'Breaking Bad: Canada'?
I first came across thismeme a few days ago, from someone in my Facebook feed. The joke, for those of you who don't watch "Breaking Bad" (or are merely a bit thick), is that the show wouldn't make sense in Canada, because Canada has a comprehensive national health-care system. Thus the rationale for the launch of a mild-mannered chemistry teacher into the world of meth-cookery -- his cancer diagnosis and need for treatment -- wouldn't make sense.
Yesterday, I saw that someone at Slate had actually cited this meme in an article explaining why "Breaking Bad" is the best medical drama on television (because of its realistic treatment of illness):
Another telling scene that somehow escapes the attention of most medical shows is the look on the faces of Skyler and Marie, Walt's and Hank's respective wives, when they receive their spouses' medical bills. Not only do the bills make no sense to them, the doctors appear as bamboozled and helpless as the patients. In fact, a popular Internet meme suggests that Breaking Bad would not have been possible in a system which provides universal free health care, such as Canada's, because Walt would never have been desperate to collect the money for his treatment.
This is odd for a number of reasons. The first is that, contra this writer's experience, I feel like many, many medical dramas spend an incredible amount of time complaining about byzantine insurance rules on what is, and isn't, covered. And second, because my husband and I, who both write about health policy from time to time and avidly follow "Breaking Bad," have spent the series lamenting how many important plot points depend on unrealistic portrayals of the health-care system. (Warning: For those who haven't made it to season three, mild spoilers lie ahead. You should probably stop reading now.)
The series starts with Walter White, a high school chemistry teacher in Albuquerque, New Mexico, who is diagnosed with lung cancer. His lousy health maintenance organization won't cover a decent doctor, or treatment. So Walter is forced to turn to crime just to pay his medical bills and ... whoa, wait a minute. You know who has excellent benefits, compared with basically everyone else in the country? Teachers, firefighters and cops. Maybe they're overworked and underpaid, but the one thing that you cannot say about them is that they're forced to endure shoestring health-care plans. According to the Internet, Albuquerque school district employees are eligible for
Medical, Dental, Vision, Basic and Additional Life Insurance, Long Term Disability, Pre-tax Insurance Premium Plan (PIPP), Flexible Spending Accounts, Long Term Care Insurance, 403(b) and the 457(b) Deferred Compensation Plans.
That's a generous package. Moreover, the Albuquerque school district self-insures, so any complaints about benefit levels should be directed at the city government, not your "lousy HMO."
Later, after Walt's actions accidentally result in the shooting of his brother-in-law, a Drug Enforcement Agency agent, Walt's wife takes a bunch of the meth money to pay for Hank's treatment. On his government salary, Hank can't possibly afford the treatment he needs, because, of course, his lousy insurance policy won't cover more than a few visits to the physical therapist ... and whoa, we just went from "unrealistic" to "ludicrous." You know who has even better benefits than employees enjoying a compensation package collectively bargained with a local government? Federal employees in a low-cost state such as New Mexico. Moreover, extra benefits are available to people injured in the line of duty.
In short, a number of key plot points hinge on the improbable assertion that people who actually enjoy some of the best health insurance in the country actually suffer some of the worst -- so bad that we are expected to believe that Walt had no choice but to cook meth to cover the gaps. For an otherwise great show, this is incredibly silly.
Is it possible that there is better treatment than that offered by even these (very good) health plans? Of course. But this is why that Internet meme is even sillier than the show. Does the meme's author think that everyone in Canada gets the most cutting-edge possible treatment with the best doctor in the area? The latter is mathematically impossible; the former, merely untrue. People in Canada have the national equivalent of Walt and Hank's "lousy insurance": it covers what it covers, and if you don't think that's enough, you'll have to go elsewhere. In the case of Canadians, "elsewhere" generally means "the U.S."
Is there a reason that I am tearing off against an Internet meme? Yes, and it's not just because it's late on a slow news day. The popularity of that meme reflected a belief that Canada is not just some place that has made different choices about access and coverage than the U.S. has, but a sort of health-care utopia where any potentially lifesaving treatment is available to anyone at the drop of a hat ... as if nationalizing the health-care system somehow means that you never have to make any difficult choices.
In a world of scarce resources, choices always have to be made. In Canada, those choices are made by the government; in the U.S., by the government and corporations and individuals, depending on the choice. But the choices remain. Which is why the actual plot of "Breaking Bad: Canada," should such a show exist, might well show Walter White of Alberta desperately cooking meth in order to buy a plane ticket to Texas.
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Megan McArdle at firstname.lastname@example.org