As the campaign clock counts down to Election Day, some prime time entertainment programs seem as if they’re trying to help influence the outcome. In just over 24 hours, NBC viewers could have seen three different drama series pushing plot lines which reinforced some of the Gore campaign’s favorite themes, including the notion that profiteering and exploding health care costs are enriching private business while putting the public at risk.

On The West Wing, U.S. drug companies were painted as an obstacle to successfully treating the AIDS epidemic in Africa. On Law & Order, an HMO executive whose company was in charge of administering a prison clinic was prosecuted for his cost-conscious policy against referring patients to outside specialists, which in this case meant a psychologically-disturbed inmate was released from prison only to murder a woman for her reading glasses. And on ER, a doctor who blew the whistle against a superior who was trying to deny treatment to an uninsured patient found himself out of a job.

Here’s a run-down of last week’s NBC shows:

President Bartlett held a summit with the president of a fictional African nation and the corporate leaders of American drug companies to try and find a way that would cut the costs of AIDS treatments. Bartlett’s Communications Director, Toby Ziegler, was one of the main participants in the substance of the negotiations, and he provided some of the most liberal lines of the show, including twice pointing out that the anti-AIDS drugs are cheaper in Norway than in Africa where the need is greater.

During a meeting, the drug company executives were arguing that they are doing as much as they possibly can, at which point the African president asked about the profits on a different drug. One of the executives questioned the point of bringing up that other drug, which is apparently a treatment for impotence. Toby interjected, "I think President Nabala is saying there’s more money in giving a white guy an erection than curing a black guy of AIDS."

Outraged, the executive responded that "My company has given away over $120 million worth of free drugs a year, including free doses of Zyclocents (sp?), which is one of two drugs in your country curing eye infections right now."

Toby, again speaking on behalf of the African president, retorted: "They’re not dying from eye infections, Alan."

"Well, they’re not dying ‘cause of me either, Toby, and I’d like not to be talked to this way," the executive defended himself.

"Alan, if it was 26 million Europeans dying, we’d have had a solution yesterday," declared Toby.

At this point, Josh Lyman, another White House aide, interrupted to ask one of the drug company executives how much it would cost to distribute the medicine to patients in three countries. The executive said he did not know. Incredulous, Josh asked, "Why not? We’re talking about 130,000 patients, 200 milligram pills, three times a day, every day. What’s the x factor?"

"We don’t know how long they’ll live," the executive answered, reinforcing the cynical interpretation that the corporate leaders were solely interested in the bottom line. The meeting is adjourned, without reaching a resolution.

In the corridor later, Josh warned Toby to take a more tactful approach with the executives. Toby, disagreed, pointing out that "the pills cost them four cents per unit to make." Josh corrects him: "You know that’s not true. The second pill costs them four cents; the first pill costs them $400 million," referring to the research costs that each company must recoup.

But Toby was undeterred: "They also enjoy unprecedented tax breaks: foreign tax credits, research and experimentation exemptions, and expensing of research expenditures, to say nothing of the fact that business is pretty good."

Toby tried to put together an arrangement in which the three African countries which this one president is representing at the summit will receive discounted medicine if they promise to help protect the patent rights of the U.S. companies involved. The African president mournfully explained how demeaning it was for him to plead for help from the Western business leaders. "It’s a terrible thing to beg for your life, terrible," he told Toby. "My father was a proud man. He built homes. He wouldn’t like what I came here to do."

Toby assured him that he’s doing the right thing, but the show concluded with the African president returning home to his country despite a military coup, and the White House staff receiving the news that he was shot to death at the airport when he arrived.

A woman was slain on the New York subway, and the detectives spent the first half-hour of the show discovering that her killer was a recently released inmate with psychological problems. The killer claimed that his name was Regis Philbin, and that he killed the woman for her eyeglasses because he couldn’t see who was talking to him. The prosecutors, Abbie Carmichael and Jack McCoy, however, used the fact that the suspect (whose actual name was Brian Gallant) fled from the scene of the crime as an indication that he understood right from wrong, and successfully persuaded his defense attorney to accept a plea agreement that would mean a 10 to 20 year prison sentence.

At the court proceeding, however, the dead woman’s husband angrily stood up in the courtroom, outraged that no one else was being held liable for his wife’s death. "You say the one and only person responsible for Steph getting killed is this lunatic?" he asked indignantly. The judge told him that while she understood his view, the court proceeding was not the right place to make his argument.

"Tell me when you’re going to hold someone accountable for turning him loose on Steph, and I’ll be there," the husband challenged the others before sitting back down.

