ESCAPE FIRE: THE FIGHT TO RESCUE AMERICAN HEALTHCARE (DOCUMENTARY FILM)
Summary
A documentary film about the failings of the United States healthcare system and people working to improve it. Dr. Don Berwick, head of Medicare/Medicaid from 2010 to 2011, expresses his thoughts on the waste inherent in the United States healthcare system. To illustrate his thoughts on what a solution to the problems plaguing the system might entail, he uses a metaphor drawing on the story of a firefighter in the 1940's who protected himself from a raging forest fire by using a technique known as an "escape fire:" setting the ground at his feet alight so as to starve the forest fire of fuel before it could reach him. Various healthcare problems are examined from many different parts of the country, beginning with the Dalles, Oregon, where Dr. Erin Martin, a primary care worker at a local clinic, is quitting her job. She expresses her frustration that government reimbursement is dependent only on the number of patients treated and not the effectiveness or results of individual treatments. She also is dismayed that the clinic has become a "revolving door," treating the same people for the same preventable ailments again and again. Upon leaving the clinic she tries to determine a way that she can provide each individual patient with the time and care they require. Medical journalist Shannon Brownlee points to some statistics, noting that each United States citizen pays $5,000 more per-capita in healthcare than the average of any other first-world nation, but without any demonstrably better results. While the healthcare system is adept at providing specialized treatment and high-tech procedures, it is insufficient on a more generalized level. She refers to United States healthcare as a "disease care system" uninterested in providing real benefits to its beneficiaries. To address concerns such as these, Dr. Andrew Weil, a professor of medicine interested in integrative treatments and more inclusive medical education, starts a graduate fellowship at the University of Arizona in 1994. Its purpose is to educate medical professionals on topics such as nutrition and lifestyle adjustment for patients, and to wean them of their over-reliance on drugs and medication. Dr. Weil hopes to encourage the patients' natural healing process instead of merely fixing problems as they arise. Pharmaceuticals play a major role in the United States healthcare system, and their prevalence has grown by leaps and bounds. It is especially a problem in the military, where veterans returning from tours of duty in places like Afghanistan are issued, and often become addicted to, painkillers and other medications. Studies have shown that drug addiction of this variety could be one of the causes of many soldiers' suicides, which have experienced an alarming rise in recent years. One soldier, Sergeant Robert Yates, has a number of health problems from his tour in Afghanistan, including debilitating back pains and post-traumatic stress disorder. During his evacuation back of Afghanistan he overdoses on morphine and collapses. The aero-vac doctors have difficulty sorting through the many different pills he was prescribed for his pain. Upon landing, he recounts the deaths of many of the members of his platoon in Afghanistan, causing further emotional stress. Brownlee compares many of the intricacies of the healthcare system to dark matter in its opacity to the general public. She mentions statistics of the disparities of individual prices for patients, and how they don't necessarily reflect a better level of care. Hospitals are given monetary incentives to perform procedures and tests, sometimes regardless of their actual effectiveness. One such example is Yvonne Osborn, a woman from Caledonia, Ohio who suffered a heart attack at the age of 34 and was given a stent in her heart to ease her pains. When the stent did not prevent further heart attacks she was given more stents over a period of time, all of them ineffective. Finally she visits Dr. Leslie Cho in Cleveland, Ohio, who points to Yvonne's diabetes as the cause of her heart problems. Dr. Cho notes that doctors often skip straight to treatments instead of discussing a patient's problems in-depth, in part because such treatments give the doctors monetary compensation and discussion does not. Some healthcare problems are a symptom of overspecialization amongst medical fields