Film maker Paul Hochfeld, MD, doesn't fantasize about festivals or fame. He doesn't long for an Oscar. In fact, Dr. Hochfeld really doesn't want to entertain anyone. What the Oregon emergency physician (and part-time movie maker/colorful activist) does want is to educate his fellow Americans and stir up a little debate about the nation's “embarrassing disaster” that is health care.
Dr. Hochfeld's Health, Money & Fear is a 47-minute documentary-styled indictment of the world's most expensive health care “non-system,” a massive, multi-billion-dollar and woefully inefficient factory whose many entities are in desperate need of a single coordinator, the doctor said. The film, rolled out in April 2008 as Hochfeld's political advocacy and personal creative indulgence, also slams medical companies whose lobbyists, the movie maintains, have helped to all but destroy what used to be a profession focused on people, not profit.
The film criticizes technology companies for driving costs, insurance companies for operating inefficiently and pharmaceutical companies' mass marketing for trying to, well, convince any healthy young man he suffers from erectile dysfunction, and patients—especially the insured whose medical care is largely paid for—for blithely contributing to the crisis by demanding expensive testing and unnecessary treatment.
“There is a great conduit of wealth flowing in the wrong direction,” Dr. Hochfeld said in a recent interview. “…Lobbyists are absolutely in charge of health care.”
The current system, he says, represents the worst of capitalism and the worst of socialism: capitalism because huge sums of money are funneling into the wrong places as political donations and lobbying dollars are “investing in future profits,” and socialism because the smoker gets another stent. And the only way to get that cash flow under control, and at least start fixing an industry that leaves behind more than 40 million uninsured at great risk, is for voters to boot out of office those politicians who take part in that profit-driven political system and give at least one of the reins to the government, Dr. Hochfeld argues.
Struggles
Dr. Hochfeld acknowledged single-payer is struggling, failing to reel in political backing in many corners, including the White House, which has not supported major proposals calling for the plan. President Barack Obama, who has said in the past he supported single-payer as the preferred from-scratch reform, apparently is shifting the debate to structure of care and insurance. In a June 2, 2009 letter to Senators Edward Kennedy and Max Baucus, Obama said the nation “must attack root causes of the inflation in health care” and pointed to medical centers around the nation that offer the highest quality care at prices below national norm. He is, however, heavily backing the “public option” plan, a Medicare-like approach to compete with private insurance plans, contending it would “make the health care market more competitive and keep insurance companies honest.”
Dr. Hochfeld acknowledges single payer has little support. One reason, he contends, is that many people simply have a “deep, deep distrust of the government” and will forever reject any move to give it more power.
Reaction to the Film
Marcia Angell, MD, of Harvard Medical School and a former editor for the New England Journal of Medicine, blames the nation's political process for hijacking progress. Dr. Angell said she agreed to participate in the movie because she was “impressed with Paul Hochfeld's credentials and seriousness,” and that she was “very, very pleased” with the project.
Some industry leaders maintain that while Dr. Hochfeld indeed presents a unique delivery of health care issues with his documentary format, it simply repeats what others have said time and again. Further, said Rick Wade, senior vice president for strategic communications for the American Hospital Association, Dr. Hochfeld's proposed vote-based, political solution and single-payer system oversimplify the complexities of the problems.
“If, overnight, a law was passed for single-payer and everyone was insured, we would still have a myriad of problems,” Wade said. “…Our nation's health care problems are multi-layered, and a political solution alone won't fix them.”
Wade added there is too little consensus among parties of influence on, for instance, how to measure the quality of care, and there is no organized method to address which treatment choices are best for such chronic illnesses as diabetes.
But for Dr. Hochfeld, it's more about a personal calling to do what he sees as the right thing–to educate ordinary citizens about their broken health care system—than it is to direct the industry's “choir,” as he puts it.
Genesis of a Documentary
After nearly 30 years in the emergency department, Dr. Hochfeld grew tired of unnecessary and costly testing on patients who often simply need to go home, take the aspirin or rest the leg and call the doc in the morning–not every headache needs a CT scan, he opined. Dr. Hochfeld was further frustrated by “unethical” spending of huge sums of money on end-of-life treatment of especially the elderly, whose departures might've been more gently handled by nature.
Then he saw an award-winning documentary, Why We Fight, which examines how the military industrial complex influences policy. He did not experience a “eureka” moment, but he felt a passionate ping to “do something.” He wanted to educate voters about the broken system currently funded nearly 60% by taxpayers, and prod doctors, namely emergency physicians who have a unique point of observation treating the millions of uninsured, to take a political stand as the “voice of reason.” He pleads with emergency physicians to “speak the truth and become politically active,” he said recently. “Come to the debate as a citizen and not a stakeholder.” The film can be viewed online and purchased for a $25 donation at www.ourailinghealthcare.com. It's also posted on YouTube under the same name.
Dr. Hochfeld committed months of his time, $13,000 of his own money (family and friends donated another $5,000 and Universal Health Care of Oregon gave him $2,000) and got the cameras rolling. He never considered donating his money to a political action committee—part of the appeal was the creative expression afforded in making the film. The film's 17 chapters trace the evolution of health care in America, expose the power of politics and profits behind the scenes, examine the layers of issues and propose solutions. It is primarily composed of back-to-back interviews, conducted by Dr. Hochfeld, with some of medicine's intellectuals–doctors, policy experts, politicians.
Spread his Word
But when Dr. Hochfeld rolled out his film he did not launch a formal public relations campaign to get his message out to the people, and mainstream media have failed to bite his “one-man” hook. “I am really frustrated in getting media coverage, actually,” the doctor said. “I'm having a very hard time finding an audience that is not already part of the choir.”
Perhaps big news programs just aren't impressed with the work, Dr. Hochfeld wonders. “Maybe the video is not quite good enough,” he said. “Maybe I'm too small.” Then Dr. Hochfeld, sounding frustrated, noted that media companies make a lot of money from medical advertisements.
Call for Change
The movie calls for a single-payer system with the government at the center of patients, physicians and the slew of medical companies/services and claiming a potential savings of up to 25%. The film also advocates for malpractice reform, a national electronic medical records system (like VA hospitals now have), education for the public on end-of-life issues (Dr. Hochfeld is working on that movie now; it's due out in a few weeks) and the value of primary care doctors for preventive medicine.
The solution, the film maintains, is political. Voters are urged to contact their members of Congress and insist on change in exchange for support at the ballots. Dr. Hochfeld considers himself politically independent and considered voting for John McCain in the presidential election for his reform promises. But McCain wavered, Dr. Hochfeld said, and once again he voted for a Democrat. He is not, however, sanguine about the new administration.
“The noise coming out of Washington is more of the same,” he said. “One could argue we're not going to fix the health care system until we fix our political system. I'm concerned. The only way to fix it is through election reform.”
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