My inner sociologist was prodded awake by an artful question and discussion at erudite horror blog And Now The Screaming Starts:

Would Obama style health care reform have prevented the creation of Jigsaw, the conceptual franchise-like serial-killer meme embraced by the various murderers of the film series?

Sadly, I am little qualified to directly answer such a question, possessing neither the critical nor the intestinal fortitude to endure a single Saw movie, let alone five. I let brave voyagers like CRwM, proprietor of ANTSS, run reconnaissance for these inky corners of our shared popular reality. Though the joy of the original article is of course its in-depth analysis of conjoined trivialities, I instead wondered to what degree social institutions determined serial killer types.

Let’s accept, for the sake of argument, that technical changes to medical coverage laws could point fictional villain John Kramer down another twisted path. And social institutions certainly influence the types of serial killers to emerge – from opportunity if nothing else. For instance, geographical, infrastructural and social factors made an Ivan Milat easier to emerge in Australia. Specifically, long, empty highways next to forest, between relatively distant population centres gave a certain pattern of opportunities. Similarly, figures like Ed Gein, hunter and babysitter, seem intertwined in the details of small-town American life.

If we take serial killers as a horrible symptom of humanity, or at least that they emerge in all industrial societies, presumably an Obamacare America will get the real and fictional serial killers it deserves, just as Bush and Eisenhower America did. But what would a socialized medicine serial killer look like?

Harold Shipman.

Shipman, embedded in the medical profession and the welfare bureaucracy. Silent before and after arrest, not admitting guilt, motives only fuzzily deducible in aggregate from a pattern of victims, leaving people to speculate on the mix of malice and a brutish utilitarianism usually only seen in cartoon villains. Professionally trained, but grubbing for jewelry in a sad post-mortem black market. He’ll get to you, but only after you make an appointment. This is the psychopathology of the welfare state.

Now, this isn’t just a chance to bag out the abused and beloved NHS. (Though honestly, Atlantic anglosphere, your health care systems all suck – please pay more attention to the French.) Before anyone gets all excited and declares that socialized medicine brings both communism and serial killers, note that Shipman, Gein and Milat were all freaks on the edge of the system. If anything it points to a rule of thumb for identifying a totalitarian regime: one where the psychopaths are on the inside, running the show.