doctors notes and other key information on paper and in binders, according to patients and employees at the network. The massive change in workflow has delayed everything from lab work and imaging results to discharging patients and sending prescriptions to pharmacies.

The situation has most affected people with complicated cases requiring inpatient care, like Hammond. Patients who have routine appointments with primary care or specialists or patients with straightforward health care needs may not see a significant change in their care. Ascension said the situation may change day by day as hospital officials work to restore technology.

Ascension has warned patients that there may be delays and rescheduled appointments but has declined to provide specifics about changes in the way providers deliver care.

"We are also working diligently on our restoration efforts. We are making progress, however, it will take time to return to normal operations," an Ascension spokesperson said in an email. "As systems and services come back online, we will share those updates so that our patients and communities can plan accordingly." 

Hospital workers scrambling

The tectonic shift to paper and fax from bedside technology has put some health workers, who already feel spread thin, on edge and in fear of making critical mistakes.

The wrong dosage. The wrong vital sign. The wrong diagnosis.

"A simple task that is crucial to patient care is now a long process with a lot of room for error," said one nurse at Ascension who asked not to be identified because she fears losing her job.

"The consensus among all of us are bad things are going to happen."

While some veteran health care providers may remember days before computers, it's been a decade or two since that was a routine practice at hospitals.

The lack of health information and records, which are critical for diagnosis and treatment, can "cause a lot of harm," said Tinglong Dai, a professor at Johns Hopkins University's Carey Business School with expertise in health care operations.

"You're shooting in the dark," he said.

Although they have little control over the situation, patients and insurers are often left paying for the delays and extended stays, Dai said.

Staff need more help

In recent years, two Ascension health workers said, they would turn to paper charts for several hours during scheduled down times, when technology required an update. Then it was back to normal.

Whenever staff have to resort to paper, charting takes far more time than with computers, time that nurses and other providers just don't have, employees say.

"Staffing is really tight and has been tight," she said. "... Now is not the time to have unsafe staffing."

Over the past few harrowing days, said another provider who spoke anonymously due to fear of losing her job, the team has figured out workarounds. However, she expressed surprise that the hospital has continued to accept high-risk cases despite the challenges.

Health care has become a lucrative target for cyber criminals because such facilities have massive amounts of personal data, making them easy to extort or sell for profit, said John Nicholas, a professor at Ball State University with expertise in cybersecurity.

Attacks like these on hospital systems are becoming more common. Last year, Community Health Network had a data breach. In 2021, Eskenazi Health suffered a ransomware attack.

Cyberattacks have become so common in health care that the U.S. Department of Health and Human Services announced this week it would invest $50 million to develop tools to protect hospitals from such attacks.

Some may not notice a difference

But not everyone is experiencing a change in care.

Sue Squiller wouldn't have known anything was wrong during her May 9 doctor's appointment, the day Ascension announced it had been hacked, if her doctor didn't take notes by hand during it.

The discharge was fast and she picked up her medication from CVS without delay.

While she is worried about inpatient delays in the future, she said she will continue to seek care at the health system.

"I do feel confident in them," she said.

Ascension told patients that doctors' offices and urgent care clinics are open but patients may experience delays. The network recommended patients bring in notes on symptoms and a list of medications, including prescription numbers or bottles.

The network's retail pharmacies can't fill prescriptions, so providers are looking for alternatives.

The network is updating the latest information for patients on its website: https://about.ascension.org/cybersecurity-event/regional-pages/indiana

The Unique Burial of a Child of Early Scythian Time at the Cemetery of Saryg-Bulun (Tuva)

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Pages:  379-406

In 1988, the Tuvan Archaeological Expedition (led by M. E. Kilunovskaya and V. A. Semenov) discovered a unique burial of the early Iron Age at Saryg-Bulun in Central Tuva. There are two burial mounds of the Aldy-Bel culture dated by 7th century BC. Within the barrows, which adjoined one another, forming a figure-of-eight, there were discovered 7 burials, from which a representative collection of artifacts was recovered. Burial 5 was the most unique, it was found in a coffin made of a larch trunk, with a tightly closed lid. Due to the preservative properties of larch and lack of air access, the coffin contained a well-preserved mummy of a child with an accompanying set of grave goods. The interred individual retained the skin on his face and had a leather headdress painted with red pigment and a coat, sewn from jerboa fur. The coat was belted with a leather belt with bronze ornaments and buckles. Besides that, a leather quiver with arrows with the shafts decorated with painted ornaments, fully preserved battle pick and a bow were buried in the coffin. Unexpectedly, the full-genomic analysis, showed that the individual was female. This fact opens a new aspect in the study of the social history of the Scythian society and perhaps brings us back to the myth of the Amazons, discussed by Herodotus. Of course, this discovery is unique in its preservation for the Scythian culture of Tuva and requires careful study and conservation.

