I wrote earlier this fall about several new documentaries about health care. I’ve now had a chance to watch one of them, “Escape Fire” and talk to the filmmakers Matthew Heineman and Susan Froemke.
The film has a fairly simple basic message: The American health care system is a mess. But solutions, at least partial solutions, are there for the taking.
Part of the film focuses on the payment and delivery of health care – what those of us who write about this a lot may think of as the Dartmouth Atlas message. The fee-for-service system rewards quantity over quality and encourages all sorts of stuff to be done that doesn’t make a lot of sense and isn’t necessarily right for the patients. A part of the film looks at the – related – issue of designing a health care system around people who are sick, rather than emphasizing investment in keeping people well; Dean Ornish, Andrew Weil and Wayne Jonas all appear. We know a fair amount about keeping people well. But that’s not what our system primarily pays for.
The filmmakers, Heineman and Froemke, whose interest in the health care system was stirred when they made a film a few years ago on Alzheimer’s disease, spent more than three years on this project. The more they learned about the health system, the more astonished they became at the scope of its flaws.
“We have worse outcomes but we’re spending twice as much as other nations, “ Heineman said. And despite all that money, we don’t have a “patient-centered preventive and safe system.” The system, as he put it, is “high-tech over high-touch.”
The filmmakers weren’t alone. “We found out that no one in the medical profession is happy” about much of American medicine, they said. Doctors who want to do primary care, or who want to have a more “whole patient” approach even as a specialist, encounter all sorts of barriers. “It’s the spending structure,” Froemke said. “Medicine became a for-profit industry; we lost our moral compass.”
The film has its share of experts, some of whom like Donald Berwick, M.D., will be (I hope!) familiar to health journalists. But the heart of the film, as Froemke put it, is the stories it tells about ordinary – or maybe not so ordinary—patients and doctors.Three stories in particular stood out for me: Continue reading