An escape fire is a swath of grassland intentionally ignited to protect humans from an oncoming blaze. Escape Fire: The Fight to Rescue American Healthcare, which premiered at Sundance this week, argues that we need to do something equally drastic if we are to save the economy from the health care system. While everyone knows health care is broken, the filmmakers go further, portraying health care itself as an out of control system, one which, if left unfixed, will burn until it consumes everything in its path.
Several elements, as the film demonstrates, make health care costs grow uncontrollably. Providers, who are paid on a fee-for-service basis for the most part, want to provide more care, whether it’s needed or not. Since patients often switch insurers, there is little incentive to invest in prevention, which might save money. And finally patients—us—actually want more care than even the most fortunate are already getting, because we have come to believe that it will be good for us.
The final ingredient is a health care lobby with two simple goals: Block any law that cuts costs, and support only reforms that will increase health care spending. The 2003 prescription drug law—which both subsidizes drug purchases and bars the government from negotiating lower prices—is perhaps the greatest testament to the lobby’s efforts. But Obama’s health care law suffers from some of the same problems: By forcing everyone to buy health care, it also, ultimately increases costs. The result is a health care system that, to switch the metaphor, is growing like a cancer—now $2.7 trillion now dollars per year. The sheer volume of spending is not itself a problem; the problem is spending so much money while providing health outcomes that are well below the average for the developed world.
Other health care documentaries, like Michael Moore’s Sicko, focus on the individual tragedy of denied health care. And the focus of the Obama administration and some reformers has been extending coverage to everyone. But Escape Fire makes it clear that even if everyone had coverage, the system would still be out of control, with questionable benefit for the public’s health. This cancer may very well destroy its host.
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