without a level of communication between specialists to facilitate patient care. Over 187,000 patients die in hospitals every year from such miscommunications, including medical errors and infections. Dr. Pamela Ross, working at a hospital in Charlottesville, Virginia, notes that many healthcare costs are directed towards repeated care for chronic conditions such as morbid obesity or heart failure. Dr. Ross blames this problem on a lack of effective solutions for preventative care. One of her patients, Roy Litton, experiences problems because he leads an unhealthy lifestyle, partially by choice: he is too poor to afford health insurance, smokes, eats unhealthy food, and can no longer afford to pay for his medication. Dr. Weil points to rising obesity rates as one of the biggest health problems plaguing the United States. Part of the problem is that the agriculture board subsidizes food like corn and sugar instead of healthy foods like carrots or apples. Part of the blame rests on Earl "Rusty" Butz, the secretary for agriculture in the 1970's, who subsidized commodities such as corn so that they could be sold overseas and turn in a profit for the United States. The legal system surrounding healthcare is subject to the desires of powerful and wealthy healthcare lobbyists in Washington. Much of the money generated from healthcare goes into the pockets of pharmaceutical companies and medical device manufacturers, and they are invested in keeping the system unchanged. Wendell Potter, former head of communications for the healthcare management company Cigna, talks about the relationship between healthcare companies and their investors. They are unwilling to support legislation for preventative medicine since they want to be able to keep their ability to control health insurance premiums, which have inflated considerably over the years. Potter talks about how he suffered a "crisis of conscience" when he visited Remote Area Medical, a service providing free healthcare to thousands of underprivileged citizens. He was wracked with guilt that he had played a part in making healthcare unaffordable to so many people, and quit his job at Cigna. Dr. Steven Nissen feels that the privatization of medicine has robbed it of a code of ethics. One example that he is involved in is the controversy surrounding Avandia, which in 2006 was the best-selling diabetes medication in the world. However, Dr. Nissen discovered that in clinical test trials Avandia was responsible for a 30% increase in the chance of heart attacks or complications, which he calls a "catastrophe." He brings the matter before Congress and gets the Senate to order the FDA to severely restrict the drug's availability, but not before tens of thousands die from its use. In 2012, GlaxoSmithKline, pled guilty to falsifying information in a $3 billion lawsuit. Potter talks about the extensive influence of medical corporations in Washington, and how it extends even to the Patient's Rights Bill, which allows them to eliminate competition for their health insurance. Months after his evacuation, Sergeant Yates is still recovering and talks about his experiences in Afghanistan. His best friend died from an overdose of narcotics and he is terrified that the same could happen to him. He is brought to Walter Reed Army Medical Hospital, where he constantly struggles against painkiller addiction. At the Pentagon, military officials pursue alternative treatments to medication, most notably acupuncture, which has garnered some success among veterans suffering from post-traumatic stress disorder. Some soldiers are skeptical as to acupuncture's effectiveness, but others have begun to embrace it. Although medical consensus rules that acupuncture is safe and effective as a post-operative procedure, hospitals have yet to introduce it as a service. Dr. Dean Ornish, a noted figure in modern medicine, advocates lifestyle changes such as diet and exercise as a means of reversing conditions such as heart disease and prostate cancer. He likens a physician to a "quarterback," in that they should assemble a team of other specialists in nutrition and stress relief in order to fully facilitate patient recovery. His treatments have already worked for patients such as restaurateur Mel Lefer, whose heavy smoking and heart attack placed his life in serious jeopardy, but Dr. Ornish's treatments allowed him to recover and lead an active life. His is the first