While Rome Burns . . .

This post was intended to be written and shared on Sunday, March 17th, while much of the rest of America will be either celebrating being (or pretending to be) Irish. Such foolishness was always strongly discouraged in my family: the reason I spell my name with one “t” is because that was my father’s way of reminding me that I am Scottish. And I’m pretty sure the only day my grandfather seriously frowned upon drinking was St. Patrick’s Day.

But the real reason I am sharing this today instead is that I watched Escape Fire: The Fight to Rescue American Healthcare last night. I had planned on giving myself a few days to get through it, but  I stayed up much later than I wanted – or should – because I found it compelling, disheartening and yet, incredibly inspiring. The feature film’s title has an interesting foundation, and I share that at the bottom of this post.

The one-hour-and-forty-minute documentary, produced and directed by Matthew Heineman and Academy Award-nominee Susan Froemke, provides candid and balanced insights into the inherent structural and systemic elements of our country’s healthcare challenges. For those intimately involved in healthcare delivery there is nothing here that will necessarily surprise you – though I personally found coverage of healthcare delivery in the military to be both enlightening and very concerning from the perspective of national defense.

The storyline organizes and weaves together a root cause analysis from first hand perspectives of various industry stakeholders, e.g., patients, caregivers, industry executives and journalists. It features commentary from holistic health experts Dr. Andrew Weil and Dr. Dean Ornish, Safeway grocery chain CEO Steve Burd, medical journalist Shannon Brownlee, Cleveland Clinic cardiovascular chairman Dr. Steven Nissen, and former Director of CMS, Dr. Donald Berwick.

Unlike Michael Moore’s documentary, Sicko, in which balanced research and evidence were largely supplanted by rhetoric and well-positioned emotion, this film is not an effort to indict, lay blame or point fingers. As Dr. Berwick offers, “between the healthcare we have and the healthcare we could have lies not just a gap but a chasm … I don’t blame anybody – they’re just doing what makes sense – and we have to change what makes sense.” The film does a wonderful job of fairly explaining without getting technical how we got into this situation – and how if we do not make fundamental changes the system will ultimately collapse under its own weight. A lot of lives are going to be lost in the rubble of that collapse.

From a healthcare policy perspective our debate should be focusing on who gets to define what makes sense and who is responsible for making the changes necessary to create individual incentives that align with desired systemic outcomes. A consistent theme in the film is the incredibly impactful power that individual action and accountability can have in healthcare. While at the same time, the inbred allegiance between industrial and political powers in this country are culturally embedded in our social psyche and represent enormous obstacles to change.

If you are even a little concerned about the future of healthcare delivery in the United States, I strongly encourage you to watch this film. And then I encourage you to share your thoughts and insights with us in the HCPolicy Discussion Group (see the picture icon at the top of this blog).

Escape Fire can be seen this weekend on CNN @ 8pm and 11pm EDT (and again at 2am on the 17th – in case you’re already up getting ready for the parade).


On the Film’s Title
In an interview with Sundance Film Festival’s Nate von Zumwal,  Matthew Heineman explains how the movie received its title:

For over a year, we struggled to find a title for the film. How could we synthesize this complex problem and potential solutions under one label? We were stumped. Then we came across Dr. Don Berwick’s healthcare manifesto, “Escape Fire: Lessons for the Future of Healthcare,” delivered years before he became head of Medicare/Medicaid.

Dr. Berwick draws a striking parallel between our broken healthcare system and a forest fire that ignited in Mann Gulch, Montana in 1949. Just as the healthcare system lies perilously on the brink of combustion, the forest fire began to burn out of control, threatening the lives of 15 smokejumpers.

On the spot, the leader Wag Dodge came up with an ingenious solution: he lit a small fire that consumed the fuel around him. He urged his men to join him, but they ignored him, clinging to what they had been taught. The fire overtook the crew, killing 13 and burning 3,200 acres. Dodge survived, nearly unharmed. He had invented what is now called an “escape fire,” and soon after it became standard fire-fighting practice.

Dr. Berwick applies the “escape fire” analogy to healthcare, exploring how our system is “burning,” while there are solutions right in front of us. Upon reading the manifesto for the first time, we realized how perfectly it fit our subject matter. We knew we had our title, and soon after we contacted him about taking part in our film.

As Dr. Berwick says in the film, “We’re in Mann Gulch. Healthcare, it’s in really bad trouble. The answer is among us. Can we please stop and think and make sense of the situation and get our way out of it?”\

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