Healing the Homeless on the Cheap

Very often it seems that one of America’s tribes want to see the vulnerable (undeserving) cared for (coddled) and the other wants to spend as little tax money (government resources) as possible on the nanny state (compassionate social programs). And sometimes there are issues that line up just that way. I want to spend more or social programs and you want to spend less. Period.

But there are also issues where much more compassionate programs cost a good deal frequent flyer 2less than punitive ones (or than no programs at all) and you and I ought to be on the same side of those issues, working together to achieve mutual success.

There is a lovely instance of such an issue in Season 1, Episode 11 of the NBC series, New Amsterdam. [1] Dr. Bloom, who is in charge of the emergency room, introduces Dr. Goodwin (the director of the hospital) to Andy Keener, who spends a lot of time at the New Amsterdam hospital, and is therefore “ a frequent flyer.” Dr. Goodwin (Max) responds the way he responds to every situation, “How can I help?” Here is scene 1.  Max is in the blue scrubs in this picture.  Dr. Bloom is on the right.

Dr. Lauren Bloom: You said you wanted to know the next time a frequent flyer came in.

Dr. Max Goodwin: Yeah, frequent flyers mean we’re not doing our job.

Lauren: Well then, you’re in luck. Meet the Amelia Earhart of frequent flyers: Andy Keener.

Max: (to Andy) How can I help?

Nothing complicated so far. But in the next scene, Max arrives at a dollar figure; this is what “treating” Andy Keener has cost the hospital this year. [2] Here’s that clip.

Max: Did you know that Andy Keener has been in this hospital over 100 times.

Lauren: He’s a frequent flyer

Max: If my math is correct—and I’m pretty sure that it is—Andy Keener has cost New Amsterdam $1.4 million this year. And we haven’t done a thing to help him.

frequent flyer 3Well…the “help” in “help him” is a different “help” than “How can I help?” They have helped Andy Keener in the sense that they have ruled out, each and every time he has come in, some more serious possibilities. That’s a help; sort of. And they treated the presenting problems each time. Max rattles off four on his way to a “solution.” The four are fatigue, heart arrhythmia, stress, and malnutrition, but we know there are more. So it is not true that Max and Colleagues have not helped, but they have not dealt with the fundamental problem, which is that Andy lives on the street and bad things happen to him.

So Max deals with it head-on. “ Mr. Keener, I’m prescribing you a home.’

The case so far is that effective medical treatment requires the solution Max has invented. But when we get over to social policy, conservatives are going to get really uncomfortable. The hospital is renting an apartment for a homeless person? And then when we get to spending policy—what we want to spend tax dollars on—the fiscal conservatives are going to get uncomfortable. On the other hand, the savings are dramatic, and you would think the fiscal conservatives would like that.

The role of the several kinds of conservatives is played by the “dean” of the hospital [3] In this discussion, Max gets to be the fiscal conservative. Max is a tax and spend liberal, so the Dean is momentarily confused.

Dean Fulton: So…who is Andy Keener and why are we renting an apartment for him?

Max: Andy is a…um…frequent flier. His homelessness has cost this hospital $1.4 million this year alone and many of those costs will go away if Andy just has a full-time place to stay. I mean, renting this man an apartment is actually going to save this hospital money.

Dean: So you suddenly decided to care about money?

You see the Dean’s incredulity in the bold “you.” You, of all people, have decided to spend less? Max is on good ground. If the apartment cost $1000 dollars a month, the hospital saves $1,388,000 every year. This should make the Dean happy once he gets over his surprise that Max is doing this. Max’s medical rationale, after all, is pretty good at the level of the hospital, Max’s answer is pretty good. “ Well, I care about money when it’s only going to one patient when it should be going to thousands.”

So now we turn to social conservatism.

Dean: This is socialism. This is exactly what’s wrong with our whole healthcare system.

Max will not be redirected, “You’re right Somebody really should fix it.” But, of course, “somebody ought to fix it” does not change the subject and it doesn’t take account of the political character of the Dean’s objection. So the Dean gets more specific.

Dean: So this guy abuses the system and he gets a free apartment. What about all the other guys who are working their asses off? You think this is fair to them?

Max: It’s not fair to them, but it’s smart business for us. We’re talking about saving over $1 million a year. That’s a million dollars that could be spent on those very people who are working their asses off, who do deserve more.

Max agrees with the name socialism, but he doesn’t really care. Max agrees with the unfairness to people who are badly off, but not quite as badly off as Andy, but he justifies it as a smart business decision for the hospital. On those grounds, it is really hard for the Dean to object.

That really ought to end the episode. If the writers didn’t care about any more than the policy preferences of liberals and conservatives, the story would end there. It doesn’t, though, and there is this final scene, which I have enjoyed. Max goes to the ER and finds Andy in a bed.

Andy: You going to take away my apartment?

Max: No. I don’t know what to do.

Andy: I…I guess I just like it here.

Max: …You are always welcome here…when you’re sick. And when you’re not sick we have a lot of people that we have to take care of, and that’s just the way it has to be.

Andy: I’ll…I’ll leave. No problem.

A visitor: Excuse me. Sorry, does anyone know how to get to the ICU? [4]

Andy: Oh, dude, you can’t get to the 12th floor from this building. You gotta take the elevator to the 3rd floor, then take the breezeway to Harriman. Then you take the second set of elevators to 12. Then you walk to the end of the hall.

Visitor: Thanks, man. You’re a lifesaver.

Max:  Do you[also] know how to get to the oncology ward?

Andy:  Of course. I’ve had many the nonexistent tumor examined there.

Max:  How would you like to start paying off that apartment:?

Andy: How?

Max:  By spending a little more time at New Amsterdam.

They turn him into a guide for new patients, where, we are led to believe, he functions superbly.

[1] You get “Amsterdam” by damming the Amstel river in the Netherlands, by the way, or so they told us when we visited there. Maybe it’s just a tour guide joke.
[2] I couldn’t find a way to make that dollar figure reasonable, so, rather than lose the narrative, I just translated it into “lots of money.”
[3] I have no idea why a hospital should have a dean, but you need to know that Dean is not his first name.
[4] This little intervention out of nowhere is narrative fraud. I don’t care. I like it.

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About hessd

Here is all you need to know to follow this blog. I am an old man and I love to think about why we say the things we do. I've taught at the elementary, secondary, collegiate, and doctoral levels. I don't think one is easier than another. They are hard in different ways. I have taught political science for a long time and have practiced politics in and around the Oregon Legislature. I don't think one is easier than another. They are hard in different ways. My wife, Bette, is the First Reader (FR) of the posts. I have arranged that partly because she helps me write better posts than I would otherwise and partly because I can hold her responsible for the mistakes that I would, otherwise, have to own up to myself.. You'll be seeing a lot about my favorite topics here. There will be religious reflections (I'm a Christian) and political reflections (I'm a Democrat) and a good deal of whimsey. I'm a dilettante.
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