study to prove that heart disease is reversible, although it draws a great deal of controversy amongst medical professionals. He is also working with Nobel Prize winner Dr. Elizabeth Blackburn to apply his treatments to lengthening telomeres, thus slowing the rate of chromosomal degradation in the body. After a year in Dr. Weil's fellowship, Dr. Martin establishes a practice in White Salmon, Washington, where she serves in a clinic providing services to the entire county. She considers herself a "guide," educating her patients on healthy lifestyle choices. Her desire to give patients the time and consideration they need appears to be in full effect here. However, the government announces that they will be cutting their monetary reimbursement, meaning that Dr. Martin will need to see more patients, thus undercutting her dream. However, she is still inspired by what she learned in the fellowship and still hopes to help put her vision into effect. Sergeant Yates is told to forego all of his medications. He is subjected to acupuncture, which he disparages at first, but soon comes to appreciate it. To help cope with his post-traumatic stress disorder, Sergeant Yates is enrolled in a meditation class, which he calls "scary" but effective for dealing with his emotional problems. He believes the meditation is helping to replace the function of his medication and is optimistic about his progress. Dr. Ornish's treatments are reimbursed by Medicaid in 2010, and he offers a status report to Senator Ron Wyden, who agrees with his ideas. In Pleasanton, California, the Safeway supermarket chain has devised a solution to the rising cost of healthcare, spearheaded by CEO Steve Burd. Drawing inspiration from car insurance, he changes his company's healthcare insurance policy to reward his employees for healthy lifestyles, rewarding them based on factors such as BMI or cholesterol level. To this end, Safeway has provided employees with gym facilities and healthier cafeteria options. Many employees eagerly take to exercise and dieting, believing that it has vastly improved their quality of life. Burd asserts that "making money and doing good in the world are not mutually exclusive." Another example of modern thinking about healthcare comes in the Cleveland Clinic in Cleveland, Ohio, founded on a principle of mutual cooperation between physicians. All the doctors there are salaried, and the remaining money goes back into funding the clinic's systems. Because of this, there is a great deal of consensus and discussion between doctors about patient needs. Their services come at low cost but deliver concrete results, and they focus on empowering patients to take control of their own health. The film ends showing Sergeant Yates being discharged from the hospital, no longer on his medication and "not changed, but changing."
Details
- NETWORK: N/A
- DATE: 2012
- RUNNING TIME: 1:39:51
- COLOR/B&W: Color
- CATALOG ID: 108522
- GENRE: Public affairs/Documentaries
- SUBJECT HEADING: Public affairs/documentaries
- SERIES RUN: N/A
- COMMERCIALS: N/A
CREDITS
- Doug Scott … Executive Producer
- Jeremy Martino … Supervising Producer
- Matthew Heineman … Producer, Director
- Susan Froemke … Producer, Director
- Elyssa Hess … Co-Producer
- Bradley J. Ross … Co-Producer
- Adam J. White … Co-Producer
- Jessamyn Ansary … Associate Producer
- Matt Porwoll … Associate Producer
- Nicole Rizzo … Associate Producer
- Manifestovision, NYC … Animation
- Marguerite Imbert … Researcher
- Maximilian Haslberger … Researcher
- Joyce Mishaan … Researcher
- Chad Kelly … Music by
- Moby … Music by
- Clive Alonzo … Cast
- Don Berwick … Cast
- Elizabeth Blackburn … Cast
- Krystal Bracy … Cast
- Shannon Brownlee … Cast
- Dan Bullis … Cast
- Steve Burd … Cast
- Robin Carnes … Cast
- Peter Carroll … Cast
- Leslie Cho … Cast
- Toby Cosgrove … Cast
- David Fridovich … Cast
- Joshua Friedbauer … Cast
- Betty Garner … Cast
- Wayne Jonas … Cast
- Katy Kasch … Cast
- Mel Lefer … Cast
- Roy Litton … Cast
- Tieraona Low Dog … Cast
- Erin Martin … Cast
- Richard Niemtzow … Cast
- Steven Nissen … Cast
- Dean Ornish … Cast
- Yvonne Osborn … Cast
- Wendell Potter … Cast
- Cindy Robertson … Cast
- Pamela Ross … Cast
- Mark Sadausky … Cast
- Joseph Smith … Cast
- Richard Thomas … Cast
- Richard Umbdenstock … Cast
- Eric Ward … Cast
- Andrew Weil … Cast
- Ron Wyden … Cast
- Robert Yates … Cast
- Earl "Rusty" Butz
- Robert Wagner "Wag" Dodge