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2012-06-28

"Escape Fire": As Supreme Court Rules on Healthcare, Film Tackles U.S. Inefficiency, Spiraling Costs

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As the nation waits for news today on the Supreme Court’s landmark ruling on the Patient Protection and Affordable Care Act, we look at the state of our healthcare system through the new documentary, "Escape Fire: The Fight to Rescue American Healthcare." The film follows the dramatic human stories of people fighting to transform healthcare, from the highest levels of medicine, industry, government and even the U.S. military. We’re joined by director Matthew Heineman, who began the film in 2009, before the political firestorm erupted over President Obama’s healthcare bill. [includes rush transcript]

Transcript

This is a rush transcript. Copy may not be in its final form.

JUAN GONZÁLEZ: As the country waits for news today on the Supreme Court’s landmark ruling on the Patient Protection and Affordable Care Act, we end today’s broadcast looking at the state of our healthcare system. That’s the focus of a new documentary called Escape Fire: The Fight to Rescue American Healthcare. Here’s a clip from the film, featuring medical journalist Shannon Brownlee and Dr. Don Berwick, the former head of Medicare and Medicaid.

SHANNON BROWNLEE: We spend a spectacular amount of money on healthcare. Just sheer numbers, $2.7 trillion per year. The average per capita cost of healthcare in the developed world is about $3,000, and in the United States it was around $8,000 annually. We spend one heck of a lot of money.

DR. DON BERWICK: The healthcare system isn’t affordable anymore. Who pays for that? Where does that money come from? This is all coming out of our pockets. It’s your money.

SHANNON BROWNLEE: The really astonishing part about the fact that we spend more is we have worse health outcomes.

DR. DON BERWICK: If you need real serious technology today, like a very complex cardiac surgery, you’re lucky to be in this country. Rescue care is second to none. As an overall system, no, we’re not anywhere near the best in the world. I mean, look at our results. Our lifespan isn’t even in the top 20.

SHANNON BROWNLEE: We have a disease-care system, and we have a very profitable disease-care system. And the disease-care system, actually, I mean, if it really was honest with itself, it doesn’t want you to die, and it doesn’t want you to get well. It just wants you to keep coming back for your care of your chronic disease.

AMY GOODMAN: Medical journalist Shannon Brownlee and Dr. Don Berwick, former head of Medicare and Medicaid, from the documentary Escape Fire: The Fight to Rescue American Healthcare. The film also follows the dramatic human stories of people fighting to transform healthcare, from the highest levels of medicine, industry, government and even the U.S. military.

For more, we’re joined by the film’s director, Matthew Heineman. He began by making the film in 2009, before the political firestorm erupted over President Obama’s healthcare bill. But the questions it attempts to answer are very timely today and will continue no matter what the Supreme Court decides.

Matthew Heineman, welcome to Democracy Now!

MATTHEW HEINEMAN: Thank you.

AMY GOODMAN: Why the title? Why Escape Fire?

MATTHEW HEINEMAN: So, Escape Fire draws on a metaphor that Dr. Don Berwick, the former head of Medicare and Medicaid, draws for us between our healthcare system and a forest fire that happened in 1949, where a group of smokejumpers were dropped in to fight this fire, and they realized that the wind shifted directions, and they found themselves running up the hill for dear life. And the leader of this group, Wag Dodge, came up with a solution. He lit a match, and he burned the area around him, in what’s now known as an "escape fire." He called for all of his men to join him, but nobody did, and they kept running up the hill for dear life. And I think the metaphor is very strong, that there’s these very simple solutions around us. Our healthcare system is burning. Why can’t we pay attention to these solutions?

JUAN GONZÁLEZ: And why did you decide to make this film?

MATTHEW HEINEMAN: I think, like many Americans, we were very confused about what was happening in healthcare. Healthcare had really become this political football that was being thrown back and forth by both sides in Washington. We really wanted to get to the heart of why this system came to be, how did this perverse system come to be, why did it not want to change, and people out there who are trying to change it.

AMY GOODMAN: In this clip of your film, Escape Fire, medical journalist Shannon Brownlee and Dr. Leslie Cho of the Cleveland Clinic describe the fee-for-service approach to healthcare.

SHANNON BROWNLEE: The vast majority of doctors in this country are paid by a fee-for-service system, and that simply means that they get paid for each office visit. If they’re surgeons, they get paid for each procedure. If it’s a radiologist, they get paid for each CT scan that they deliver.

DR. LESLIE CHO: If I spend five minutes with you and then put in one of these stents, probably get paid $1,500. For me to spend 45 minutes on a established visit with a patient to make sure they’re doing their exercise, make sure their diabetes is going OK, and to try to figure out what their true problem is, probably get paid $15. It’s a completely irrational system.

SHANNON BROWNLEE: Fee-for-service rewards physicians for doing more. It doesn’t reward them from doing a better job. It doesn’t reward them for keeping their patients healthy. It rewards them for delivering more care.

JUAN GONZÁLEZ: I want to play a comment from Dr. Erin Martin, a primary care physician who you interviewed in Escape Fire. In this clip, she describes her frustration with having to treat a high volume of patients with not enough time for preventative care.

DR. ERIN MARTIN: Instead of basing things on outcomes, on how good of a job we’re doing, the government sets the reimbursement completely on the number of patients that we see. It doesn’t matter how complicated they are, how much time that we spend on them. It’s just a number—one, two, three, four, five. You have to play this game with, what does this patient need and how much time am I willing to spend with them, because the administration is telling you, "You need to see more patients. We’re in the red." And if you try and buck the system, someone says, "What can we do to get your productivity up?" I’m not interested in getting my productivity up. I’m interested in helping patients.

AMY GOODMAN: That, Dr. Erin Martin, primary care physician who you interview, Matthew Heineman, in Escape Fire. You’re solution-oriented, these stories.

MATTHEW HEINEMAN: Yeah, I think, you know, the story of Dr. Martin is really the story of a primary care physician who is an idealist, who just wants to practice medicine but is handcuffed by the system. She’s forced to see a revolving door of patients, and she’s not allowed to practice the medicine that she was taught to practice. And I think, you know, the key message of our film is that we really have a disease-care system, not a healthcare system—a system that profits and is oriented towards disease, towards acute care, towards high-tech, not towards prevention, not towards health, not towards, you know, low-tech interventions that work just as well.

JUAN GONZÁLEZ: But you also highlight companies that have managed to dramatically lower the healthcare costs precisely by going into preventative mode as opposed to treatment mode.

MATTHEW HEINEMAN: Yeah. I mean, one of the escape fires that we have is the story of the Safeway corporation, that has recognized, you know, rising healthcare costs and provided incentives for their employees to stop smoking, lower their cholesterol. They not only cut costs, but they improved the health of their employees, so.

AMY GOODMAN: And veterans—you talk about care for soldiers coming home.

MATTHEW HEINEMAN: And the military is a major storyline in our film, as well, where the military has this huge problem of overmedication and suicide. And they are looking at out-of-the-box ideas. They’re giving acupuncture, meditation and other forms of alternative therapies, in lieu of drugs, to help reduce the amount of drugs these soldiers are on.

AMY GOODMAN: Well, Matthew Heineman, the film opens around the country in October. It’s called Escape Fire: The Fight to Rescue American Healthcare. Matthew Heineman is its director.

And that does it for our show. At 10:00 Eastern [Daylight] Time this morning, we’ll be broadcasting live from the steps of the Supreme Court to getting reaction around the country, including filmmaker Michael Moore. Tune in, democracynow.org.

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