FDL Movie Night: Money Driven Medicine
My mother was diagnosed with esophogeal cancer after spending months in the hospital with complications, including an antibiotic resistant bacterial infection and a feeding tube, after a series of operations. Back surgery for which she was not really a good candidate–osteoporosis, 50 years of smoking, decades of heavy drinking were all overlooked or downplayed–left her pretty much home bound and in as much pain as prior to surgery, just different pain, a year of her life lost to hospitals where more than once she was left tied to the bed moaning and thrashing from a urinary track infection until I got there and raised hell, where a rapid intubation (performed by a doctor in a hurry to get to Nancy Reagan’s house and check on her broken hip) caused Mom to be unable to swallow correctly for a month; ICUs; nursing facilities, and home health care.
When the cancer diagnosis came, we looked at the options and outcomes: Two to five years with treatment, two to five years without. And the treatments protocols were invasive, unpleasant and unwanted by her, as well as expensive, even with insurance. Her doctors were upset and unhappy that she said no to treatment. She was relieved I supported her decision.
Mom lived two years after her diagnosis, not happily, she was never very happy even when healthy, but without the agony of chemo and radiation, having to haul herself up and down the stairs to the car, wait in doctors’ offices and be more generally uncomfortable.
Even before that, I had a healthy cynicism towards modern medicine, towards doctors and hospitals. But recently I saw a county hospital treat the friends and family of a dying man with such dignity, grace and compassion, explaining options yet pointing out that even the most extreme measures had only the smallest chance in saving his life, and that the life that would be saved would not be even 1% of the person we knew before the stroke. This experience showed me what actual caring health care could be like, the love that is mentioned in tonight’s film selection Money Driven Medicine. Granted the insurance lady did ask us if the patient had a green card, but aside from that, the whole experience gave me hope for our health care system–if only all doctors and hospitals were that way.
Money Driven Medicine provides a thoughtful, deeply informative, patient-focused look at health care reform, stressing the need for human contact over dependence on technology, emphasizing that patients and doctors should build relationships on a primary care level and that the patient’s care and welfare should supercede all other concerns.
Money Driven Medicine points out a huge problem with the American health care system: Profits versus people. While doctors take the Hippocratic oath to never harm and to heal, health care corporations must care for their shareholders–which means making a profit and engaging in (unhealthy) competition. Within this model there is a disconnect, a disparity, between the money spent and health care indicators. And while we spend 16% of our GDP on health care, America has the same mortality rates as industrialized countries that spend less.
One of the doctors who wants to change this, Dr. Donald Berwick, president and CEO of the Institute for Healthcare Improvement says:
The United States doesn’t really have better care than other Western democracies. It just has more care.
And less of that care is in the primary care/general practitioner/family practice fields, points out Dr. Dan Larson in an interview for the film. Higher pay for specialists raises costs, but lowers preventative care providers.
As Money Driven Medicine points out, America we as country believe more is better, and that technology can solve almost every thing, and our infatuation with healthcare technologies surpassed our emphasis on the basics: Healthy food, clean air and water, exercise.
Our dependence on the newest latest developments doesn’t always serve the best ends, as Dr. James Wienstein sadly discovered when his oldest daughter developed leukemia. He was threatened with a lawsuit by the treating hospital if their protocols were not followed. Now the director of the Dartmouth Institute for Health Policy and Clinical Practice, Dr Weinstein stresses that involving patients in their treatment and allowing them to make informed decisions–as opposed to pressuring and persuading them–leads to lower costs, a drop in surgery rates and increases in satisfaction and better outcomes.
But lower costs and a drop in surgery rates don’t translate into in profits for corporations which run the hospitals which are in constant competition to attract doctors and patients.
And as Lisa Lindell discovered when her husband was badly burned at work, the care at a one of the country’s finest corporate-run hospitals was subpar. Her husband nearly died and then almost lost his eyesight due to medical errors and neglect. She has since become an advocate for patient care and for “mandatory national public reporting” of medical errors, rather than keeping malpractice settlements under a seal of confidentiality–by some estimates, medical errors and preventable infections kill four times as many people annually as roadway crashes, and accurate reporting could help hold hospitals accountable.
One of tonight’s guests, Maggie Mahar, the author of Money-Driven Medicine: The Real Reason Health Care Costs So Much provides an insightful narrative thread through the film. Mahar collaborated with a group of documentary filmmakers led by Alex Gibney (“Taxi to the Dark Side” and “Enron: The Smartest Guys in the Room”) to create the film. She explains a basic flaw in out health care system:
Up to one third of the more than $2 trillion that we spend [on health care] is wasted on ineffective, often unproven procedures, overpriced drugs and devices that are no better than the drugs and devices that they’re replacing.
Innovations don’t necessarily translate to better care. And while Republicans rail that the government needs to stay out health care, it’s a smart bet that keeping purely profit-driven corporations reigned in is one way to lower costs and provide better care for patients.