The issue of health care ‘rationing’ is one rarely absent from today’s news agenda. As NHS budgets come under acute strain in the context of rising demand, the issue of who gets access to which medical treatments, and who meets the costs of that care, has become one of the dominant political questions of our times. New radio drama Culture, part of the latest season of Dangerous Visions programmes on BBC Radio 4, imagines a near-future Britain in which those dilemmas have been settled. In this piece of speculative fiction, the gap between the haves and the have-nots has become a chasm.
Doctor Anna works in a busy city hospital triaging patients arriving in her department. But in a country in which private medical insurance has become a requisite of real citizenship, her primary job is not to assess medical need, but instead to establish her patients’ ability to pay. Other factors (also spun from today’s headlines) are in play too: non-UK nationals enjoy few healthcare rights; ‘poor lifestyle choices’ may end in the denial of treatment; and the declining effectiveness of antibiotics has led the pharmaceutical industry to hike the price of those drugs that do still work.
Listeners follow Anna as she makes two assessments: one for a young immigrant, working as a cleaner, who is facing a potentially life-threatening infection; the other a semi-invalided dairy farmer equally desperate for medical help. Neither has the money to pay and when their appeals are rejected, by the heartless clinical judgement of the Quartermaster, both face the reality of being ejected from the hospital untreated.
Al Smith’s politically-charged drama, all of which unfolds within the confines of the consultation and court room of the hospital, does not shy away from controversial issues. As a result, this is an intimate character piece with a great deal to say about questions of entitlement, rights, inclusion and the nature of the ‘social contract' between citizen and state. Culture compels the listener to consider the implications, and the ethics, of health rationing, and the relationship between money, means and medicine.
It's arguable that this dystopian makes-you-thinkpiece loses the courage of its bleak worldview in the drama’s finale, revealing individuals still capable of setting aside prejudice and paperwork to embrace humanity and act decently. But maybe that’s a necessary rebalancing act in a story that might otherwise leave you feeling sick and slightly out of sorts (although for all the right emphatic reasons). This is intelligent, thought-provoking stuff.
CULTURE / WRITER: AL SMITH / DIRECTOR: SALLY AVENS / CAST: PIPPA NIXON, DAVID CALDER, OLIVIA POPICA, CHETNA PANDYA, PHILIP FOX / FIRST BROADCAST: 26TH JUNE / AVAILABLE NOW ON BBC IPLAYER