Revisiting Escape Fire: The War to Rescue Our Health
Escape Fire: The Fight to Rescue American Healthcare debuted on CNN in March of 2013 to great fanfare from the integrative health and medicine community.
Here, finally, in this Sundance Films-backed project was a documentary with significant mainstream penetration that talked our talk. Ours is a disease management system, not a healthcare system. Lifestyle issues are at the basis of our health and cost problems. We need deeper reforms than a change in payment or expansion of access.
Former administrator of the Center for Medicare and Medicaid services Don Berwick, MD and author Shannon Brownlee teed up the topics with exacting if awful beauty. Then integrative medicine icons Andy Weil, Dean Ornish and Wayne Jonas took the camera to articulate the transformation in our conversation about health. They were relied upon for emerging strategies.
All this was another step to arrival on the main stage for integrative health and medicine. Look! We are gaining prominence as the change agents we’ve always thought we were.
I watched the film this week in preparation for a panel on Escape Fire scheduled for the International Clinical Congress on Complementary and Integrative Medicine on October 30, 2013 in Chicago. Perhaps it was my mood. Mainly I felt that the movie is in serious need of a heavy-lifting sequel if there is any chance that this incendiary mess can be escaped.
Like the industry at which it hacks away, Escape Fire is best at description, decent at diagnosis and thinnest on prescription.
The case-taking lays out the ugliest characteristics in US medicine’s house of horrors. 187,000 deaths due to medical errors and hospital-spawned infections. (A more recent analysis put the total at 210,000-450,000 deaths per year.) $2.7-trillion annual price-tag that more than doubles any other country’s per capita costs. 30% of care is waste, and much of that harmful. In the meantime, we rank 50th on life expectancy.
This bludgeoning criticism is hardly news to those of us who have been in this movement. These data, this killing and maiming of humans and of budgets, both personal and national, scream for the damning outrage of a Michael Moore. Such outcomes deserve it.
The directors choose to lay out these descriptors without huge judgment or emotion. Their even, anti-Moore tone – clearly strategic -- continued in the establishment of etiology. The script reminds us of the requirement that profits of publicly-traded corporations must legally trump any other concerns as businesses plunder and expand these golden silos. The directors touched repeatedly on the financial “perverse incentives” to always do more testing, procedures, and surgeries in the palaces of marble and art that are our nominally not-for-profit hospitals. They described the optimal patient: seriously ill, regularly returning for care, but not quite dead.
The movie’s power is in presenting this chosen collage of outcomes and contributors to the disease contagion of a medical system focused not on health but on profit. This system for enhancing earnings takes a steady, relentless pummeling. For many viewers, the portrait is likely new, and shocking, and thus the quiet tone perhaps optimal.
But the movie promises an escape path. What is it? More importantly, how do we create it?
Here the directors took an approach like a somewhat whimsical Hansel and Gretel, tossing crumbs here and there without much thematic continuity. Berwick and Brownlee push more focus on primary care. Weil urges putting nutrition in medical education and changing the foods in our stores. Provide acupuncture and meditation in place of opioids is suggested by Jonas and the segments on military care. Incent employees to make healthy choices like Safeway does. Put medical doctors on salary, like the Cleveland Clinic does. Replace volume with positive health outcomes as the basis for payment, as Berwick promotes.
All are interesting, each is useful, and together are a montage of perhaps critical characteristics of an actual healthcare system.
Yet the missing energy in this movie is also modern medicine’s short-coming. We can describe and diagnose. But we are horrible at successful prescription. What of sitting with the patient – us the viewers in this case -- evaluating readiness for change, then laying out the fight plan that will move us toward health.
Ornish, truly a warrior of payment change with red badges of courage to prove it, provided perhaps the best strategic advice. His logic is this. If we want to change health care, we need to transform medical education (and, I would add, that of other healthcare professionals). To do that, we need to shift what insurers reimburse. Since private insurers often follow government payment practices, the buck starts with Medicare. That’s where to apply pressure.
This is the path Ornish took with his revolutionary, multidisciplinary, multi-modality, integrative health and lifestyle intervention for reversing coronary artery disease. Yet, as he describes, it took 16 years for Medicare approval of this single treatment approach. As close observers will know, despite the evidence Ornish has assembled, the challenges of medical culture guarantee that this rogram has remained roughly one million miles from becoming a standard of care.
This strategy is hardly a prescription for escaping a ravaging fire.
The incendiary impulses in our medical-industrial complex erupt from beneath corporate medicine’s for-profit and not-for-profit collaborators. These flames rise inside finance, research, food, gribusiness, retail, entertainment, and politics.
Ours is not a “fight.” Neither does “battle” capture the multiple, desperate fronts on which campaigns must be waged. The directors may have decided that our readiness for change was merely to hear the hard news. They stayed away from politics and political parties. The Affordable Care Act was not mentioned.
Yet we need to engage the organizing, coalition-building, demonstrating and vote-counting dimensions that are demanded by the dimensions of this horror. Unless the actual escape fire of Berwick’s metaphor is to in fact burn down the mission.
The fact is, nearly our entire economy is continuously at war with those who would change the status quo. We need a sequel that is something more like this: Escape Fire: A War Strategy to Give Health a Chance.