After two decades of neglect, the hospital-based medical series is suddenly the hottest genre on the tube. NBC's ER, set in an emergency room in a Chicago hospital, has been topping the charts for months. And CBS's Chicago Hope, also set in a Chicago hospital, while not yet doing as well as its racier competition, is gradually picking up, too.

Like the failed Clinton health-care package, both these shows reek of the humanistic, caring, "I-feel-your-pain" cliches that Clinton and company love to wallow in.

Both offer up images of universal, personalized, easily accessed health care for the masses. But both, beneath their slick and schmaltz surfaces, turn out to be a hodgepodge of heart-warming platitudes covering over the less romantic truths about how, and in whose interests, our health-care system really operates.

Since at least 1976--the year both Marcus Welby, M.D. and Medical Center got canceled--it has been harder and harder to sell the idea of doctors as altruistic, compassionate out-to-save-lives-at-any-expense martyrs and healers. Most of us, after all, haven't seen that kind of "family doctor" in many a moon. Indeed, too many of us haven't seen much in the way of health care at all. And when we do, we've hardly found it personalized, accessible, or even reliable. But the networks dusted off the old genre, anyway. The dominant issues, diseases, and especially the technologies are different, of course. The contemporary issues of urban chaos and violence, of social and family disintegration are now present as backdrop. But the "men in white" (still mostly white men) are as dedicated, self-sacrificing, and compassionate as old Dr. Welby.

The styles, however, especially ER's, are different. Style probably accounts for ER's higher ratings. Chicago Hope, while clearly more thoughtful and dramatically developed, has a dated feel. Its propensity to delve more deeply into ethical and social issues may well be its problem. It's hard to like or believe in the show's Godlike heroes, who make life and death decisions and put the world to rights, week after week, by virtue of their brilliance and integrity.

They are arrogant, self-centered, and self-righteous.

Nor does the cultural ambience of the show quite make it. The aging yuppie doctors of Hope perform surgery to the sounds of country-and-western radio, and the head surgeon, played by Mandy Patinken, even sings, at any plausible opportunity, the Broadway tunes of his musical-comedy days. Small wonder this slow-paced, ponderous, vaguely retro style doesn't work for the MTV crowd.

Another problem for Chicago Hope is its grandiose idealization of the high-tech, big-budget hospital, and its Rolls-Royce-driving medical elite. The series blithely assumes--to the AMA's great joy, no doubt--that the top-heavy allocation of economic and medical resources portrayed here is justified because, as the heroes tell each other ad nauseam, "We are the best."

Technology and individual genius underlie this view of medicine. Dr. Jeffrey Geiger (Patinken) and Dr. Aaron Shutt have the kind of megalomaniacal egos which in real life would be unbearable. But here they are seen as no more than fitting for such ubermenschen. The doctors stomp through the halls like gendarmes, shouting orders and handing out humiliating criticisms to underlings as they go.

"You're a nurse, damn it. You're not a rocket scientist. You're not a brain surgeon," says Dr. Shutt (who is of course a brain surgeon) to his understandably estranged wife, who happens to be not just any nurse, but the head nurse.

Which rings me to the generally offensive portrayal of women in this show. Dr. Shutt's supposed wife problems are nothing compared to the serious woman trouble of Dr. Geiger. His estranged wife is--no kidding--an institutionalized schizophrenic who drowned their only child (a son, of course), but whom Geiger still loves and remains faithful to. "What a guy," we think. "No wonder he is an absolute creep and bully; he has this tragic cross to bear."

Among the other female regulars is an administrative staffer whose sexual misadventures regularly lead her to shame and humiliation. Once she and her lover-of-the-moment got stuck in the CAT scan machine to which their raging libidos had led them. There is an occasional female doctor here, but rarely for long. A strong, black woman doctor character lasted a single episode. She was a potential love interest for Geiger. But he--martyr to the end--couldn't "cheat" on his institutionalized, psychotic wife. Another female doctor lasted a bit longer. But no sooner had her relationship with Shutt begun, than she was killed off by a brain tumor, no less.

Still, until recently, this series did attempt to tackle social and moral issues with some seriousness and complexity. The chief of staff, for example, was once charged with sexual harassment by a young nurse. (She turned out to be a manipulative bitch, unfortunately. And there have been segments about malpractice suits and euthanasia.

The low ratings of the series, however, have put a crimp in the more serious side of the show. There's a lot more joking around these days and an increasing dose of the kind of adolescent sexual pranks and innuendo--the CAT-scanner debacle, for instance--which has made Steven Bochco's "serious" TV dramas so easy to take.

Never mind. The serious issues were presented rather offensively, anyway. A black gang member was once critically injured during a shoot-out which he initiated right in the hospital. The boy died under Dr. Shutt's knife, and his family sued. Dr. Shutt himself was anguished and distraught--as he is each week at least once--because he wasn't sure he didn't intentionally let the boy die. The Solomon-like judge resolved the issue handily, however. He absolved the hospital and Shutt fully, and harshly chastised the family and their attorney for wasting the precious time of this heroic surgeon with "pointless litigation."

"The health-care crisis in this country is caused," he pronounced with rage and contempt, "by the rise in the very street violence which your client engaged in!" At which point he instructed the lawyer to say "I am a toad" three times, to all those present. With political analysis like that, we're better off with MTV.

ER is the MTV version of medical care in America. It takes as its controlling metaphor not the hackneyed, high-modernist, cliche of the Healer as Godlike Genius, but the more contemporary view of the hospital, and the health-care system, as a war zone. There is no effort whatever to explain or analyze the system here. "Stuff happens and someone has to deal with it," seems to be the show's guiding intellectual principle.

