Great stories are often tragedies. This is one of those. With a careful and measured narrative style, Don Berwick - the former CMS Administrator - summarizes the story of a technique called "escape fire.” This technique was first described by James Fenimore Cooper in his 1827 novel The Prairie, but Don uses the more current version as discovered independently by Wagner (Wag) Dodge during a wildfire near Helena Montana.
Don’s summary version is designed to set the stage for the 99 min documentary – Escape Fire: The Fight to Rescue American Healthcare – which is scheduled for release this Friday - October 5th (select theaters nationwide, On Demand and on iTunes). Don's narration opens the film.
In 1949 a forest fire broke out in Mann Gulch Montana. Smokejumpers were parachuted in – a team of 15 headed by a foreman named Wag Dodge. The fire exploded – it was moving over 600 feet a minute – faster than most people can ever run and so 15 firefighters were trapped. Wag Dodge had an idea. He knew that they would lose the race back to the top of the ridge so he suddenly stopped. He lit a match and he lit a fire at his own feet. The fire spread around him. I imagine the other smokejumpers thought the guy was crazy. But his idea was this. If I burn the fuel around me – then when the fire comes and overtakes me – I’m safe – I’ll be in what came to be known as an escape fire. He tried to get the other smokejumpers to join him and nobody did. The fire overtook the crew killing 13 men and burning 3,200 acres. Wag Dodge survived nearly unharmed in his escape fire. It is just tragic to think of the answer being there but just in the moment not able to see it. That’s how embedded people come in the status quo. They can’t recognize an invention when it’s among them and they can’t give up their old habits. We’re in Mann Gulch. Healthcare is headed for really, really bad trouble. The answer is among us. Can we please stop and think and make sense of the situation and get our way out of it. It’s the same challenge.
The filmmakers were so captivated by this story that they chose to name the film after it. From here it follows the traditional - and compelling documentary style of threaded narratives. These, in turn, highlight specific ways in which our healthcare system is a raging wildfire driven by perverse economic incentives. A few examples:
- The cardiac patient who had 27 cardiac catherizations and more than 7 stents - without regard to her high cholesterol, diabetes and high blood pressure
- The immersive lifestyle program pioneered by Dean Ornish for reversing heart disease - which took 16 years to be approved for medicare reimbursement
- The infantryman returning from a 9-month tour in Afghanistan (during which his platoon of 23 was reduced to 8) clearly coming to grips with a new enemy - PTSD
- The primary care physician who's frustrated by the constant demands to "increase her productivity"
In each of these cases - and several others - the system is clearly, visibly and painfully broken. Interspersed with the story threads are comments by several leading healthcare activists who also share additional insights and statistics. Some of the (paraphrased) thoughts I captured were:
- Rescue care in America is second to none - at the expense of primary care for millions
- We have a disease care system that doesn't want you to die - and doesn't want you to get well
- Nutrition is clearly overlooked - and often omitted outright from most medical training
- Half of Americans will be diabetic or pre-diabetic in the next 10 years
- The calories are only cheap when you first buy them. In terms of our health - they wind up being the most expensive
The film has already won several prestigious awards and was an "Official Selection" at this years Sundance Film Festival.
As filmmakers - we were deeply affected by many of the personal stories - but the financial impact really hit home when we talked to Steven Burd [Chairman & CEO of Safeway]. Safeway spends over $1B a year on healthcare - and that number was going up by $100M every year. That just blew us away." Matthew Heineman – Filmmaker
Some of the shorter threads include brief interviews with patients at various stages of care.
Two of the patients in the documentary really highlighted the twin faces of our crazy health care system - the uninsured don't get the treatment they need, while the insured get way too much.” Shannon Brownlee – Film Commentator
As critical as the film is - there are some truly hopeful and inspiring stories. Like the story of Wag Dodge and his "escape fire," some of these do seem almost accidental in nature. That may also help to explain Don's philosophical and clearly forgiving view.
I don't blame anybody - they're just doing what makes sense and we have to change what makes sense. Don Berwick in Escape Fire