Abbie and Jack, informed their boss, the new District Attorney Nora Lewin, that the man was released from prison only days before with a subway token and a dollar and a half, and that he had logged numerous visits to the prison’s clinic. Further investigation showed that the city had recently privatized its prison clinic, placing the clinic in the hands of a managed care company called SMJ Medical Services. Abbie told Jack that the company was awarded monthly bonuses when it held down costs.

"Which it does by not sending inmates to hospitals," Jack quickly surmised.

"Which is why Brian Gallant was never referred," concluded Abbie.

The killer’s doctor then told Jack and Abbie that he wasn’t allowed to have the inmate properly evaluated by outside specialists. Gallant’s doctor related that another doctor was fired by SMJ for making too many outside referrals, and that the chief executive had made it clear that he, too, would be fired if he increased bottom line costs. "Look, I did the best I could. I was paying off medical school loans, a mortgage. I have two kids," the doctor explained to the prosecutors.

Jack McCoy agreed not to prosecute the doctor if he cooperates, but ordered that he must lose his medical license for a year. When the doctor’s lawyer protested, Jack insisted, "He took an oath, and it wasn’t to an HMO."

They decided to prosecute the chief executive of the HMO, but only after Nora Lewin warned them to "be sure and differentiate the conduct of this HMO from the conduct of HMOs in general. That said," she added, "I’d like nothing better than to hang their heads on our wall."

At the trial, the CEO declared that hospital referrals were lower since his company assumed control of the prison clinic because they had improved the clinic’s efficiency. He also argued that he had no oversight role of Gallant’s treatment, or any other individual patient.

As he began his cross-examination, Jack McCoy began flipping through patient files. "Inmates diagnosed with heartburn would turn out to have coronaries. HIV patients left untreated. Psych patients left unevaluated. Is that your idea of improved medical services, Mr. Andrews?" he challenged.

The CEO declared, "Like it or not, medical care is a business today. No HMO can survive without conducting a realistic cost-benefit analysis of its treatment protocols."

In his summation, the CEO’s lawyer offered this defense: "The big, bad HMO — uncaring, unfeeling, placing profits before people in its savage quest to make money — a convenient political target if ever there was one." He then argued that the executive did his job properly and wasn’t negligent. "Don’t let the political ambitions of a district attorney pervert this court of law," the defense lawyer admonished the jury.

The jury acquitted the CEO of the main charge, second-degree manslaughter, but convicted him of a lesser included charge, criminal negligent homicide. Afterwards, the D.A. told Jack and Abbie that she’s going to appear on Dateline to talk about the verdict. Jack told his boss, "They’ll probably try to get you to say it opens the door to massive malpractice claims."

"Well, it’s worth it if it changes the way HMOs do business in this city," Nora declared. Noting that the CEO will serve his time in the same jail in which his company provides health services, she acidly commented: "Let’s hope he’s got a good immune system."

ER
Thursday, October 26, 10:00 pm ET/PT, 9:00 pm CT/MT

On a previous week’s episode, Dr. Peter Benton sought permission to treat an indigent patient who required regular kidney dialysis treatments but who did a relatively poor job of taking care of himself between treatments, a fact which meant he frequently arrived in the ER in need of more costly emergency care. Dr. Robert Romano, the hospital’s prickly chief of staff, told Benton that he wouldn’t give his permission for the operation, instead telling Benton to give the man bus fare to a different city so that he would no longer be a drain on the Chicago hospital.

Unwilling to deprive the man of care, Benton anonymously called a government investigator and related the facts of the case to her. When Romano found out that the investigator was visiting the patient, he raced to the ER and told the investigator that it was all a misunderstanding, and the patient received the needed operation.

In this week’s episode, Dr. Benton arrived to work and found that the key card he normally used to get into the parking garage no longer worked. Benton then discovers that he can’t log onto the computer system. He asks Dr. Romano what the problem is, and Romano tells him that he should be getting a letter saying his privileges have been revoked.

Romano tells Benton that his "tattle-taling to the Inspector General cost me a $50,000 fine, which my malpractice insurance doesn’t cover"

"Look, I was just looking out for my patient," Benton insisted.

Romano said the hospital also had to pay a substantial fine. "Now, I had to recoup those moneys from somewhere, so I was forced to eliminate the attending position. It’s all in the letter," Romano informed Benton.

"We can’t talk about this in private?" Benton asked.

"Why, Peter?" Romano said smirking. "You didn’t seem to feel the need to talk in private about our problem. You just decided to go off on your own."

Benton then asked, "So what is my position here?"

"You have no position here, Peter" Romano coolly replied.

"You’re firing me?" Benton asked.

— Rich Noyes