Money And Medicine

Money And Medicine debuts tonight on PBS at 8 p.m. Eastern in most markets, but you should check local listings.

This is a disaster. A multi-billion dollar industry is causing untold physical and emotional damage to millions of Americans. Senators and ordinary citizens are up in arms about working out a financial deal that pleases everyone.

Wait, did you think I was talking about healthcare? No, no, this is a far bigger issue: NFL referees. A made-up game with made-up rules that artificially designated replacement arbitrators didn’t articulate in a way that satisfied people on Twitter. Forgive me for not caring all that much, but as the saying goes, we have bigger fish to fry, namely ballooning healthcare costs that threaten to take up so much of the federal budget that nothing else can enter the equation.

A documentary like Money And Medicine, while a complex and insightful conversation starter, isn’t going to light a passionate fire that gets more people vocally involved in advocating for larger health care reform. The basic premise of Money And Medicine is that we as a nation are grossly overspending on intrusive and potentially harmful minor procedures that are entirely unnecessary. To illustrate the difference in care, the doc compares Intermountain Medical Center in Salt Lake City to UCLA Medical Center in Los Angeles, where patients spend way more time in the hospital, see their doctors many more times, and incur incredibly expensive bills.

The doctors at UCLA and Intermountain offer their hospitals’ approaches to delivering babies, end-of-life care, and what we’ll call midlife screenings for high-profile diseases like breast and colon cancer. Intermountain argues that statistically, hospitals like UCLA are wasting epic amounts of money overusing C-sections, sustaining life far beyond what is comfortable, and performing unnecessary tests that lead to emotional pain and suffering when a patient wouldn’t otherwise need to worry about a potentially life-threatening illness.

One of the doctors at Intermountain points out that once the unnecessary screenings and tests are taken, if they see something they have to act on it no matter what. If they don’t, they leave themselves open to being sued. And even if they think a man has early-stage prostate cancer, perform invasive surgery that begets complications for the rest of the guy’s life, and it turns out he was never going to be that 1/15 whose life was saved by that procedure, he’s still going to think that the doctors did him a huge favor. The only way to prevent unnecessarily invasive care is to not do the tests. Prostate cancer and breast cancer are two examples of diseases that have entered popular consciousness as very pervasive and dangerous, but the data presented in Money And Medicine suggests that they have become poster children for overspending in medicine.

The best point Money And Medicine advocates for is that at some point, late in life, everyone needs to have a conversation with a physician—ideally a family doctor who has overseen care for a number of years—about an end-of-life plan. The goal here is to determine the best way to spend the last moments of life in comfort and dignity, surrounded by those you care about. Oh, and by the way, it will save the country billions of dollars. There’s a lot of moral grandstanding about the dignity issue, and yes, it is important, but the doctors at Intermountain also really like to trumpet the fact that they’re shaving off their own profits to do what they think is right. It’s admirable for sure, and the statistics other talking heads provide shows that they may be giving the same quality care as UCLA does while spending vastly less money, but squawking about it incessantly isn’t the way to make the point land with humility.

Some moments are incredibly tough to watch. One elderly woman sits in a hospital bed for 10 months after suffering multiple strokes, and her son insists that his mother would want every possible step taken to prolong her life, even as she struggles miserably to breathe and basically only lives because of machines. It’s a terrible way to live, but this guy believes in miracles. His mother racks up over $5 million in Medicare costs, and this guy has the audacity to view doctor’s trying to ramp down his mother’s care as euthanasia or a death panel. This is an extreme case to be sure, but there are also a lot of people out there who are just plain afraid to die, or want to take another gasping breath even if it means they have to suffer in vegetative pain.

Countries like Sweden and others with socialized medicine don’t let you take that, since they’ve begun to scale back cradle-to-the-grave medical care. In the United States, if you’ve got the money or the coverage, you can get hooked up to any number of machines and be supported by artificial means. But Intermountain and UCLA doctors agree that at some point miracles run out, and the best course of action for a comfortable death with dignity. As one doctor says, “I think there’s a disconnect between what we can do, and what we can do that helps.”

My father is a physician, so I get to hear about the state of hospital care and the health care debate with certain regularity. This is an incredibly complex moral and ethical issue that doesn’t do well in a binary discussion of simply providing or not providing care. UCLA clearly wastes a lot of money, but as their administrative representative says during the documentary, it’s all good and fine to criticize when looking at the bigger picture and a mountain of statistics, but when you get down to individual patients who are mothers, fathers, spouses, siblings, and children, it’s much harder to say what care is unnecessary.

For whatever reason, I can stomach hours and hours of this discussion because I’m kind of desensitized to the intensity of the unstoppable force/immovable object feeling on both sides of the debate. A documentary like this, with low production value, scare-tactic dramatic music, and information you’ve heard before but not quite this specifically, isn’t going to be a significant factor in changing anyone’s mind—but that’s not its purpose. Money And Medicine aims to start a conversation with an easy-to-approach comparison between two hospitals, but the problem is that this conversation has been chugging along strongly for decades without this kind of intervention.

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