Interview: Matthew Heineman of the Health Care Documentary, “Escape Fire”

“Escape Fire” is a new documentary about what does not work in our system for preventing and treating illness, and what some people are doing to make it better.  I spoke to Matthew Heineman, co-director and co-producer of the film.

Tell me about the reactions you have been getting from people who see this film.

I think one of the most inspiring things for us is to really see what happens when a local community screens the film. Just two weeks ago we screened the film at 62 medical schools across the country, all on one night.  There is an outpouring of optimism, that this is a problem that we can fix, a problem that we don’t have to wait, necessarily, for someone to come in from Washington, that change can really happen on the local level, sort of doctor-by-doctor community, system-by-system, and that’s how change can happen quickly.  One of the real goals of the film is to transform how our country views health and habit.  Medical school is the future, so their response is important.  We also screened last week at the Pentagon, hosted by the U.S. Army Surgeon General, and have sort of a room full of leadership generals and medical leadership at the Pentagon. And again, they recognize this problem that they have with over-medication, recognize that the status quo’s not working, and the Surgeon General said herself that she really thinks that this film can help change the culture of medicine in the army to begin with, but hopefully with the military at large. So it’s pretty amazing, we’re already seeing impact happening.

A big light-bulb moment for me comes fairly early in the film when somebody says, “We don’t have a healthcare system, we have a disease-management system.”

We did 6-8 months of research on the topic and almost everyone was saying that.  It’s a system that profits from sickness, not on health. 75% of healthcare costs go to preventable diseases, so how did this system come to be? Why did it not want to change? We wanted to try and find people out there who are trying to change it. Just to quickly mention one thing I didn’t say about your first question,

It seems to be that the problem which you touch on in the last part of the film, the inevitable corruption of corporate money and politics, is the real insoluble problem.  You can have the good will in the world and you can have all the data in the world, but when people are getting paid hundreds of millions of dollars under the current system, it’s very hard to get them to change it.

There’s no question about that.  As Andrew Weil says in our film, there’s rivers of money flowing to very few pockets, and the owners of those pockets don’t want to see anything changed.  I think what’s different now, and one of the reasons why we made the film is that things can’t get any worse.  We’re spending 2.7 trillion dollars a year on healthcare. That’s just a number, but when it comes down to individual companies or healthcare systems or cities or towns or small businesses or individual people, it’s bankrupting us. So, we’re being forced to change, we’re being forced to adapt, because what’s happening now is unsustainable.  We see that with the military in our film, we see that with Safeway Corporation in our film, we see that at the Cleveland clinic, that these major institutions are being forced to change, and so I think, yes, the system is making a lot of money out of the way things are, but many of the players in the system recognize how unsustainable it is and thus are being forced to change.

Your movie makes the case that when you spend more money it doesn’t necessarily correlate to better outcomes.

That was one of the most eye opening things for us.  In America we have this fascination with faster, bigger, better, now; we want the quick fix. We want that pill, we want that procedure, we view healthcare as something that somebody gives to us or does to us or something that we put in our throat, and I don’t think we really recognize that more isn’t necessarily better when it comes to healthcare, that more can often hurt us, that there’s this term called ‘over-treatment.”  We reward for quantity and not for quality. Doctors, we pay for the diabetics to get their foot amputated when they’re 60, but we don’t pay for simple nutritional counseling when they’re 20, 30 or 40 to prevent that from happening in the first place. It’s just a perverse system.

What got you interested in this as an issue?

We started the film three years ago just as the healthcare debate was heating up, and I think like many Americans we were just confused by the traditional media coverage of the topic, I mean, it was so hyperbolic and so confusing; healthcare was really dividing our country. So, I think we really wanted to try to understand, systemically, how it was broken, why it was broken, but also highlight people out there who were trying to fix it.  So many films like this are just polemics, that you walk out of there, head hanging low and just hopeless, and I think we knew from day one that we didn’t want to do that. We also knew from day one that we wanted to have real, powerful human narratives that would provoke audiences to want to keep watching.

What can a movie do that an op-ed or book or politician could not do?

I’m obviously biased; I’m a film-maker. I think documentary film has the power to really bring an issue that to life, with real human stories in a way that facts or articles or tweets don’t or can’t.  What we really tried to do was make a film that would not only move you intellectually but move you viscerally.  We look at healthcare through a number of different lessons and through a number of different characters that I think almost anyone in American can identify with, at least one, two, three or all of our characters in this film and say, “I know somebody like that,” “that’s sort of like me.”  It is just the power of film to associate at a more visceral level with an issue. I think that’s what documentary has the power to do.

Why did you choose to name the film after a technique for stopping a forest fire by setting a small controlled “escape fire?”

Escape fire is a metaphor between our healthcare system and a forest fire from 1949 that happened in Mann Gulch, Montana.  The fire fighters were filled with hubris, with the latest and greatest technology, they thought they’d have it beat by 10 o’clock the next morning—then the wind shifted directions and they found themselves running down this hill for dear life.  The foreman, the leader of this group, came up with this ingenious idea on the spot, where he lit a match and he burned the area around him to consume the fuel, so that when the fire came over to them, he’d be safe in what is now known as an “Escape Fire.”  He called to allow his fellow smoke-jumpers to join him, but nobody listened, and they kept running up the hill.  They all died, but he survived, basically, unharmed. And I think it’s a really powerful metaphor because it shows that the status quo is so strong, especially in healthcare, it’s so easy to keep doing what we’re doing, and we’re making a lot of money continuing to do what we’re doing, but we really need to look outside the box and think outside the box to come up with an escape fire for our system.  Otherwise we’re doomed.