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Fri December 7, 2012
'Escape Fire' Exposes Flaws Of American Healthcare
Originally published on Fri December 7, 2012 1:03 pm
FLORA LICHTMAN, BYLINE: This is SCIENCE FRIDAY. I'm Flora Lichtman.
IRA FLATOW, HOST:
And I'm Ira Flatow. Last week on the show, we talked about the Affordable Care Act - you know, Obamacare - and how it gave millions more Americans access to health care.
LICHTMAN: But our next guest says: access to what, exactly? Unnecessary tests? High-tech, overpriced treatments for preventable diseases? In his new movie "Escape Fire," the new movie says that our health care system is broken and offers a few ideas on how to fix it, too. Matthew Heineman is the director and producer of "Escape Fire: The Fight To Rescue American Healthcare." He's based here in New York, and he joins us today in our New York studios. Welcome to SCIENCE FRIDAY.
MATTHEW HEINEMAN FILMMAKER: Thanks for having me.
LICHTMAN: If you want to check out the movie, you can get it at iTunes or Video On Demand. So why did you make this film?
FILMMAKER: So we started making the film in 2009, just as the health care debate was heating up. And I think like many Americans, we were just confused about what was happening. The debate was so polarizing. It was so hyperbolic. And we really wanted to try to get the heart of, you know, why was this system so perverse? How did it come to be? Why did it not want to change? And also high-light people out there who are trying to fix it.
LICHTMAN: It seems like a daunting task to make health care not only comprehensible, but also something people might want to watch for two hours, an hour and 30 minutes.
FILMMAKER: Yeah. I think those are our two biggest hurdles, is how do you make this crazy, amorphous topic tangible? And how do you make it entertaining, as well? So...
FLATOW: Say - but you had a big task, because didn't Michael Moore make a whole film on health care system?
FILMMAKER: He did.
FLATOW: What was your approach? How is it different than what he was doing?
FILMMAKER: Sure. His film was really about insurance reform and how, you know, broken our insurance system is. Our film is much more sort of holistically looking at the system from a number of different angles, and really, how we a disease-care system, not a health care system, a system that profits and is oriented towards sickness, not towards health. And so I think the goal of the film was to really shift how our country views health and healing and really create a system of health and wellness, as opposed to a sick-care system and disease-care system.
LICHTMAN: And it seems like part of the point was that the incentives are messed up, right?
FILMMAKER: Yeah. I mean, take diabetes, for example. We pay for a diabetic to get their foot amputated when they're at 60, but we don't pay for simple nutritional counseling to prevent that from happening in the first place when they're 20 or 30 or 40. The system's littered with pervasive incentives all across the board. Doctors are incentivized to do more, not to do what's right for the patient.
LICHTMAN: When you say we don't pay for that, what do you mean exactly?
FILMMAKER: Insurance companies don't reimburse for that. They don't pay doctors to give that type of medicine. And so, you know, we, as consumers, need to pay out of pocket, or we just simply don't get that kind of care.
LICHTMAN: Did you think in doing - in working on this movie, that there is a way to change that?
FILMMAKER: Yeah, I think - you know, it's been three-and-a-half years of this journey, and I think - you know, what I'm most optimistic about in this topic - you know, I think there's - we screened the film at film festivals across the country and theaters. We screened it at 60 medical schools. We just last week screened it at 152 VA hospitals. I think what I'm optimistic about is that, you know, we really are at a tipping point where things can't get any worse, and I think institutions are really - really recognize this, and are being forced to change.
In our film, we see, you know, the Safeway Corporation, a corporation where their health care costs were rising, and five years ago, the CEO, Steve Burd, woke up and said this is not sustainable. And so he completely redesigned his health care plan, incentivizing his employees to stop smoking, to lower their cholesterol, lower their weight. And not only did he improve the health of his workforce, but he, you know, flatlined his health care costs.
LICHTMAN: And he found a whole cultural shift in that company, it sounded like.
FILMMAKER: Exactly. So I think what I'm optimistic about is that change will happen institution by institution, community by community, and that hopefully collectively that change will inspire, you know, this epidemic of rising health care costs.