Keywords: Tuva, Early Iron Age, early Scythian period, Aldy-Bel culture, barrow, burial in the coffin, mummy, full genome sequencing, aDNA

Information about authors: Marina Kilunovskaya (Saint Petersburg, Russian Federation). Candidate of Historical Sciences. Institute for the History of Material Culture of the Russian Academy of Sciences. Dvortsovaya Emb., 18, Saint Petersburg, 191186, Russian Federation E-mail: [email protected] Vladimir Semenov (Saint Petersburg, Russian Federation). Candidate of Historical Sciences. Institute for the History of Material Culture of the Russian Academy of Sciences. Dvortsovaya Emb., 18, Saint Petersburg, 191186, Russian Federation E-mail: [email protected] Varvara Busova  (Moscow, Russian Federation).  (Saint Petersburg, Russian Federation). Institute for the History of Material Culture of the Russian Academy of Sciences.  Dvortsovaya Emb., 18, Saint Petersburg, 191186, Russian Federation E-mail:  [email protected] Kharis Mustafin  (Moscow, Russian Federation). Candidate of Technical Sciences. Moscow Institute of Physics and Technology.  Institutsky Lane, 9, Dolgoprudny, 141701, Moscow Oblast, Russian Federation E-mail:  [email protected] Irina Alborova  (Moscow, Russian Federation). Candidate of Biological Sciences. Moscow Institute of Physics and Technology.  Institutsky Lane, 9, Dolgoprudny, 141701, Moscow Oblast, Russian Federation E-mail:  [email protected] Alina Matzvai  (Moscow, Russian Federation). Moscow Institute of Physics and Technology.  Institutsky Lane, 9, Dolgoprudny, 141701, Moscow Oblast, Russian Federation E-mail:  [email protected]

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Savvino-storozhevsky monastery and museum.

Zvenigorod's most famous sight is the Savvino-Storozhevsky Monastery, which was founded in 1398 by the monk Savva from the Troitse-Sergieva Lavra, at the invitation and with the support of Prince Yury Dmitrievich of Zvenigorod. Savva was later canonised as St Sabbas (Savva) of Storozhev. The monastery late flourished under the reign of Tsar Alexis, who chose the monastery as his family church and often went on pilgrimage there and made lots of donations to it. Most of the monastery’s buildings date from this time. The monastery is heavily fortified with thick walls and six towers, the most impressive of which is the Krasny Tower which also serves as the eastern entrance. The monastery was closed in 1918 and only reopened in 1995. In 1998 Patriarch Alexius II took part in a service to return the relics of St Sabbas to the monastery. Today the monastery has the status of a stauropegic monastery, which is second in status to a lavra. In addition to being a working monastery, it also holds the Zvenigorod Historical, Architectural and Art Museum.

Belfry and Neighbouring Churches

Located near the main entrance is the monastery's belfry which is perhaps the calling card of the monastery due to its uniqueness. It was built in the 1650s and the St Sergius of Radonezh’s Church was opened on the middle tier in the mid-17th century, although it was originally dedicated to the Trinity. The belfry's 35-tonne Great Bladgovestny Bell fell in 1941 and was only restored and returned in 2003. Attached to the belfry is a large refectory and the Transfiguration Church, both of which were built on the orders of Tsar Alexis in the 1650s.  

To the left of the belfry is another, smaller, refectory which is attached to the Trinity Gate-Church, which was also constructed in the 1650s on the orders of Tsar Alexis who made it his own family church. The church is elaborately decorated with colourful trims and underneath the archway is a beautiful 19th century fresco.

Nativity of Virgin Mary Cathedral

The Nativity of Virgin Mary Cathedral is the oldest building in the monastery and among the oldest buildings in the Moscow Region. It was built between 1404 and 1405 during the lifetime of St Sabbas and using the funds of Prince Yury of Zvenigorod. The white-stone cathedral is a standard four-pillar design with a single golden dome. After the death of St Sabbas he was interred in the cathedral and a new altar dedicated to him was added.

Under the reign of Tsar Alexis the cathedral was decorated with frescoes by Stepan Ryazanets, some of which remain today. Tsar Alexis also presented the cathedral with a five-tier iconostasis, the top row of icons have been preserved.

Tsaritsa's Chambers

The Nativity of Virgin Mary Cathedral is located between the Tsaritsa's Chambers of the left and the Palace of Tsar Alexis on the right. The Tsaritsa's Chambers were built in the mid-17th century for the wife of Tsar Alexey - Tsaritsa Maria Ilinichna Miloskavskaya. The design of the building is influenced by the ancient Russian architectural style. Is prettier than the Tsar's chambers opposite, being red in colour with elaborately decorated window frames and entrance.

At present the Tsaritsa's Chambers houses the Zvenigorod Historical, Architectural and Art Museum. Among its displays is an accurate recreation of the interior of a noble lady's chambers including furniture, decorations and a decorated tiled oven, and an exhibition on the history of Zvenigorod and the monastery.

