While everyone waits for the Supreme Court to declare whether Obamacare is constitutional, a pair of films at the 2012 Full Frame Documentary Film Festival reminds us that the U.S. health care system is an enormous scam and scandal of very long standing—though nothing that would bother Justices Antonin Scalia or Clarence Thomas.
The Waiting Room is a dreary but well-done depiction of why our health care system is so expensive and still produces lousy outcomes. (The U.S. ranks 50th in the world in life expectancy.) Escape Fire: The Fight to Rescue American Health Care will give you hope or depress you further about the fact that the solution—the "escape fire"—is so obvious and yet, because of politics, nearly impossible to achieve.
The solution is to replace the many useless but expensive "treatments" and drugs that are hugely profitable for the health care industry with effective, low-cost disease-prevention programs that emphasize health education, lifestyle change, improved nutrition and exercise.
Instead of endlessly applying costly Band-Aids to disease, take the up-front steps to prevent it or, if that chance was missed, the steps needed to reverse it. Unfortunately, as these films demonstrate, the financial incentives in our "fee-for-service" system focus on services that manage disease or rely on drugs to curb its symptoms. Very little is paid for preventing it.
Directed by Peter Nicks and William B. Hirsch, The Waiting Room depicts a day in the life of the emergency room at Highland Hospital, a public facility in Oakland, Calif. America's medically uninsured consider a visit to the ER as going "to the doctor's," as one woman, while waiting, tells someone on the phone. For most of the people who come to the ER, the only emergency is that they suffer from chronic disease. None has a regular doctor. This is where they go when they experience chest pain, fall down, have high blood pressure or, in one case, have a testicular tumor that was diagnosed at another hospital. Because the patient was uninsured, the first hospital declined to operate. Highland Hospital, one of its doctors says, "is the safety net ... an institution of last resort for our society."
Will Obama's Affordable Care Act help? Yes, it will, by bringing everyone into the health insurance system, through the extension of Medicaid to the working poor or, for those with somewhat higher incomes, by subsidizing private insurance. Insurance which, unless the Supreme Court screws things up, they will be mandated to obtain.
Obamacare may also be a first step in real reform because, with everyone covered, hospitals and insurers won't need to dodge the sick or shuck them off on the Highland Hospital ERs. A coordinated system of American health care is possible.
How? Escape Fire, directed by Matthew Heineman and Susan Froemke, shows a series of reformers—at the Cleveland Clinic, at the Pentagon (after 10 years of war, the military's casualty list is a financial and moral catastrophe) and in small community-care centers—using variations of the same approach.
Each has established a system to improve outcomes for their patients while cutting costs. Instead of piecemeal "fee-for" services, these providers team up to help patients lower their blood pressure, reduce cholesterol levels, eat better and lose weight. The patients' results are so much better that the providers stay in business even as they forgo costly but potentially remunerative procedures such as installing a stent to open an artery. One doctor, for example, says she's paid about $1,500 to make a snap diagnosis for a stent, even though it will not prevent a heart attack. If, instead, she spends 45 minutes with a patient, which could help him avoid or reverse his heart disease, she'll be paid about $15.
Preventive care is cost-efficient. For example, Safeway, the grocery chain, was paying $1 billion a year in health care costs in 2005, with the price rising $100 million a year. An analysis suggested 70 percent of the costs were lifestyle-related. So Safeway installed gyms and offered nutrition and weight-loss counseling programs. Employees paid toward their health insurance, but they earned discounts if they reduced their body mass and lowered blood pressure and cholesterol levels. The company reports that its health care bill stayed flat while health insurance costs in the country rose an average of 40 percent.
"Escape fire" is a firefighting term. The old way of fighting wildfires was to charge in with water, which got a lot of people killed. Finally, in 1949's Mann Gulch fire in Montana, someone had the wit to set a fire around himself, starving the wildfire of the fuel needed to burn right through him. That day, 13 other firefighters died. The one who set the escape fire survived. And firefighters everywhere learned.
Health care professionals are learning, too. Unfortunately, as Escape Fire makes clear, they don't control the health care industry. Insurance corporations, Big Pharma and Congress remain in control.
This article appeared in print with the headline "Waiting to escape."