Escape Fire: Rescuing the American Health Care System

I teach Medical Ethics at Fitchburg State University, and so naturally the Nursing students thought that I would be a good fit for their panel discussion following a screening of Escape Fire: Rescuing the American Health Care System.  This documentary was released in 2012, and has some won some awards (Best Documentary Produced Within the Last Two Weeks About how Fucked Up Our Country Is, or something like that).  Those who know me better will be wondering, not without reason, what I could possibly have to contribute to a panel on the failings of our health care system, and the answer is: not much.  But I do have a few thoughts, which I’ll share here.

First, there is a complete disconnect between the documentaries that receive awards in this country and, well, this country.  Americans are so easily outraged by injustice on film, and yet–nothing changes.  (That’s not true–things change.  But not nearly as fast as you think they would given the outrage.)

Second, Escape Fire is an answer, so far as I can tell, to the following question: what happens when health care is treated as a commodity to be bought and sold on the ‘market,’ rather than as a critically important social good to which citizens might plausibly claim a right?  The answer?  Lots of bad things, including:

*People receive ‘care’ they don’t need.

*People who desperately need care don’t get it.

*We generate a perverse incentive, whereby those who are supposed to help us get better are given an economic incentive to keep us ill.

*We place disproportionate emphasis on acute response over prevention.

*Health care practitioners are alienated from their labor (to use a Marxian turn-of-phrase).

Right, ok.  The film does a really good job of showing how the commodification of health care leads to these bad consequences.  So, the argument is that we should completely de-privatize our health care system, right, and the difficult questions concern how to do that in a way that neither sacrifices efficiency nor runs roughshod over individual liberty?

Apparently, no–at least that’s not the conclusion urged by the filmmakers.  Rather, they suggest that we need to begin making better lifestyle choices, and that we need to see the American health care system for what it is–viz., a ‘disease-maintenance’ system, in the words of one of the documentary’s heroes, Dr. Andrew Weil.  Seeing this, we need to eat better, exercise regularly, give alternative medicine a chance, etc., etc.  That’ll show ’em.

I’m in a bit of a quandary, here.  On the one hand, if the filmmakers are right, and the SYSTEM is designed in such a way that all but the few lose, how can telling the majority to change their habits be the appropriate response, rather than, say, telling us to grab our pitchforks and storm the castles?  On the other hand, maybe there’s something to this approach–a kind of grassroots response to a dysfunctional system, one which is refreshingly apolitical in the sense that it doesn’t call for our recalcitrant politicians to effect any systemic changes.

In short: maybe the idea is: never mind trying to change the fact that health care is bought and sold.  Rather, do what you can to put yourself in a position where you don’t need to buy it.

I guess.  But it still seems like a lame response to me.  Which leaves me with the question:

What the hell am I going to say tomorrow? 

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3 Responses to Escape Fire: Rescuing the American Health Care System

  1. Josh says:

    Just off the cuff- what you should say is that that conclusion is pernicious neo-liberal ideological crap. Recommendations of “personal lifestyle changes” are usually just covers for the maintenance of for-profit structures. A simple comparison with other countries’ health care systems should show that there ARE structural ways that health care can be made better, and that though perhaps “personal responsibility” is part of that equation, that personal behavior can be affected through institutional change, etc. We live in a society that both values “personal responsibility” but also places ridiculously unrealistic demands on the part of people like mothers, who have 0 guaranteed paid maternity leave (vs weeks, months and even years in many European countries). Of course at that point, preventative care is hard to get people to use, so then they end up in the hospital – it’s hard to be “personally responsible” when you need to go to work 8-10 hours each day AND take care of your children. That’s just one example but it’s a dynamic that plays itself out in many settings.

  2. Josh says:

    Point out how “personal responsibility” is a rhetoric that things like the tobacco industry and the alcohol industry have always used to resist structural changes like advertising restrictions, anti-smoking education campaigns, etc.

  3. David says:

    –“Point out how “personal responsibility” is a rhetoric that things like the tobacco industry and the alcohol industry have always used to resist structural changes like advertising restrictions, anti-smoking education campaigns, etc.”

    That’s a good point. Alas, I didn’t think of it.

    I was perhaps a bit hard on the film. It’s ok, I guess, as a bit of consciousness-raising, but even here the message is pretty banal: eat better, exercise, etc., etc., and although people in the film call for systemic changes to a society/culture in which the poor cannot really afford to ‘eat better and exercise regularly,’ they don’t do much beyond calling for that change.

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