Escape Fire is a new film that aims to spotlight problems in the U.S. health-care system and offers examples of solutions – escape fires – that could point to new ways of making the system sustainable.
Film review by Rose Hoban
Those not familiar with some of the numbers behind the U.S. health-care system – $2.7 trillion in annual spending, more than $300 billion each year on pharmaceuticals, tens of thousands who die from medical errors – might be stunned by the magnitude of them.
The makers of the new documentary Escape Fire use those numbers to good effect to draw a comprehensive portrait of a health-care system that is irrevocably broken and in need of structural reform.
Equally stunning in the film is the optimism, in the face of great odds, that some people have about fixing the system. Chief among the optimists is one who knows health care well, former Medicare head Dr. Don Berwick, who presents the analogy of the title, “escape fire.”
Berwick recounts the spontaneous innovation of a Montana firefighter during the infamous Mann Gulch fire of 1949 that killed more than a dozen “smoker jumpers.” One firefighter, realizing that he could not outrun the quickly moving fire, decided to drop a match and burn the area around him to deplete the fuel on the ground. When the main fire caught up with him, it passed him by. His quick thinking had provided him with a safe area to huddle and wait for the conflagration to pass, saving his life, while those of his more traditionally operating co-workers were lost.
After a sobering hour detailing the structural problems of the health-care system, Berwick and others in the film spend the final half hour describing what “escape fires” are being innovated by individual practitioners and institutions as potential fixes to the system.
Avoiding polemics
The filmmakers initial critiques are not unfamiliar to people on the left: Access to care for many poor and uninsured is inadequate, with too few doctors who are then forced into providing mechanistic care to too many for too little reimbursement.
Noted health journalist Sharon Brownlee is blunt, pointing out that much of the system is set up as a “disease-care” system rather than a health-care system.
“The disease-care system doesn’t want you to die and it doesn’t want you to get well, it just wants you to keep coming back for care of your chronic disease,” she states.
But the filmmakers also make an effort to address critiques of health care from a more conservative perspective: that Americans don’t get enough quality for the money spent, that overtreatment ends up harming patients – especially those who can afford it – and that the cost of the U.S. health-care system is fast becoming unsustainable.
They drive home the idea that the current fee-for-service payment system is one of the roots of the problem.
“When you reward physicians for doing procedures instead of talking to patients, that’s what they’re going to do, is do procedures,” explains Dr. Leslie Cho from the Cleveland Clinic. “If I spend five minutes with you and put in a stent, I will probably get $1,500. But to spend 45 minutes with you … to figure out what’s the problem, I’ll probably get $15.”
The filmmakers’ vision becomes one that could be accessible to people of any political stripe. Staying far away from the polemics of Michael Moore’s Sicko – and hardly mentioning politics – the film focuses instead on facts and figures, and uses footage that ranges from a Fox News interview with Senate minority leader Mitch McConnell, a Republican, to interviews with Berwick, who was appointed by President Obama, to build its argument.
And when the filmmakers go looking for answers, they focus on innovations being developed by groups as disparate as the corporate leadership of the Safeway grocery chain, doctors at the Cleveland Clinic and the U.S. military health-care system.
Particularly compelling is the story of Army Sgt. Robert Yates, who we first meet as he is being med-evaced from Afghanistan on a military transport. Yates is so doped up on narcotics for pain that he falls out of bed.
Yates eventually ends up in a pain-treatment program at Walter Reed Army Medical Center in Washington, where he is helped to withdraw from the dozens of pain pills he takes daily and cope with his post-traumatic stress by using acupuncture, meditation and yoga.
Yates, who describes himself as a “good ol’ boy” from Louisiana, embraces the unconventional treatments because they work for him. The filmmakers document the military’s use of these techniques, which have been successful at helping wounded veterans and active-duty military reduce dependency on pain medication at less financial and human cost.
Missing pieces of the puzzle
Even with their cogent critique of the system, the filmmakers miss some important points. There’s little focus on the role of early intervention in the lives of children, even though obesity, and associated conditions, is skyrocketing in children and adolescents. That oversight could be a function of the difficulty of getting access and permission to film minors, but it’s a critical omission.
And the filmmakers almost completely overlook the role of nurses, nurse practitioners, therapists and many other professionals who provide care that’s often more effective and cheaper than expensive specialty intervention, but which requires more time and hands-on care than doctors are empowered to supply in the current system.
Despite those shortcomings, Escape Fire is worth 90 minutes to watch with a friend of a different political stripe. Then you should follow up with a cup of coffee (or perhaps something stronger) to discuss what each of you took away.
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