Monday, August 31, 2009

Middlemarch Revisited, Part VI: George Eliot on Health Care Reform

When Dr. Lydgate arrives in Middlemarch, he immediately stirs up animosity among the medical establishment in town. Lydgate is a surgeon. In the rigid class system that pervaded all aspects of nineteenth-century English life, physicians were the gentlemen of the medical establishment; apothecaries were the lower class tradesman. Surgeons like Lydgate were of middling status, between physicians and apothecaries. For example, surgeons often dispensed drugs, like apothecaries. But Lydgate refuses to dispense drugs, viewing it as an invitation to quackery. He believes that many surgeons dispense drugs not because of their effectiveness against disease, but because they bring in extra income. In an age of reform, Dr. Lydgate is a medical reformer. This, of course, stirs up resentment and distrust in conservative Middlemarch. It makes little difference that his outcomes are as good, if not better, than those of other Middlemarch doctors.

As the Middlemarch lawyer tells Mr. Bulstrode: "If you like him to try experiments on your hospital patients, and kill a few people for charity, I have no objection. But I am not going to hand money out of my purse to have experiments tried on me. I like treatment that has been tested a little."

Dr. Lydgate's methods are generally misunderstood. When a patient dies of a mysterious illness, and Lydgate asks for permission to perform an autopsy, popular opinion caricatures him as a monster. "Mrs. Dollop [the landlady of a local pub] became more and more convinced by her own asseveration, that Dr. Lydgate meant to let the people die in the hospital, if not to poison them, for the sake of cutting them up without saying by your leave or with your leave..." (481).

George Eliot understands perfectly well how facts become distorted and how public opinion is shaped by that distortion. There would be nothing new to her in the gross distortion of end-of-life counseling (supported by the GOP in the 2003 Medicare prescription drug bill) into government-mandated "death panels."

"Oppositions," she tells us, "have the illimitable range of objections at hand, which never need stop short at the boundary of knowledge, but can draw forever on the vasts of ignorance."

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