Questions Raised by John Q

Alice M. Maples, J.D., LL.M. Candidate

The recent release of the movie John Q has fueled a debate about access to health care in the United States. See John Q (New Line Productions, Inc. 2002), The movie depicts a father who takes people in an emergency room hostage in order to compel a hospital to place his son on the waiting list for a heart transplant. The father’s health insurance has a $20,000 cap on benefits, and his son does not qualify for publicly funded health care. Because the father is not able to raise a percentage of the cost of the transplant, the hospital refuses to add the son to the transplant list.

There has been a great deal of commentary regarding this movie. John Q has been criticized for its portrayal of compelling results through threats of violence. See Stephen Hunter, John Q Shoots Itself in the Foot, Wash. Post, Feb. 15, 2002, at C1. It has been described as a "two-hour infomercial . . . on the subject of the flaws of the American health care system." See Michael O’Sullivan, John Q Tugs Heartstrings, Wash. Post, Feb. 15, 2002, at T45. The American Association of Health Plans highlighted the movie in recent advertisements to demonstrate the dangers new laws might present to "employers like John Q’s [in their attempt] to provide quality, affordable health care." See Judy Sarasohn, An HMO Group Adopts ‘John Q.’, Wash. Post, Feb. 14, 2002, at A31.

Recently, an article in Time discussed whether the scenario presented in John Q was realistic. See Jeffrey Kluger (with reporting by David Bjerklie), The Hollywood Version, John Q: How Real Is This Horror Story?, Time, Mar. 11, 2002, at 44. The article noted that various funding sources are available for transplants, including insurance, state and federal funding, and private foundations. The article quoted a United Network for Organ Sharing (UNOS) representative as saying that transplant hospitals have financial advisers that assist patients in seeking funding. Indeed, in recognition of the daunting task of financing a transplant, federal regulations have required the Organ Procurement and Transplantation Network Board of Directors to develop "[p]olicies that reduce inequities resulting from socioeconomic status, including . . . procedures for transplant hospitals to make reasonable efforts to obtain from all sources, financial resources for patients unable to pay such that these patients have an opportunity to obtain a transplant and necessary follow-up care." 42 C.F.R. § 121.4(a)(3). Of course, these policies cannot guarantee that funding will in fact be made available for the transplant.

John Q raises a more interesting question that the Time article noted. The author observed that "other pricey medical procedures that are also matters of life and death do not come with the same financial safeguards." See Jeffrey Kluger, supra, at 44. Indeed, the article noted that 40 million Americans are uninsured, and that 10 to 15 million Americans are underinsured. See id. at 44-45. James Childress, a bioethics scholar, described this system of health care finance as "morally flawed and unjust." See James F. Childress, Rights to Health Care in a Democratic Society, in Practical Reasoning in Bioethics 237 (1997).

Most Americans would agree that the situation portrayed in John Q is unfortunate, and our immediate reaction might be to make funding widely available for all transplants, much like the benefits available for kidney transplants under the End Stage Renal Disease Program (see 42 U.S.C. § 426-1). However, when deciding whether to publicly fund all transplants, we must heed the words of Childress: "if we ask about the fairness of providing or not providing funds for extrarenal transplants, it may be difficult to answer that question in an unfair system." See Childress, supra, at 216. Thus, before we consider expanding funding to cover all transplants and/or other extraordinary measures, we should first consider whether that same money might be allocated more justly to provide basic health care to more Americans.