Escape Fire: The Fight to Rescue American Healthcare
American healthcare. The phrase alone invites emotionally-charged debates and polarizing stances from both sides of the aisle. But at the center of the American healthcare system are people - patients, practitioners, policy-makers - who are struggling every day to find better answers. Escape Fire: The Fight to Rescue American Healthcare tells the stories of some of these people.
While the documentary exposes some of the critical issues at the heart of this system and its failures, it more importantly asks questions about how we might - together - begin to resolve them.
The film takes its title from the story of Wag Dodge, one of the only smokejumpers to survive a 1949 forest fire that ultimately changed the way fires were fought in the United States. An escape fire requires igniting the immediate vicinity in the face of an oncoming fire, then stepping into the newly burnt area as the oncoming fire approaches, engulfs, and ultimately passes by the survivor. Wag Dodge invented the technique out of necessity during the 1949 Mann Gulch fire, but his crew refused to follow his risky move, and 13 of them were overtaken, along with 3,200 acres of forestland.
Producer and director Matt Heineman spoke with Net Impact recently about the film, and what it might take for each of us to channel Wag Dodge and light our own escape fire in the face of a disease-care system that threatens to engulf us all.
Jess: What are some of the critical systemic roadblocks you've seen based on your work on this film?
Matt: The escape fire metaphor is a really strong metaphor: our healthcare system is burning but there are these simple solutions, or escape fires, right in front of us. So why can't we pay attention to them? The status quo is very powerful; there are a lot of people making money off our disease-care system who don't want to see things change...
This is the classic example of no one's happy - doctors aren't happy, patients aren't happy. Like any movement in our nation's history, we as Americans and consumers of healthcare have to demand a real cultural shift in how medicine is practiced.
We need to change how we reimburse for care, for example. We pay for the diabetic to have his foot amputated but not for the nutritional counseling when he's 23 to prevent the diabetes in the first place.
In some ways you vote with your dollar, but in another sense you're often handcuffed by what your insurance provider gives you. It's hard as a consumer to find the type of medicine or doctor that you want when you're given little to no options.
Clearly, this is a story of a broken system, but it's told through stories of individual people playing a number of different roles within it. Can you talk a little about how each of these different roles can create change?
It's not just the responsibility of the health care providers, or the regulators. We're all a part of the equation. To provoke the type of change we hope to provoke with the film, it's going to require a mindset shift from everyone.
We as patients, we Americans, we're used to getting things quickly. We want that pill or procedure, and we don't really realize the power we have to heal ourselves. So the change needs to happen on all levels...
Each one of us has a responsibility to be open to new things. In America we have this mythical dream of what our healthcare system is. In some sense we do have the best system in the world. People fly from all over the world to get high-tech procedures done here. We've sort of developed this mythos in the American public's mind that more is better, or high-tech Is better. But the fact that one third of healthcare costs don't actually improve health - that there's an enormous amount of overtreatment - shows that we, as consumers, need to be smarter.
So how you do break out of that? How do those people going into work every day trying to make these changes keep from just giving up in the face of such challenges? How are they lighting their own escape fires?
One of the most powerful stories in the film is the story of Dr. Martin, a young primary care doctor who's handcuffed by the system. She's being forced into a revolving door with her patients, forced into spending only five to ten minutes with each patient. It's impossible to get to the bottom of an illness when you're forced to put band-aids on the problem. So she leaves a clinic she feels hamstrung by, and is seeking a place where she can practice the kind of medicine she wants to. She's the perfect example of an idealistic doctor who's trying to swim upstream and do what's right.
What are some other examples of successful changes being made?
There are some institutions doing this better than others. At the Cleveland Clinic, doctors are on salary. Instead of being incentivized to see more patients or to do more, they're incentivized to do better. Not every healthcare institution is able to do that, and there are plusses and minuses, but they figured out a way to align the incentives for the doctors with the benefits to the patients.
And how do we change the perception at the individual level so that the system can change?
What we're trying to do with the film is ignite a conversation, and have this conversation with all the stakeholders in this system. Almost everyone in the film, from Sergeant Yates to Wendell Potter to three-star generals, they all have this desire and passion for change, and they all recognize that they have to do this together. It's really exciting to see this collective energy for positive change.We really hope that we can generate a movement where our country really looks in the mirror and asks, what kind of healthcare system does our country want?
Escape Fire: The Fight to Rescue American Healthcare opens October 5. The film's website now offers a first aid kit, but instead of Neosporin and band-aids, it's an online virtual kit that encourages people to make change on a personal level and on a community level, and hopefully on a societal level.