LICHTMAN: Tell us some - give us some of the stories that you tell in the movie. What's your favorite character? You had some great ones.
FILMMAKER: Sure. So I think there's two characters that are really the heart and soul of the film. One is Dr. Martin, who is a young primary care doctor, idealistic, wanting to, you know, go into medicine to change the world. I think what she encounters is this revolving door of patients where she's forced to see, you know, patients for five, seven minutes. And it's really hard to actually give health care - to help people in that short amount of time. You know, she's really forced to put Band-Aid fixes on much deeper problems.
And so, you know, she really gets sick of this revolving door. She leaves this practice, and ultimately she goes on this journey, seeking a place to practice medicine where she can actually help patients.
LICHTMAN: So let's also talk about Army Sergeant Robert Yates. He's a really compelling interview, I thought. Maybe you can tell us a little bit about his background and sort of how things changed for him over the course of the film.
MATTHEW HEINEMAN: So we really looked at the military as a microcosm for the rest of America. The military has this, you know, problem of over-medication, of this default reliance on giving pharmaceutical drugs. And, you know, we see that almost every day in the paper, you know, over-medication, suicide in the military. And so, you know, we wanted to look at the military both to highlight this problem and to highlight how they were trying address it, looking at alternative means to deal with it.
And the story of Sergeant Yates began in Germany, where I met him before this Medevac flight in which he travels to Andrews Air Force Base. And when we meet him on this plane, he has been seen by many, many different doctors. He's sort of been given fragmented care and he end up being on this whole cocktail of drugs. His blood pressure drops, and he almost, you know, dies on the plane. And it's this is very chaotic, dramatic scene. And so we end up following him for many, many months.
Ultimately, he goes to Walter Reed and enters into this innovative program at Walter Reed where he gets acupuncture, meditation, group therapy. And he really gets, you know, ultimately gets better. And so I think it's a great story of a man sort of opening himself up to healing.
LICHTMAN: Let's play a clip from Sergeant Yates.
(SOUNDBITE OF MOVIE, "ESCAPE FIRE: THE FLIGHT TO RESCUE AMERICAN HEALTHCARE")
SERGEANT ROBERT YATES: I chose to get off all narcotics, all medicine, everything.
UNIDENTIFIED WOMAN: Just take a couple of minutes to kind of arrive. All right. So take a breath.
YATES: I'm a redneck, South Louisiana boy, just an old hillbilly, you know? I don't believe in that stuff, you know, Eastern medicine? Anybody else would laugh, you know? They'd be like, what's that, boy? Hold my beer while I shoot this gator, you know? But I decided to give it a shot. So we're going to open up some chi?
UNIDENTIFIED WOMAN: We're going to open up some chi. It's a good way to think of it.
YATES: Wow. That's the way I like to look at it. Because at this program that's here, there's yoga.
UNIDENTIFIED WOMAN: I'm just going to go ahead and put the last one in.
YATES: I meditate, and it has opened up a whole new world for me.
LICHTMAN: I'd like bring on another guest now who can talk to us more about this, about some of the ways that the military is treating and dealing with soldiers' pain. Chester "Trip" Buckenmaier III is an anesthesiologist and a colonel in the U.S. Army Medical Corps. He is also the director of the Defense and Veterans Center for Integrated Pain Management in Rockville, Maryland. And he joins us by phone. Welcome to SCIENCE FRIDAY.
COLONEL CHESTER BUCKENMAIER III: Pleased to be here.
LICHTMAN: So we heard in this clip kind of a shifting culture, it sounds like. Does that sound right to you?
III: Well, I do want to congratulate Matt Heineman on "Escape Fire." In fact, I'll mention that the current Army surgeon general, Lieutenant General Horoho, recently showcased that film to the medical - military medical leadership because we are a reflection of civilian medicine. We just happen to practice it in some rather strange places around the planet, and we do that very well. But we obtain our standards from the civilian community. And sometimes, particularly in conflict, those standards don't necessarily serve us as well in that extreme environment. So it did cause us to really reflect and take a top to bottom look at how we were managing pain and how we were using these medications and where we could possibly improve the system.
