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Week of 9.26.08

Interview: "Critical Condition"

NOW on PBS talks to award-winning producer Roger Weisberg ahead of the broadcast premiere of "Critical Condition," his latest documentary on America's ailing health care system. The film, told through the eyes and words of four ordinary Americans who are battling critical illnesses without health insurance, will air on P.O.V. on Tuesday, Sept. 30, 2008.

NOW: Why did you choose to make a film about Americans without health insurance?

Roger Weisberg Roger Weisberg (RW): Many of my previous documentaries have taken viewers inside the health care system, including "Sound and Fury," "What's Ailing Medicine," and "Our Children at Risk." In making "Critical Condition," my principal goal was to build on my previous body of work in order to contribute to this historically significant moment when the nation is debating how to extend health insurance coverage to all Americans. I keep returning to the problems of the uninsured, because the crisis continues to worsen. In 1980, when I produced my first PBS documentary on this issue, the nation spent $250 billion a year on health care and 29 million Americans lacked insurance. Today, we spend over $2 trillion—more than eight times what we spent in 1980—and well over 40 million Americans lack insurance. We've seen how recent films like "An Inconvenient Truth" can become an effective call to action. I would love for "Critical Condition" to play a similar role as the health care reform debate heats up.

NOW: In the film you put a human face on the nation's health care problems by following the emotional stories of four critically ill Americans using a cinema vérité style. Why did you take this approach?

RW: My previous productions on this subject were public affairs documentaries with lots of information, analysis, and talking head experts. I chose a cinema vérité style because I wanted viewers to vicariously experience the medical, financial, and emotional impact of being unable to obtain necessary health care. Instead of interviewing experts or policy makers who would tell viewers what to think, I wanted these disturbing stories to unfold through the experiences and words of our primary subjects. I believe that these narratives of uninsured patients in the midst of their own medical crises will engage viewers far more effectively than yet another recitation of grim facts and statistics. No matter how staggering it is to learn that 22,000 Americans die every year simply because they lack health insurance, that number is still only an abstract statistic. However, a single uninsured individual who dies prematurely after you've grown attached to him is a tragedy. Viewers cannot help feeling a sense of outrage while watching a loving husband and father lose his life because he cannot afford the medication or doctor visits he needs to manage his chronic disease.

NOW: Was there one character in the film that stood out for you?

RW: One of my favorite stories is that of Carlos Benitez, an uninsured chef at a French restaurant, who has a severe back deformity that has caused him 15 years of unbearable pain and taken seven inches off his height. After learning that the county hospital will not perform surgery, he becomes convinced that the only way to find an affordable cure is to travel to Mexico, where orthopedic specialists recommend he have surgery as soon as possible. Even though the cost in Mexico City is a fraction of what it would be in Los Angeles, he still can't afford the procedure or the time away from work. Carlos resigns himself to a life of chronic pain and deformity until he experiences what he calls a miracle. Dr. Patrick Dowling, the Chief of the Department of Family Medicine at UCLA, had seen Carlos at a local health fair where the doctor was supervising his medical students as they offered free check-ups to the public. Making a rare exception to the rule, Dr. Dowling arranged for a private orthopedic hospital and a team of surgeons to waive their $300,000 fees for Carlos's operation. Dr. Dowling is "very pleased that we could help this one individual out," but laments that "we can't do endless surgery on uninsured patients; it begs a national solution."

What I love about Carlos' story is that he is such a perfect example of a hard-working decent, honest man who plays by all the rules and still can't get desperately needed medical care. His story vividly illustrates our multi-tiered health care system, the access barriers faced by the uninsured, and the high cost of medical care in the U.S. versus other countries.

NOW: What did you learn about uninsured Americans by making this film that you didn't know before?