The doctors here are as neurotic and driven as at Hope. But they are hardly as introspective or anguished about it. The show--like the managed-care insurance plans which provide short-term, shot-gun treatment programs for every emotional ill--eschews Chicago Hope's deep-analysis approach to emotional distress in favor of the more trendy (and therapeutically less time-consuming and costly) discourse of addiction.

The staff at this emergency room craves the rush of living on the edge. They give up offers of more lucrative practices, not because they want to serve--the poor, or anyone else--but because they are hooked on the high of crisis and emergency. They are junkies, not maladjusted geniuses. But like the older, richer guys at CBS, their personal neuroses form the core of their personalities.

Unlike Chicago Hope, ER is an equal-opportunity employer. Women and blacks do get to be practicing physicians. And even the nurses are serious partners in the struggle to ward off chaos. But while paying lip service to multiculturalism, the show is hardly less offensive in its portrayals.

The lead black male character, an ambitious resident surgeon destined for the big leagues, is not the real male lead, but only second in command to the head (white) resident. The only black woman surgeon is as ambitious and aggressive as her male counterpart. But far from being respected for it, she is played as the proverbial ball-breaker.

The other women are far more damaged and less effective. The female lead, Dr. Susan Lewis, is loaded down with so much personal and emotional baggage that it's amazing she can move at all. Not only is she constantly being pushed around by her superiors, she buys into their humiliating condescension. Self-doubt, which on Chicago Hope shows the male doctors to be caring and morally serious, here, when applied to women, is somehow a less noble trait. Lewis is a weak, neurotic loser, in danger of getting sacked every week.

The same double standard applies to personal failings. The male doctors on both shows are workaholics who neglect their families. But Dr. Lewis, whose personal life is endlessly complicated and overwhelming, gets portrayed as doubly messed up because, unlike the guys, she actually takes her personal relationships seriously. And what a set of relationships they are. Patients she takes an interest in come on to her. Her psychiatrist boyfriend attempts suicide. Her messed-up sister moves in on her and robs her blind. And week after week she beats up on herself, or lets everyone else beat up on her, for her "failings."

The other women on the show aren't much better. The head nurse, embroiled in sexual complications with a variety of male doctors, also attempts suicide. And the kinds of women who frequent the ER range from overly libidinous teenagers obsessed with the young interns, to high-priced hookers who "give" their married clients heart attacks, to hysterical or neglectful mothers the harried doctors have to deal with.

In both these shows, the real issues of health care are strangely missing or invisible. At neither hospital does money change hands, even via plastic. Both seem to admit everyone, from every class and race, with every conceivable ache or pain, with no mention whatever of method or means of payment. No staff meeting or coffee-break conversation ever turns to matters of economics or policy, even when--in real life--such matters are of urgent concern to medical workers. Managed care, hospital closings and layoffs, the commercialization of hospital services are of no consequence on this show.

Patients just show up, it seems, and there are harried but intensely concerned medical staffers to attend to their troubles. Everyone has access to the best doctors you never met, whether by private appointment or emergency. No one waits to see specialists. No one struggles through bureaucratic red tape or humiliating financial inquisitions. No one gets notices that their insurance is being canceled, that their provider refuses payment for treatment, that their doctor is no longer available on their plan, that their plan is being phased out for cost reasons.

Nor are the issues of illness and death even dealt with in ways that force the characters to confront reality as we on the outside are forced to. When patients die, it is not they who lose their lives, but the doctors who lose their patients. When a choice must be made about whom to give an organ, it is the doctors who suffer and agonize and feel endless guilt, for which they are endlessly comforted, not the poor wretch who got the short straw and was quietly wheeled off screen.

As in the network police shows which also qualify as "quality television," these medical shows tend to distort economic and political realities of American life so that the plights of those who are most harshly affected by the system are somehow made invisible if not worse. Black teenaged gang members are an easy target on all these shows. And they tend to get what they deserve, in the eyes of the professional keepers of social order through whom we see the plot lines. "Bad" mothers, no matter what their problems, are treated with contempt. A black single mother on one show, for example, was made to feel terrible because she couldn't miss work--it was her first week off welfare--to take her child to the clinic. Those who cause "trouble" to the keepers of order are sent to jail or reform school or an early grave, and good riddance, we are meant to feel. Happy endings are similarly presented in terms of "good" and "bad" patients, those who deserve health and those who simply take up space and time. "Good" family men get heart transplants. "Bad" family men, if they survive, become, by the time the credits roll, "good" family men, eager to make up for lost time. Even a young prostitute, dying of AIDS, was forced to go through a moral conversion before the producers would allow us to feel sorry for her. But no matter how things turn out for the patients, the final scenes invariably portray the sorrow, guilt, relief, or joy of the doctor/heroes, whose feelings and experiences are what really count.

This is the most important parallel with Washington. The news media have a way of presenting every policy issue, every Congressional vote or Presidential press conference, as a drama in which the fates of the Beltway big shots--not those whom they are meant to serve--are at stake. The fate of the Clinton health plan has been almost exclusively presented as a personal defeat for the President and First Lady, a personal tragedy requiring a whole new set of advisers and hairstyles and personal-development gurus to put the First Couple back together again. The dramas of the rich and powerful hold renter stage in our consciousnesses. Their victories and defeats are everywhere in our faces-dissected, judged, applauded, reviled.

Meanwhile, those whose neighborhood clinics are daily shutting down, whose food stamps and welfare checks and disability payments and insurance policies are dwindling, are nowhere to be seen. Their sufferings and moral agonies are mere fuel for the really important questions about who is rising and falling, suffering and celebrating, in the corridors of power.

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