Palace of Tsar Alexis

The Palace of Tsar Alexis was built in the 1650s and is now one of the best surviving examples of non-religious architecture of that era. It was built especially for Tsar Alexis who often visited the monastery on religious pilgrimages. Its most striking feature is its pretty row of nine chimney spouts which resemble towers.

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• Cast & crew
• User reviews
• Episode aired Jan 16, 1995

While pursuing the trail of Maquis rebels, a newly commissioned Starfleet ship gets pulled to the far side of the galaxy. While pursuing the trail of Maquis rebels, a newly commissioned Starfleet ship gets pulled to the far side of the galaxy. While pursuing the trail of Maquis rebels, a newly commissioned Starfleet ship gets pulled to the far side of the galaxy.

• Winrich Kolbe
• Gene Roddenberry
• Rick Berman
• Michael Piller
• Kate Mulgrew
• Robert Beltran
• Roxann Dawson
• 26 User reviews
• 7 Critic reviews

• Capt. Kathryn Janeway

• Cmdr. Chakotay

• B'Elanna Torres
• (as Roxann Biggs-Dawson)

• Ensign Harry Kim

• The Caretaker

• Lieutenant Stadi

• Ocampa Doctor

• Ocampa Nurse

• Human Doctor
• All cast & crew
• Production, box office & more at IMDbPro

Did you know

• Trivia This is the only episode in the history of Star Trek for which the hairstyling cost more than visual effects because most of the Janeway scenes had to be re-shot after the studio requested that Janeway have a different hairstyle.
• Goofs When we first see the shuttle carrying Tom Paris, the registry number is 71325. In the second shot of the same shuttle, the registry number is 1701-D, indicating it belongs to the Enterprise. In the final shot, when the shuttle is flying over the saucer section of Voyager, it has returned to 71325.

Captain Kathryn Janeway : Gentlemen, welcome aboard Voyager.

Harry Kim : Thank you, sir!

Captain Kathryn Janeway : Mr. Kim... at ease, before you sprain something.

• Alternate versions Reaired in syndication and in UPN repeats as a two-part episode with a commercial break added after the opening credits.
• Connections Featured in Troldspejlet: Episode #17.13 (1997)
• Soundtracks Star Trek: Voyager - Main Title Written by Jerry Goldsmith Performed by Jay Chattaway

User reviews 26

• Jan 26, 1999
• January 16, 1995 (United States)
• United States
• Official Site
• Star Trek: Voyager - Der Fürsorger
• Los Angeles Convention Center - 1201 S. Figueroa Street, Downtown, Los Angeles, California, USA (underground Ocampa city)
• Paramount Television
• See more company credits at IMDbPro

Technical specs

• Runtime 1 hour 31 minutes
• Dolby Digital

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1 Person Is Killed After Gas Explosion Rips Facade Off Ohio Building

One person was in critical condition and six other people were also injured after the midafternoon explosion in Youngstown.

By Aimee Ortiz and Jenny Gross

A natural gas explosion ripped the facade off a building in downtown Youngstown, Ohio, on Tuesday afternoon, killing a 27-year-old man and injuring at least seven others, one critically, officials said.

The explosion happened just before 3 p.m. at the Realty Building on East Federal Street. Firefighters pulled people out of the building, which houses a Chase Bank branch, and rescued others from apartments on the top floors.

The body of a Chase employee, Akil Drake, who had been reported as missing on Tuesday, was recovered at around 12:30 a.m. on Wednesday and pronounced dead, officials said. Mr. Drake had been observed in the building just before the blast.

Barry Finley, the Youngstown fire chief, said at a news conference on Wednesday that firefighters entered the building, despite concerns about its stability, and went room by room to ensure that everyone was evacuated. Officials said that the cause of the explosion was unknown, with the Ohio Fire Marshal’s Office leading an investigation.

Security video footage from the local news outlet 21 WFMJ shows the moment of the explosion, when a quiet street is suddenly engulfed in a cloud of dust and debris. Crews on site worked with emergency responders to contain the area and shut off gas for the entire block as a safety precaution, according to a statement by Enbridge Gas Ohio.

The Mahoning County Emergency Management Agency urged people to avoid the downtown area in a statement on social media on Wednesday so that emergency personnel could assess the situation and investigate the cause of the explosion. Several streets remained closed on Wednesday because of loose debris and as officials assessed the area.

Seven people, including one in critical condition and on a ventilator, were treated for injuries, Chief Finley said. By Wednesday morning, three of the injured people had been released from the hospital, and four remained in the hospital, according to Mercy Health, a health care system.

Angela Reighard-Rand, a spokeswoman for JPMorgan Chase, said in a statement on Wednesday that the company was mourning the loss of a colleague. “We will continue to work with local officials to support them,” she said.

Aimee Ortiz covers breaking news and other topics. More about Aimee Ortiz

Jenny Gross is a reporter for The Times in London covering breaking news and other topics. More about Jenny Gross