'Escape Fire' calls for drastic changes to U.S. health care

By Kenneth Turan

Los Angeles Times (MCT)

Published: Friday, Oct. 5 2012 6:33 p.m. MDT

Dr. Erin Martin with a patient in "Escape Fire."

Roadside Attractions

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"Escape Fire: The Fight to Rescue American Healthcare" — ★★★ — documentary on the U.S. health care system; PG-13 (some thematic material); Tower

Cogent, convincing, determinedly non-ideological, "Escape Fire: The Fight to Rescue American Healthcare" tells us that everything we think we know about that incendiary topic might be wrong. And it offers us a way out of the morass.

And a morass it certainly is. We spend huge amounts of money on health care — a staggering $2.7 trillion in 2011 with no reductions in sight — and do not have as much to show for it as we should. We spend $8,000 per capita on health care while the rest of the developed world spends $3,000, but our population is not nearly as healthy. And 75 percent of our spending is on chronic diseases that could be prevented.

These statistics come courtesy of codirectors and coproducers Matthew Heineman and Susan Froemke. They not only tell us what we're doing wrong, they also use a combination of talking-head interviews with articulate experts and slice-of-life vignettes with ordinary people to show us what we could be doing differently.

The film's title comes from a forest-firefighting landmark, Montana's 1949 Mann Gulch blaze (memorably written about by "A River Runs Through It" author Norman Maclean in his classic "Young Men and Fire").

With that terrifying inferno coming up behind him, smoke jumper foreman Wag Dodge had a counterintuitive insight. He stopped running, lighted a match and burned the brush around him, hypothesizing that the fire would jump over his area. He called on his crew to join him, but they did not. Dodge guessed correctly about his escape fire and survived; 13 members of his crew did not.

That anecdote is related by Dr. Don Berwick, former head of Medicare and Medicaid. His point, and the film's, is that we are embedded in the health care status quo, prisoners of old habits, and that unless we can change how we think about and deal with the situation, we are doomed to fiscal catastrophe.

What we have now, Dr. Andrew Weil and others in the film attest, is actually not a health care system but a disease management system. It's a system that believes drugs are the only way: We spend as much on them as the rest of the world spends combined. It's a system, these folks say, that does not want you to die or to get well; it wants you to keep on spending. And spending. If milk prices had risen as astronomically since 1945 as drugs have, a gallon of milk would cost $48.

"We're in the grip of a very big industry," medical journalist Shannon Brownlee says, "and it doesn't want to stop making money."

The desire to maximize profit makes it difficult for primary-care physician Dr. Erin Martin of The Dalles, Ore., first met on the last day of her job with her clinic. She's leaving because she has to maximize the number of patients she sees and minimize the time spent with each one because of the dictates of the system.

What we should be doing instead, "Escape Fire" posits, is creating a disease prevention system that makes healthy lifestyle choices easier. This is no pie in the sky idea; it's the tack taken by Steve Burd, president and chief executive of grocery giant Safeway. He's given his workers financial incentives to make healthy choices, and as a result the firm's health care costs stayed stable while the national average skyrocketed.

In some ways, the most impressive figure in the film is someone we follow through a remarkable cycle. When we first meet U.S. Army Sgt. Robert Yates, injuries suffered in Afghanistan have left him a wreck, barely able to walk and frighteningly dependent on medication.

But after time spent at Walter Reed Army Medical Center with alternative medical techniques such as meditation, this least likely convert is a changed man.

"I'm a redneck, south Louisiana boy, just an old hillbilly, you know," Yates says. "I don't believe in that stuff. Eastern medicine? Anybody else would laugh, you know. They'd be like, 'What's that, boy? Hold my beer while I shoot this gator.' But I decided to give it a shot." Unconventional ideas changed his life, and, "Escape Fire" says, they could turn the health care crisis around as well.

"Escape Fire: The Fight to Rescue American Healthcare" is rated PG-13 for some thematic material; running time: 99 minutes.

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