Show pushed issues, strove for resonance

Various explanations were offered when “ER” burst onto the scene, with many convinced that the medical drama’s instant popularity owed as much to real-life fear and frustration as racing gurneys.

Part of “ER’s” success “must stem from the American public’s escalating anxieties over health care in the wake of the utter confusion and helplessness in Washington,” New York Times critic John J. O’Connor wrote after the show premiered and vaulted into TV’s ratings elite.

“ER” made its debut in 1994, following the Clinton administration’s failed attempt to reform the U.S. healthcare system. And while critics lauded its pacing and cast, some saw hunger for heroism in the public’s embrace of the program.

As the series gears toward its April finale 15 seasons later, healthcare remarkably remains a widespread source of debate and concern — an industry where a new president, Barack Obama, is again speaking boldly of reform and the term “crisis” never seems far behind. It’s an unsettled policy area in a way those closely associated with “ER” couldn’t have anticipated — not because they expected the show to alter things, but because they’re disappointed that matters haven’t improved.

After the Clintons’ efforts, healthcare “became a third-rail issue in politics, where people wanted to have nothing to do with it, and it allowed the whole situation to get progressively worse,” says John Wells, the exec producer who has overseen “ER” since the start.

“The system is really broken,” adds producer Neal Baer, a medical doctor who worked on “ER” before moving on to preside over “Law and Order: Special Victims Unit.” “We’ve seen how the ER has become even more important as the primary place where people get care. … We did a lot of talking on ‘ER.’ Things haven’t changed.”

Indeed, in a USA Today op-ed, Dr. Kevin Pho referred to a “nationwide crisis of emergency department overcrowding,” wasting more than $18 billion annually on unnecessary ER visits. Pho further called the outlook for progress “dismal.”

Wells and Baer both recall the heady days when “ER” could influence the U.S.’ healthcare knowledge from Thursday night to Friday morning. As the show’s ratings swelled, naturally, everyone wanted a piece. Advocacy groups lobbied the producers to take on specific issues. The show never lost sight of its primary mandate — to function as a drama — but did shine light on health-related matters.

“We were able to illustrate these complex health issues in a profound way, by telling stories that resonated with the audience,” Baer says.

“People were getting health information from a TV show. They went to a doctor based on something they’d seen.”

“ER” came at a time when television had left “Dr. Kildare” or “Marcus Welby, M.D.” in its rear-view mirror.

“If you said a character was a doctor, they were the villain in the piece,” Wells says. The show’s sales pitch, in fact, was a simple one: While the show’s doctors had human foibles, if viewers or their loved ones were on that gurney, the series would represent “the people they would want to take care of you.”

“ER” never pretended to be utterly real, but it tackled tough issues such as AIDS when that was hardly fashionable. And in recognizing the system’s shortcomings, the program is a marked departure from a series like “House,” where patients are provided one extraordinary diagnostic procedure after another and nobody says “boo” about the cost.

Given the financial pressure on primetime dramas, Wells sees the prospects for future medical-related series as a source of concern. He notes that “ER” rejected numerous product-integration pitches that might not be in the best interest of consumers. It’s unclear whether new shows will have the same latitude to say no. “Issues come up that you don’t have with car commercials,” he notes.

Having spent years meeting with healthcare experts to ensure the show’s veracity, both Wells and Baer are less than optimistic about the likelihood of real-world reform, since Wells says powerful forces are determined to resist government intervention. “The free-market system has no financial incentive to help people who are unable to pay for those services.”

Dramatic television’s approach to medicine will likely continue to be aspirational, reflecting the lingering impulses that critic O’Connor identified back in 1994. “Given the current disenchantment with the health-care debate,” he concluded, “the public is bound to applaud the caring, $36,000-a-year workaholics on ‘ER.’ “

Yet while those salary levels might have changed, the system fundamentally hasn’t. Perhaps that’s why Wells says after 15 years of being immersed in the healthcare discussion, at least in terms of that aspect of the job, he’s glad — even relieved — to move on.

“Absolutely,” he says. “I’m ready not to talk about it anymore.”

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