If you want to get a clearer understanding not only of why the U.S. health care system fails so many of us but, more importantly, how we can transform it to make it the best in the world, go to the movies this weekend.
Regardless of your political affiliation or your opinion of Obamacare, you will find Escape Fire: The Fight to Rescue American Health Care, a compelling and convincing indictment of a health care system controlled by special interests that profit from the status quo and that spend millions of dollars every year to make sure nothing happens in Washington that would be harmful to their bottom lines.
You will also find that it offers some common sense ideas of how to fix many of the things about our system that are badly broken, including fixes that won't require an act of Congress but that will require some innovative thinking and risk-taking on the part of health care providers, employers and other stakeholders in the private sector.
Escape Fire describes how health care in America has turned into a business, how the quest for money has hurt the quality of care provided to patients and how it has kept millions of us from having access to even mediocre care.
As a consequence of allowing this to happen, our system has become littered with perverse incentives, such as paying for medications and procedures that address only the symptoms but not the underlying causes of illness and disease, and not paying for prevention. Because of those perverse incentives, we have a system that rewards quantity instead of quality and that leads to unnecessarily expensive and often harmful overtreatment. And we spend enormous amounts of money on the latest high tech equipment but give short shrift to high-touch care, which in many cases is exactly what the patient needs.
Directors Matthew Heineman and Susan Froemke set out to make a film that entertains, educates and offers hope, and they have succeeded. (Disclaimer: They interviewed me for the film. I am among several people, including some of the country's leading health policy experts and clinicians -- who offer perspectives on what can and must change.)
Their documentary shows how and why the issue of health care reform has become so polarizing, and it shows the consequences--to real people -- of those perverse incentives.
A physician friend of mine, who recently retired as a top medical officer in the Army, refuses to even call what we have a "system." Instead, he says, we have a sickness industry. He is right, and Escape Fire explains why, and how, our sickness industry affects even those in uniform who all too often come back from combat badly injured, physically, mentally and emotionally.
One of the most remarkable stories in the film is told about and by a young soldier from Louisiana. We meet Sgt. Rodney Yates as he is being transported to Germany and then to Walter Reed hospital in Bethesda, Md., after being injured in combat in Afghanistan. His journey to recovery -- and from addiction to a long list of painkillers and other medications -- is woven throughout the film. Heineman and Froemke couldn't have found a better person to personify what can happen to someone who becomes a victim not only of injury and illness but of overtreatment.
One of the surprises in the film is how Sgt. Yates' traditional treatment regimen is changed radically while at Walter Reed to include acupuncture and medication to alleviate his pain and end his addiction to opiates and other medications.
Sgt. Yates' journey to health is in many ways a metaphor for the journey we as a country can and must take to get us to a health care system that is more equitable and cost-effective and that focuses on preventing illness and allocating resources to finding cures instead of just paying for drugs and procedures that attack only symptoms.
The title of the film was inspired by a true story. Dr. Don Berwick, former administrator of the Centers for Medicare and Medicaid Services, tells to make the point that solutions to seemingly intractable problems are often hiding in plain sight. These solutions can be transformative when proposed and implemented by people willing to take risks and go against conventional wisdom.
The story is about a deadly wildfire in Montana in 1949. Thirteen firefighters were killed in the conflagration but three survived because one of them came up with the then-unheard-of idea of actually setting another fire in a circle around them. When the wildfire approached, it jumped over his escape fire, saving his life and those of two others who were willing to trust that he wasn't a lunatic. The 13 others who perished refused to believe it would work and made the deadly mistake of trying to outrun the blaze.
Berwick argues, convincingly, that we need to apply the same kind of thinking to solving the many problems within the U.S. health care system that Obamacare, despite its positive aspects, will not. There are many examples of such creative thinking in the film that leave you hopeful that transforming our health care system is possible and not just crazy, wishful thinking. The film has the potential to change the conversation about health care.