In a grassland wildfire, when the fire is spreading so quickly that there’s no way to run away from it, there’s one last solution to save yourself: an escape fire. In this technique, you light a ring of fire around you, using up the fuel that is feeding the wildfire so that it has nothing to burn when it reaches you. The problem is, when you’re running for your life, the most effective solution is also the least obvious – stopping in your tracks to light a fire is the last thing a panicked person would think to do. You could die from your inability to face and accept the choice that is right in front of you.
That’s the idea behind the title of the film Escape Fire: The Fight to Rescue American Healthcare. I had a chance to see it this weekend on CNN (it’s available now online and on DVD), and it makes a compelling argument that our current system for dealing with rising health care costs and falling positive health outcomes is akin to running away from a seemingly insurmountable problem when there are solutions right in front of us. In example after example, patients dealing with chronic illness, which is the main driver of skyrocketing health care costs, are dealt with by disease management that does nothing in the way of future prevention.
Take the case of Yvonne, who had a heart attack in her mid-30s that was treated with the installment of a stent. The stent addressed the symptoms of her heart disease, but throughout the next few years, she was back in the hospital several times for more surgery and more stents. Her doctor, as she reported, told her, “I don’t know what else to do for you.” Yvonne changed course and went to the Cleveland Clinic, where a team of doctors worked with her to control her diabetes and heart disease through nutrition, exercise, and stress management. Instead of paying lip service to prevention, they held her accountable and followed up on a regular basis to watch her progress. She is now in good health and hasn’t needed any additional surgery.
The Cleveland Clinic, however, is not your average hospital. It is designed to play by a very different set of rules. The doctors are salaried so the influence of profit is taken out of the picture. The cost of care is among the lowest in the country, and their health outcomes among the best. The film does not by any means suggest that doctors around the country are not doing their jobs; it contends that the jobs are designed wrong. Under the fee-for-service model, they are rewarded for the number of procedures they perform and make no money for spending time with patients discussing things like lifestyle choices. Just to stay in business with Medicare and Medicaid reimbursement cuts, the only solution for primary care physicians – the main line of defense against chronic disease – is to see more patients and spend less time with each of them, managing disease as best they can in the time they have.
Why does this system persist in America when so many other countries have far lower health care costs and much healthier populations? The answer is, in a way, simple: profit. But the details are extremely complicated. There are too many profit-driven interests in keeping Americans alive but sick, with enough political power to maintain the status quo. We spend $300 billion on drugs every year in the U.S., as much as the rest of the world combined, due in part to the fact that U.S. is one of two countries in the world that allows drug companies to advertise their products on television. Often pharmaceutical companies are able to fast-track medications through the FDA approval process – sometimes with deadly consequences – in order to get profits flowing quickly.
Apart from drug companies, there are insurance companies, which answer to their shareholders and not the American public. Insurance premiums have increased at a rate far beyond that of salaries. While health care reform has made improvements and forced insurance companies to end some of their worst practices, such as denying coverage for people with pre-existing conditions, it has not by any measure solved the problem. In fact, the insurance mandate in the Affordable Care Act benefits them, as does the omission of the public option, which would have created more competition for them.
And with all the profits being made in the medical business, the amount of money that goes into lobbying is mind-boggling. With this kind of political influence, we are left with a health care system that skips over the basic needs of patients – most notably poor patients, who cannot afford health insurance and are the most likely to suffer from chronic conditions that wind them up in the hospital for recurring care with little prevention counseling, driving up the cost to the public over time while keeping them sick.
As depressing as this sounds, Escape Fire offers real hope and examples of exciting progress. Dr. Dean Ornish, who has shown through his studies that heart disease can be reversed through diet and lifestyle changes, has succeeded in getting his program reimbursable through Medicare – something that he is convinced is the first step to instituting widespread acceptance of preventive health programs. Dr. Andrew Weil has begun a program to retrain doctors to address poor nutrition and other basic underlying causes of disease that they weren’t taught how to deal with in medical school. Walter Reed Medical Center is revamping their care of soldiers with physical and mental health issues following military service by including things like acupuncture and meditation in their regimen – treatments that are proved to be effective and yet difficult to gain acceptance for – and decreasing the amount of medication prescribed. Safeway, held up by President Obama as an example of a company doing things right, has decreased their health costs by 40% while vastly improving the health of their employees, by providing financial incentives for them to exercise and eat right, as well as providing the tools to do it. And hospitals like the Cleveland Clinic are working to change the very basis of how patients are treated.
With all of this positive change happening, the film asks us, health care consumers, to join in the fight and demand a new health care model. To learn more about Escape Fire, the movie and the movement, visit www.escapefiremovie.com.