How can we cure our ailing health care system?
That was the question posed by the film “Escape Fire: The Fight to Rescue American Health Care.” The film was presented as part of the Center for Community Growth’s 2014 film series on Friday at the Indiana Theater along Philadelphia Street.
“American health care costs are rising so rapidly that they could reach $4.2 trillion annually, roughly 20 percent of our gross domestic product, within 10 years,” according to the film’s website. “We spend $300 billion a year on pharmaceutical drugs –– almost as much as the rest of the world combined. We pay more, yet our health outcomes are worse.”
[PHOTO: Peter Broad, left, moderated the panel discussion with Dr. Abigail Adams, IUP anthropology professor and medical anthropologist; Dr. Kim Hatcher, president of the Indiana County Medical Society; Lee Bevak, certified application counselor for the Affordable Care Act; and Elizabeth Sierminski, board member of Healthcare 4 All PA. (James J. Nestor/Gazette photo)]
Joining the film was a panel of four people, each with backgrounds in health care or health care policy. The panel consisted of Abigail Adams, IUP anthropology professor and medical anthropologist; Dr. Kim Hatcher, dermatologist and president of the Indiana County Medical Society; Lee Bevak, certified application counselor for the Affordable Care Act, with the Armstrong-Indiana Drug and Alcohol Commission; and Elizabeth Sierminski, Health Care 4 All PA development coordinator and board member and University of Pittsburgh student.
The panel was moderated by Peter Broad, an Indiana Borough councilman.
Initial comments were given by the panel prior to the beginning of the film, with a question-and-answer session held afterward.
“The U.S. spends more on health care per capita or as a percentage of gross domestic product than any other nation on earth,” Broad said, referring to the film’s premise. “At the same time we have some of the worst health care results when compared to other industrialized nations.”
Broad also cited high infant mortality rates and high obesity rates.
Adams urged the audience to go into the film thinking of health care as a business driven by economic demand. Health care has become a compartmentalized system dependent on having a large population of unhealthy individuals, she said. She also asked the audience to consider what she called “medical citizenship,” or “ideas of entitlement and deservedness that articulate what we deem to be the basic rights as citizens, what human rights are recognized as regarding health.”
“In the U.S., and pretty much globally, access to health care isn’t recognized as a human right,” she said.
Hatcher immediately commented on the claims that despite high spending on health care, the U.S. isn’t even in the top 20 in terms of life expectancy.
“It’s typical to try to relate the both, but that isn’t the case,” he said.
As a wealthy nation, we don’t have to spend as much on food, clothing and shelter, so more is left over to be spent on health care. Lifespan statistics can be affected by things like infant mortality, drug overdose deaths and homicide, which are prevalent in the U.S.
“Those are not saying we aren’t spending our health care dollars wisely,” he said. “Those are societal issues.”
Brevak explained she’s seen both sides of the spectrum while working to sign people up for coverage mandated by the Affordable Care Act.
“I have seen a majority of the people who come are between the ages of 50 and 64, because they get to have Medicare at the age of 65,” she said. “I have seen good, I have seen bad.”
Some people are able to get health care under the ACA, some have to be turned away because they are below the poverty line and must enroll under Medicaid.
Sierminski explained that Healthcare 4 All PA advocates for simplified payment systems.
“The fact of the matter is that the insurance companies and the payment system we have now are a mess,” she said. “Some people get their insurance through employers. There’s nonprofit insurance companies, for-profit insurance companies. Some people have Medicaid, some people have Medicare, some people are just paying out of pocket. All of these entities have developed mechanisms for getting people care.”
She said that there are more administrators per patients in hospitals than nurses due to the complicated process of figuring out who’s going to pay for what.
“Escape Fire” started with an explanation of the film’s title. The phrase was coined by Dr. Don Berwick in a speech made recharging the future of health care. He compared the health care system to a forest fire burning out of control. During one such fire in 1949, a team of firefighters found themselves trapped. The leader of the team decided to light a smaller fire to consume the materials around him, reasoning that if he stayed in this already burned area, the approaching fire wouldn’t be able to touch him. His risky maneuver paid off and he survived. Berwick claimed in the film that health care is in trouble, and we need to stop and make sense of the situation and find a way out.
The film addressed the system of health care as a revolving door of patients. Care providers receive payment based on the number of patients they see, not the care that is given. It’s a tradition of disease suppression and prolonged treatment where, at best, patients don’t die, but they don’t get better either, the film maintains.
Preventive medicine also typically takes a backseat to treatment-based medicine, according to the film, and these treatments are often broken into several specialties, with the system promoting specialized medicine over primary care. Hospital visits are often broken up among several specialized doctors, which can lead to unnecessary procedures when there is poor communication among the specialties.
A physician in the film explained she could get paid $1,500 for placing a heart stent, but only $15 for spending 45 minutes educating a patient on taking better care of himself.
The film also touched on the big business of medication, citing the case of the diabetes drug Avandia. Drug manufacturer GlaxoSmithKline failed to alert people to Avandia’s potential for causing heart attacks, leading to a lawsuit and an eventual $3 billion payout.
Alternative treatments were showcased, including Dr. Dean Ornish’s system of healthier living that showed lifestyle changes can significantly improve health. The film described how the Walter Reed military hospital is now using acupuncture and guided meditation as alternatives for multiple prescriptions. Even grocery giant Safeway offers health care discounts to employees who show they lead healthier lifestyles.
In the question and answer period that followed, Adams said she liked the ideas about change in lifestyle and how we all can promote health.
“One of my critiques in the Safeway context is this is still in the framework of economic gain,” she said. “There were these dueling narratives of bettering health, but … a corporation being motivated by paying less for health care.”
Hatcher explained that reimbursement is a key issue, and there is a need for more reimbursement for preventive and primary care.
“Getting reimbursed to previously talk to a patient about losing weight or a multiple of issues was very low,” he said, “and in medicine there is a greater reimbursement for procedural things than cognitive things.”
The panel agreed that how to create motivated patients and get society to shift to taking care of themselves was the “million dollar question.” Hatcher explained he advocates the three E’s to patients looking to lose weight: exercise, eating healthy and enthusiasm. But often, he explained, the enthusiasm isn’t there.
“The other important piece in the puzzle is to eat healthy in this nation is a privilege,” Adams said. “It costs a lot more to buy organic and healthy foods than to buy foods that have empty calories. There are many other variables, not just personal will.”