That process was actually started by the previous surgeon, recently retired Lieutenant General Schoomaker, and resulted in the pain task force document, which preceded the IOM report, Institute of Medicine report, "Relieving Pain in America," that was in June of 2010 by about a year. And we were very pleased that those two reports, both critically looking at large systems, in our case, the military, in the case of the IOM report looking at how we're managing pain in America, were very similar in that they recognized we had some issues in that. As Matt describes, we as physicians are often rewarded for doing things to patients and not necessarily for looking at things with less side effects or perhaps more holistic methods that focus on the health of the patient rather than disease management.
LICHTMAN: How has this problem changed for - I mean is pain a changing problem for the military in the sense that, you know, survival rates have done so much better, it sounds like, over the last couple hundred years that...
III: Well, from the current conflicts, less than 10 percent died of wounds rate, which no land army in the history of medicine has achieved that. So while we've been extremely successful using 19th century technology such as morphine to manage pain in this modern 21st century medical environment, where a soldier or Marine can sometimes, in less than 24 hours from point of injury, arrive in a major medical center in Landstuhl, Germany and pass through literally hundreds of health care provider hands.
And so in 2003, when I first deployed to Iraq, myself and many other providers were concerned that the standards that we did have back in the United States weren't necessarily available and the tool that we had at the time was morphine. And we realized very quickly that we needed to improve upon that. In fact, I was deployed at that time to specifically look at a very advanced technology at the time, regional anesthesia with continuous peripheral catheters, where we placed the catheter next to a nerve bundle serving a mangled limb or amputated limb and run a continuous infusion of local anesthetic and essentially turn that limb off.
And while that was - at that time, in 2003, we were way out ahead of really most medical centers in the nation, but we had sort of missed the point on some of the basics. But we really were like the rest of the country; when it came to our understanding of pain, we were neophytes. We've always thought of pain as a symptom of some other disease process. And now we understand that pain can be a disease process in its own right and that we really need to open up our scope beyond the technologies that we routinely use and look at some of these other things, such as acupuncture, yoga, biofeedback, medical massage, for example.
FLATOW: This is SCIENCE FRIDAY from NPR. I'm Ira Flatow along with Flora Lichtman. We're talking with Matthew Heineman, who is director and producer of "Escape Fire: The Fight to Rescue American Healthcare." That's a film that you can download on iTunes or get it on video on demand; and with Chester "Trip" Buckenmaier III. He's an anesthesiologist and colonel in the U.S. Army Medical Corps. Let me throw this open to both of you. Let me ask you, Matt, first - in making the film, people keep saying that no matter what we do, health care costs too much. It doesn't matter what health care system we have. It just costs too much, is going to break the bank of the country. Did you find a solution to that problem?
HEINEMAN: Yeah, man, I think cost is the number one problem. I think, you know, the Affordable Care Act is a good step forward. But you know, as you said at the beginning of the show, giving 30 million more people access to a fundamentally broken system isn't going to fix it. We spend literally twice as much as any other developed country per person. But we're ranked at or near or the bottom in almost every single metric of health. So I think - again, the one stat that really stands out to me is that 75 percent of health care costs, literally three quarters of the health care costs, go to preventable diseases. So we as a society need to figure out how to treat those diseases, how to, you know, prevent those diseases from happening in the first place.
FLATOW: Mm-hmm. And so that's - it's a generational change that's going to have to take - and not something overnight.
HEINEMAN: It's a (unintelligible) shift. And I think the other big thing is that literally one-third of health care costs don't improve health in any shape or form. That goes to overtreatment. That goes to unnecessary care, waste and inefficiency. So we really need to wrangle in this problem of overmedication, this problem of unnecessary treatment.
FLATOW: All right. Thank you, gentlemen. Thank you for taking time to be with us today. Thank you, Colonel.
HEINEMAN: Thank you so much.
III: Thank you. Transcript provided by NPR, Copyright NPR.