"Escape Fire: The Fight to Rescue American Healthcare" opens with an anecdotal analogy that initially seems out of place in a documentary about health care systems. Dr. Don Berwick relates how a firefighter, while combatting an out of control forest fire, chose to set a fire around him in order to burn up the fuel and wait out the rampaging flames to escape unscathed. Quickly though, the film, directed by documentarians Matthew Heineman and Susan Froemke, establishes that the forest fire our nation currently faces is our inefficient, money-gobbling health care system, and the best idea might just be to torch the whole thing to the ground. This thesis is quickly laid out with a sense of extreme urgency in a title sequence that juxtaposes talking heads, statistics, news reports and footage of patients in hospitals in order to get us all on the same page: this health care system we’re working with ain’t cutting it.
After rapidly establishing this idea, the film then slows down to take a breather and focus on the human side of things-- humanity ends up becoming one of the central themes of the film, and for all the stats and accomplished physicians the film employs, where it really shines is in the intimate stories of transformation. We are taken to rural Oregon, where a young female primary care physician, Dr. Erin Martin, is completing her last day at the free clinic where she is pressured to meet a certain quota of patients, some of whom are in desperate need for long term care and counseling. Dr. Martin is expected to deal with everything from suicidal outbursts to advanced diabetes in 10-15 minutes or less, and it’s no surprise that she’s had enough of this overloaded system.
Interspersed with the personal stories are interviews with a host of talking heads from doctors and researchers to insurance representatives to medical journalists, all spelling out just how the system, which rewards physicians financially for procedures and not counsel, has turned into a disease-care system more than anything else. This billion-dollar industry sells high tech procedures and drugs to a population that gets continually more sick because of bad lifestyle choices and a lack of knowledge about how to police their decision-making. There’s a lot of technical ins and outs of the insurance and hospital and health care systems, but ultimately what it comes down to is this: doctors make more money on procedures, so there’s no reason why they might work with a patient over time to empower a healthy preventative lifestyle, when they could be hearing "ca-ching!" every time the symptoms of a chronic disease need to be treated.
As a model for how the system might change, the film looks not to foreign countries, but within, to the health care system of our military. The tale they tell is harrowing; the soldiers suffering from extreme cases of injury, PTSD and physical wear and tear on their bodies are given strong narcotics for the pain, which is basically unregulated between the different doctors and nurses they see. We follow one soldier, Robert Yates, on his way home from Afghanistan. Not only was he shot but suffered the loss of 15 members of his platoon in nine months, and when we meet him, he is stoned out of his mind on a cocktail of morphine and various other opiates on the air transport from Germany. His journey towards recovery illustrates how the military, out of sheer pragmatism, has turned to healing techniques such as acupuncture, meditation and yoga in order to relieve the stress and pain of these men. Not only are they curbing narcotic dependency and teaching them empowering techniques to heal themselves for a lifetime, but these procedures are relatively low-cost and low-tech.
As a documentary subject, Yates is pure gold. Eminently compelling and likable, the self-described Louisiana redneck is so emotionally open that everything that passes through his mind is externalized on his face and body. Whether he’s weeping over the loss of his friends on the air transport, or experiencing a flashback during a guided meditation, Yates serves the film well as our emotional anchor within the whirling dervish of health care policies, numbers, stats and research, and it is his hope at the end of the film that makes the audience hopeful for change. He says, “I’m changing. I’m not changed, but I’m changing.” And that’s the most important idea we have to take from this. It may be slow and steady, but the tides are turning on public opinion about lifestyle and preventable disease.
It’s a compelling film built on expert testimony, personal stories and solid research, but the one downfall might be that it could stand to be about 10 minutes shorter. While each example works beautifully, the film starts to feel a bit repetitive as it goes on. But it’s understandable why they might hammer the point home. It’s a call-to-action documentary that has an agenda and works it out so that the argument is airtight. But without much in the way of counter argument, yeah we get it.
Ultimately, while 'Escape Fire' proposes numerous options for changing the system-- getting Medicare to cover healthy lifestyle counseling programs, incentivizing doctors to spend time with patients, and patients to empower their own health-- the one that is most poignant is that people should spend the time to take care of each other. So many of the patients in the film look like they just need to talk to someone, and a moment where a meditation teacher takes a hand, or a doctor really listens to someone who is scared and stressed out, that’s where you can see the healing happen onscreen. Dr. Dean Ornish’s research about the effect of the reduction of stress on genetic material, and thus the reduction of the risk of cancer is pretty mind-blowing, and makes you realize just how physically sick stress can make you. And the fact that all of these solutions are patient-driven, low-cost and low-tech and are easily available to us makes the film a truly empowering social tool. So this weekend, take a chill pill and go for a run. Your body will love you for it. [B+]