One of the best documentaries I saw at the Sundance Film Festival in January was Escape Fire, a look at doctors, patients, and hospital administrators who are trying to bend the curve on health care, both by looking at costs and insurance, but even more importantly, at what we get for our money and our insurance. From Sgt. Robert Yates, who makes the decision to kick his addiction to pain medication after suffering serious combat injuries in Afghanistan and recovers with the help of alternative therapies as part of the military’s grappling with overprescription, to Dr. Erin Martin, who moves from clinic to clinic looking for a way to practice patient-centric medicine and to focus on outcomes rather than services, the movie raises questions far beyond the problems addressed by the Affordable Care Act. I spoke with the movie’s co-director Matthew Heineman about how to tackle some of the biggest, hardest changes in health care. This interview has been edited for clarity and length.
There are a lot of different stories in this movie—in a way, it reminded me of reading through Atul Gwande’s archives at The New Yorker. How did you find your subjects for the movie? And here there any who didn’t make the cut?
I think from day one, Susan [Frömke, Heinman's co-director] and I started making the film about three years ago as the health care debate was heating up. Like so many Americans, we were so confused about all the rhetoric, all the hyperbole. Health care was dividing our country. We wanted to cut through that and find out why our system was so broken, and who was out there trying to change it? We ddn’t want to make a film that was just about the problem, we wanted to be about solutions. We found characters and storylines who looked at the story through different angles…Like many films that we’ve done, we spent six to eight months doing research before we even turned on the camera…It was a pretty organic process. We met a few of our experts early on in that process, Dr. Andy Weil and Dr. Dean Ornish, and through them met some of our subjects…It’s a really complicated, wonky subject. So we know we also had to make it interesting, make it entertaining. We didn’t just want to make a film with a bunch of talking heads. We knew we wanted powerful, human stories that would carry the narrative, so at all times, that was in the back of our heads, how can we find characters that tell larger truths about our health care system, but that also have some sort of narrative arc. We found that in Dr. Martin, the primary care physician that’s struggling in a system that’s preventing her from practicing the way she wants to practice, and to find a place where she can practice the kind of medicine she wants to, [in] Sgt. Yates.
So much of the focus of our debate over health care reform is about getting people the insurance that will let them pay for care. But Escape Fire seems to be oriented towards the next debate: what it is that we’re paying for in the first place. I loved Sgt. Yates story because it got at the heart of what our expectations are for our care, and what we’re open to.
Completely. I think health care is incredibly, incredibly important. But i think the key question that our film presents is access to what? Access to a disease care or a health care system? Access to expensive care, to high-tech care, or oriented towards health care and patient-centered care? So many of these films are preach to the choir and are so partisan. We really didn’t want to make a partisan film. We wanted to make a film that would bring all stake-holders to the table…We screened the film at 62 medical schools. Last week we screened it at the Pentagon. And I think what we’ve found is that change doesn’t really have to come from Washington, change can really come at the local level, community by community, and hospital by hospital.