This is the eighth in a series of episode-by-episode reflections on Orphan Black Season 5 (preview; episode 1 ; episode 2; episode 3; episode 4; episode 5; episode 6; episode 7). These pieces do not provide thorough plot summaries but do include spoilers; they assume readers have already been viewers. Responses via Twitter continue to be very welcome!
In a week dominated by news of the U.S. Senate’s near-miss on repealing the Affordable Care Act, here’s a hopeful paradox: the more we learn about individual genomes and move toward personalized medicine, the more pressure there will be for America to move toward single-payer insurance.
This is not my original idea. I first encountered it in Richard Powers’s stellar 2008 GQ essay on his experience of whole genome sequencing, well before such a possibility was on the horizon for the middle class. Pondering the enormous portfolio of genetic data he had just received, Powers “wonder[ed] out loud if personal genomics might ultimately force a single-payer system in this country; it’s hard to imagine how else society will be able to survive the definitive revelation of unequal, inherited risk.” In short, an expanded understanding of genetics (and epigenetics) could radically revise the health care landscape.
No, genes are not the all-determining sources of Absolute Fate that they are often portrayed. Genes are complex patterns of often-discontinuous DNA that our bodies use to build proteins, and their expression varies enormously according to environment. But the more solid our data about individual predispositions to particular health issues, the earlier it will be possible to push the parameters of “preexisting conditions.” As biostatisticians grow more capable of meaningfully assessing the relationships between particular genes and specific health outcomes, it will grow all the more necessary to choose between protecting everyone and protecting only a select few.
Superficially, Orphan Black might not seem to engage matters as mundane as health insurance, but one way the show points to its Canadian provenance is in the quiet assumption that access to comprehensive health care is a basic human right. In season five, we watched Revival draw families to “the Fountain,” only to see their children die. Their rage at Westmoreland’s deception is one of many expressions of Orphan Black’s commitment to genuine — not vampiric — medical attention for all. This season has also lamented the way that (disabled?) persons like Yanis are too often deemed unfit or even monstrous, then ostracized and denied care altogether.
But in episode eight, Neolution’s endgame bears even more fully on health care access. As Dephine worries to Cosima, “Hundreds of millions of people are about to be required to submit their DNA and Neolution is behind it.” Apparently the cabal that Westmoreland manipulates is “bribing governments for citizens’ genetics,” thereby canceling promises of privacy made when samples were collected. Siobhan’s summary of the situation for Rachel is also revealing: “Neolution wants to sell curated commercialized evolution to the one percent who can afford it. So that they could live forever, grow a bloody tail if they want to. The rest of us, Coady’s department targeted for sterilization.” In Orphan Black’s storyworld, the crisis has arrived: either treat medicine — including reproductive care — as an option only for the privileged few, or protect it for all.
This plotline is not so incredible as it may seem. We need not understand Orphan Black’s creators to be proposing any actual global conspiracy to acquire genomic data or to limit reproduction to the rich in order to appreciate its significance. The real power of the BBC America series lies in how Neolution’s extremes already reflect the underlying ideology dominating health insurance today. Indeed I would argue that the show’s nightmare scenario, with all of its many layers of coercion and obfuscation, has only become more relevant in the few months since Orphan Black wrapped. We should hear in recent episodes at least two significant theses concerning America’s immediate cultural debates over health care: first, they are driven by the forces of neoliberalism; second, they can only be solved with a deep consciousness of our dependence upon community.
First, in exposing the extent of Neolution’s transnational plot, Orphan Black’s final season is driving home biotechnology’s inseparability from the expanding power of corporations to manipulate national governments. The series is rethinking genetic enhancement and eugenics in light of Neoliberalism 101. It clearly recognizes the phenomenon that Pierre Bordieu described for Le Monde diplomatique in 1998, the global forces aimed at “call[ing] into question any and all collective structures that could serve as an obstacle to the logic of the pure market,” from nations to unions to families. In light of this ideology’s hyper-individualist, endlessly deregulatory drive, it is only fitting that Orphan Black pits the family of Siobhan, Felix, Kira, Sarah, and the sestras against forces that would happily treat the vast majority of humanity as corporate slaves.
Applied to present debates over repealing Obamacare, the show leaves little room for surprise that lawmakers’ positions often have so little to do with the needs of their constituents. Instead, much like the men and women present in the show’s dark boardroom, our politicians’ votes are regularly the product of personal rancor, ideological intractability, and indebtedness to forces that cannot be named publicly. And if that is true when congressional representatives debate basic health care access, it would be folly to imagine that such dynamics will be absent when they eventually decide policies concerning the protection of genetic testing results or the availability of gene editing as a component of human reproduction. For Orphan Black, there can be no healthy regulation of genetic medicine without a principled awareness that hierarchy and domination are cemented into the edifice of global capitalism.
Second, Orphan Black indicates that any real solutions in the actual world of healthcare policy will necessarily be communal. It may seem absurd that this need be said at all, but note Fox and Friends’s sarcastic response the morning after Senate’s failed vote on an ACA “skinny repeal”: “Congratulations, the healthy people are paying for the sick people.” In disturbingly large measure, American culture has lost sight of the fact that interdependence is inherent to the concept of insurance, that in fact it is foundational to any sense of society at all. By contrast, Orphan Black’s most recent tagline is “Together, we are one,” and one could argue that the underlying narrative logic of the last five seasons is about each of the clones uniquely recognizing the deep truth of that simple mantra. Here it does not seem coincidental that the fan artwork and social media vibrancy of Clone Club has become its own impassioned testimony to an enormous hunger for community — one that extends to all, irrespective of gender or sexual preference.
In sum, I think a major virtue of the show’s response to new biomedical possibilities is its regular implication that American healthcare must soon become more like its Canadian neighbor. Not everything is perfect north of the border; there are significant issues with wait times and limitations in coverage. However, there is also a fundamental difference in visions of who deserves treatment. In a 1994 speech that I continue to find prescient, Wendell Berry made the radical argument that “the community — in the fullest sense: a place and all its creatures—is the smallest unit of health and that to speak of the health of an isolated individual is a contradiction in terms.” Likewise, Orphan Black is an unapologetic exposé of the impoverishment of medical individualism. It is as Cosima once insisted to Delphine: “you have to love all of us.” That’s true of clones and it’s true of patients across the world, regardless of nationality, regardless of their societies’ outward affinities for democracy or socialism. At bottom, either we sell out to a vicious oligarchy, whether based on biological or socioeconomic inheritance, or we reorient our society’s priorities so as to take care of everyone.
Orphan Black’s final season (10 weekly episodes) began Saturday, June 10, at 10/9c on BBC AMERICA. Click here to read next week’s reflection.