{"id":624,"date":"2012-10-21T19:00:16","date_gmt":"2012-10-22T02:00:16","guid":{"rendered":"http:\/\/blog.stevenreidbordmd.com\/?p=624"},"modified":"2012-10-21T19:00:48","modified_gmt":"2012-10-22T02:00:48","slug":"movie-review-escape-fire-the-fight-to-rescue-american-healthcare","status":"publish","type":"post","link":"http:\/\/blog.stevenreidbordmd.com\/?p=624","title":{"rendered":"Movie review: “Escape Fire: The Fight to Rescue American Healthcare”"},"content":{"rendered":"

\"\"The independent documentary<\/a> Escape Fire: The Fight to Rescue American Healthcare<\/em>\u00a0by Matthew Heineman and Susan Froemke is a thoughtful indictment of the status quo. \u00a0Instead of focusing on political polarization, the pros and cons of Obamacare for instance, the film mainly documents the absurdity and waste of what we have now. \u00a0Instead of a system to promote health, Americans have a “disease management system” that spends almost twice as much as any other country \u2014 and nearly as much on prescription medicines as the rest of the world combined \u2014 yet we are 50th in life expectancy, and\u00a0almost 75% of healthcare costs are spent on preventable diseases that are the major causes of disability\u00a0and death in our society.\u00a0 Economic incentives maintain this status quo. \u00a0High-tech interventions are reimbursed generously, yet reimbursement for\u00a0face-to-face primary care often does not even cover the cost to deliver it. \u00a0As a result, fewer new physicians enter primary care, and doctor visits become shorter and shorter. \u00a0Meanwhile, unnecessary medical and surgical procedures are prevalent despite their risks, and cost thousands of lives each year.<\/p>\n

Escape Fire<\/em> uses a firefighting metaphor to make its main point. \u00a0In forest fires, sometimes a smaller fire is set in order to deprive the main fire of fuel, creating a firebreak. \u00a0Such firebreaks can allow firefighters to escape the area \u2014 thus an “escape fire.” \u00a0The filmmakers use this metaphor to say that the status quo in health care isn’t working, and that we may need counter-intuitive and non-traditional solutions to save the system. \u00a0I confess that I find this metaphor somewhat ill-chosen: The remedies suggested in the film do not “fight fire with fire.” \u00a0And there is no escaping our need to address health care.<\/p>\n

The film spends much time on the military, in part as a microcosm of the problems facing our larger society. \u00a0Soldiers’ use of prescription drugs has tripled in the past five years. \u00a0A large section of Escape Fire<\/em>, including fascinating footage inside a C-17 Medevac plane as it crosses the Atlantic,\u00a0follows Sergeant Robert Yates\u00a0returning from Afghanistan. \u00a0Severely injured in a battle that killed most of his platoon, he suffers chronic pain and PTSD. \u00a0Sgt. Yates\u00a0was given a shopping bag full of pills, but later replaces them with stress- and pain-management techniques he learns as part of an innovative Army program.<\/p>\n

Although the film never mentions psychiatry as a medical specialty, mental health issues loom large in both military and civilian health care. \u00a0Again and again, patients are depicted in primary care offices reviewing their antidepressant medications, or breaking down in tears. \u00a0The current system, devoted to disease management, offers poor care to such patients. \u00a0They need time, not reimbursed procedures. \u00a0As medical journalist Shannon Brownlee notes on camera:\u00a0“Health care should have a lot more care<\/em> in it.”<\/p>\n

The film proposes several escape fires, i.e., solutions, to rescue American health care. \u00a0In 2005 Safeway began to provide financial incentives for employees who engage in healthier behavior, and thereby lowered its health care costs by more than 40%. \u00a0(That’s how the film puts it. \u00a0Actually, from 2005 to 2009\u00a0Safeway’s health care costs remained flat for the 30,000 employees enrolled in the program, while\u00a0most companies’ costs rose by 40% over the same period.) \u00a0This was the one example of a monied interest realigning financial incentives to promote health. \u00a0The film would have been stronger with more such examples \u2014 I hope there are some.<\/p>\n

The military provides a solution of a different type. \u00a0Often innovation gains a foothold there before achieving acceptance in civilian society. \u00a0Just as America’s armed forces were on the vanguard of racial integration and later gender equality, perhaps they can lead the way on health care too. \u00a0The Army Surgeon General established a Pain Management Task Force to look at alternatives to narcotics, and now the Army is using acupuncture and meditation to decrease narcotic use in the wounded. \u00a0Sgt. Yates, the self-proclaimed “redneck hillbilly” who didn’t believe in Eastern Medicine, “decided to give it a shot,” and it worked.<\/p>\n

I found the profile of Dr. Erin Martin the least hopeful in the near term. \u00a0Initially shown as a primary care doctor in a low-fee clinic, Dr. Martin had high ideals, but was demoralized by\u00a0too many patients and too little time. \u00a0She was dissatisfied and frustrated by a system that made her job nearly impossible. \u00a0Her escape fire was literally to escape: She quit the clinic, became a\u00a0fellow in Dr. Andrew Weil\u2019s Integrative Medicine program, and\u00a0found a practice that supported her patient, humane approach. \u00a0The film endorses this as the escape fire for primary care \u2014 but of course those clinic patients still need a doctor.<\/p>\n

Dr. Martin’s path is similar to the one I took myself. \u00a0Early in my career I worked for two years in a public mental health clinic. \u00a0The patients were in great need, but the system was frustrating and the work demoralizing. \u00a0Providing comprehensive, humane mental health care in such a system is an uphill battle at best, and in some respects nearly impossible. \u00a0I have much admiration for those who work in such settings. \u00a0However, like Dr. Martin, I chose to leave and practice in a way that makes more sense to me. \u00a0While the makers of\u00a0Escape Fire<\/em> would likely endorse my choice, public mental health clinics still need doctors too. \u00a0Moreover, it will be a long time before the American health care system rewards Dr. Martin and others who aim to avoid commodity care<\/a>. \u00a0Indeed, the system is accelerating in the opposite direction. \u00a0Those of us who build this particular escape fire in essence work outside the larger system.<\/p>\n

As I wrote at the outset, Escape Fire<\/em> is a thoughtful indictment of the status quo. \u00a0The film has been<\/a> reviewed<\/a> positively<\/a>, and it strikes a nice balance between worrisome facts and emotional interest, ending on a hopeful note. \u00a0We should have no illusions about easy solutions though. \u00a0Healthier lifestyle choices are hard to pursue when fast food is cheap and tasty; a shift to preventative care from disease management would represent a fundamental sea change and a realignment of billions of health care dollars. \u00a0For a start, at least, we can agree that American health care is burning, and that new solutions are desperately needed.<\/p>\n","protected":false},"excerpt":{"rendered":"

The independent documentary Escape Fire: The Fight to Rescue American Healthcare by Matthew Heineman and Susan Froemke is a thoughtful indictment of the status quo. Instead of focusing on political polarization, the pros and cons of Obamacare for instance, the film mainly documents the absurdity and waste of what we have now. Instead of a […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[4,51],"tags":[48],"class_list":["post-624","post","type-post","status-publish","format-standard","hentry","category-current-events","category-psychiatry-in-general","tag-commodity","odd"],"aioseo_notices":[],"_links":{"self":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/624","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=624"}],"version-history":[{"count":6,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/624\/revisions"}],"predecessor-version":[{"id":631,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/624\/revisions\/631"}],"wp:attachment":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=624"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=624"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=624"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}