RW: I discovered a surprising degree of sadness, resignation, and even depression on the part of the people we profiled as they courageously battled serious illness without insurance. I would have expected more anger and outrage, but many of the subjects we followed seemed beaten by the system. They were hard-working citizens who became too ill to continue working, and consequently, lost their health insurance at the time when they needed it most. In some cases, I think they internalized the American ethic of personal responsibility, and assumed that if they couldn't get sorely needed medical attention, it must be through some fault or limitation of their own. Others simply gave up after being repeatedly denied medical care.

NOW: The number of uninsured dropped to 45.7 million in 2007 from 47 million in 2006, according to a Census Bureau report released in August. Is this a sign that health care for the uninsured is improving?

RW: The reason that the numbers of uninsured Americans dropped slightly in 2006 is that an increasing number of people were able to enroll in public programs like Medicaid and the State Children's Health Insurance Program. Still, the numbers of Americans that received employer-sponsored health insurance continued to decline. The current fiscal crisis, the swelling ranks of the unemployed, the budgetary constraints on public programs, and the ongoing erosion of employer based health insurance will invariably lead to greater numbers of uninsured Americans.

NOW: At one point during the film, you mentioned that there were additional costs not only to the patients, but also to the community. What are these additional costs?

RW: In the film we point out that the lost productivity, and increased morbidity and mortality of the uninsured costs the US economy up to $130 billion a year—more than the estimated cost to cover the uninsured. Also, when hospitals are overwhelmed with uninsured patients and can no longer afford to provide vital services like maternity or trauma care, both insured and uninsured patients are harmed. For example, according to the National Foundation for Trauma Care, the increasing burden of uninsured patients will cause the closing of 10 to 20 percent of the nation's trauma centers in the next few years.

NOW: What do you think American citizens need to know about this issue ahead of the presidential elections?

RW: The current system of paying 50 percent more on health care than any other country and not covering one out of six Americans is economically unsustainable and morally bankrupt. We all have to tell our elected officials that health care ought to be a right of citizenship in this country the way it is in every other western democracy. Congress of course has the power to legislate this kind of reform, but it's clearly going to require leadership from the President. Since health care accounts for one out of every six dollars spent in this country, any fundamental change will unsettle the stakeholders - doctors, hospitals, insurers, and pharmaceutical companies. But, the option of doing nothing is becoming less viable each year as costs soar, leaving increasing numbers of Americans uncovered.

NOW: What's your opinion of the Sen. McCain's and Sen. Obama's healthcare plans?

RW: Simply put, I think that Sen. Obama's plan envisions a greater role for the government. His plan is based on a system of shared responsibility where employers, individuals, and businesses all play a role in financing health care. There would be a mandate that all children are covered, and there would be government subsidies to enable low-income individuals to enroll in a broad range of health plans including a public program like Medicare.

Sen. McCain's plan relies on the tax code to try to create incentives for people to go out and buy insurance in the private insurance market. Sen. McCain would do away with the tax break given to companies for providing their workers with insurance, and instead his plan would give a tax credit to individuals to purchase their own coverage. Sen. McCain believes that increased competition in the medical marketplace will bring down costs, but he recognizes that individuals with pre-existing conditions will be excluded and has proposed government subsidized high risk pools to cover these individuals.

I believe that Sen. Obama's plan will cover more uninsured Americans and will get us much closer to the goal of universal coverage. I worry that Sen. McCain's plan will further accelerate to erosion of employer sponsored health insurance, which is how the majority of Americans are currently covered. I also worry that the McCain plan will put Americans with chronic diseases or other pre-existing conditions at much greater risk. Either they will be denied coverage in the individual health insurance market or be unable to afford the steep premiums, and I question whether the $2,500 tax credit he's offering individuals or the high-risk pools he envisions will make insurance accessible to these individuals who need coverage the most.

Related Links:

P.O.V: Basic Facts About the Uninsured

P.O.V.: Take Action

NOW: Health Care Meltdown

NOW: Children's Health Care Showdown

NOW: Michael Moore on "Sicko"