The documentary Money-Driven Medicine: What Ails American Healthcare and How to Heal It was inspired by the successful book by financial reporter Maggie Mahar with the same lead title.* Mahar is just one of a group of experts on the health care system and physicians whose insights make this 86-minute documentary worth watching.
The film opens with quick, slick cuts from brief expert commentary to surgery in progress to clips from ads to political speeches, conveying the emotional charge of ongoing debates about the U.S. system of health care. Nashville, a little-recognized national center of health care business and practice, appears frequently in the film, in comments by physicians (Dr. Ursula Norfleet and Dr. John Nixon) at the city's public hospital, Metro General (affiliated with Meharry Medical College); Dr. Keith Junior, a physician at the city's largest group of federally qualified community health centers (United Neighborhood Health Centers); and scholars, including Dr. Larry Churchill, a bioethicist at Vanderbilt University; as well as in shots of the city's Music Row (the music industry's business and recording center), Lower Broadway (center for the city's tourist honky-tonk trade), and numerous hospitals (Metro General, Baptist, Centennial, Vanderbilt, St. Thomas). The film also includes commentary on the massive health care industry that has been spawned in Nashville and nationwide by the multi-billion dollar Hospital Corporation of America (HCA), long owned by the family of former Tennessee Senator, Dr. Bill Frist.
The viewer must listen carefully during this film since the ideas that are conveyed are both complex and of great practical importance. Happily, the producers have assembled an A-list of experts and assembled their remarks in an even, comprehensible flow. The hour and a half one spends watching the film is richly rewarded. Among other luminaries who insightfully analyze such matters as chronic disease care, the effect of payment systems on what care is delivered, and compensation differences among specialties is Dr. Donald Berwick, recently appointed by President Obama to lead the Centers for Medicare and Medicaid Services (CMS). A pediatrician, Dr. Berwick founded and [End Page 1408] ran the Institute for Healthcare Improvement before moving to CMS after his recess appointment by Obama this year.
Maggie Mahar and Dr. Rashi Fein (a professor of medical economics at Harvard who has been directly involved in health care reform since President Harry Truman attempted it) both argue convincingly that the U.S. health care system has been fundamentally shaped by how money changes hands: hospital CEOs must fill beds with paying customers; high-tech services attract high-paying patients and are often the site of investments for that reason rather than for their cost-effectiveness in promoting good health generally; the spectre of malpractice claims leads to medical procedures that undivided attention to the health of the patient might not entail; end-of-life care, the source of much Medicare spending, varies widely from one region to another, although outcomes do not.
In all of these and other respects, Money-Driven Medicine repays the attentive viewer with a clearly told story about how the U.S. health care system has come to cost so much for such inconsistent results. That clear story has definite implications for how the country can overhaul its health care system, many of which go beyond the important changes that will grow out of the recently passed Patient Protection and Affordable Care Act (Pub.L. 111-148, 124 Stat. 119).
The producers have made four different length versions available on one DVD, which enhances its flexibility, enabling it to be used more effectively everywhere from conferences to community dialogues to medical student education to staff straining to organizing and coalition building. See www.moneydrivenmedicine.org for several useful backgrounders, briefs, and additional resources, along with tips on how to use the DVD. [End Page 1409]