An interview with Matthew Heineman, director of ‘Escape Fire’

September 29, 2012

 

In 2009, when Congress began debating national health-care reform, filmmakers Matthew Heineman and Susan Froemke beginning work on a health-care documentary. Three years later - with the Affordable Care Act now passed - they are about to release the final product. “Escape Fire” follows a primary care doctor and military veteran to explore the challenges facing American health care and the potential solutions.

“Escape Fire” was an official selection of the 2012 Sundance Film Festival. It opens nationally in theaters on Oct. 5. I spoke with Heineman on Friday afternoon about the film, where the title came from and what these two stories tell us about the American health-care system. What follows is a transcript of our conversation, lightly edited for clarity and length.

Sarah Kliff: Your previous work as a filmmaker hasn’t been in health care. So I was hoping you could talk a bit about how you got interested in making a health policy documentary?

Matthew Heineman: Susan Froemke and I began work on this film about three years ago, just as the health-care debate was heating up. Like many Americans, we were confused by everything we were hearing. It had become such a political football that was being thrown back and forth. Frankly, the issue was dividing our country. We wanted to cut through it all -- how our system was broken and why it didn’t want to change. We were working on the film for three and a half years. Spanned the debate, the passage and everything that has happened since.

SK: Did the big health-care debate the country was having impact the making of the film?

MH: The fact this major health-care debate was happening while making this film, to some degree did and didn’t. Obviously, it has raised the profile of the issue; it’s become one of the most pressing issues facing Americans. We didn’t want to make a film that was tied to a certain piece of legislation, and [we] didn’t even know when the film would come out, whether the bill would be passed or not passed. There were so many X factors. So we really wanted to look at the systemic problems and how we create a sustainable health-care system.

SK: Tell me a bit about the title, “Escape Fire.” Doesn’t exactly sound like a health- care documentary title.

MH: For about a year and a half we had the title “A Tale of Two Systems,” which is probably the worst film title of all time. And then someone sent us an essay titled “Escape Fire: Lessons for the Future of the Health Care System,” by Dr. Don Berwick, [the former head of Medicare and Medicaid]. The minute we heard that, we know we had it. It was this perfect metaphor for the fact that we have this health-care system that is burning while a simple solution is right in front of us.

In 1949, there was a group of smoke-jumpers who were dropped off to fight a forest fire in Mann Gulch, Mont. They had the latest and greatest technology and thought they’d have the fire beat by 10 a.m. the next morning. The fire was spreading faster than they could run, and, about halfway up the hill, they realized they weren’t going to outrun it. The foreman of the crew, Wag Dodge, had an idea. He knew they wouldn’t make it, so he lit a match and burned the area around him. That ate up all the fuel for the fire. He knew he would be safe in what is now known as an escape fire. [The rest of the smoke-jumpers] ended up dying, and he survived unharmed.

It’s just a really strong metaphor that highlights how strong and powerful the status quo is, and the fact that we need to start looking outside the box to find ideas to fix this seemingly intractable problem.

SK: The health-care system is so big and sprawling. How did you think about fitting all that into one documentary?

MH: There are two huge hurdles One is that health care is a pretty boring, wonky topic. So how do you make it interesting? We knew from day one we wanted to not just have a chorus of experts but find human stories we can follow over time, to be attached to and continue to watch. We decided we would follow two stories that provide the backbone: One is the story of a struggling primary care doctor fighting to practice medicine in a system that is inhibiting the medicine she wants to practice. She’s being forced to see these patients in seven-minute appointments.

SK: I wanted to ask you about that narrative, about Dr. Erin Martin. By the end of the film, she still hasn’t found a clinic she’s happy with and is talking about the possibility of leaving medicine. I’m curious what you wanted the audience to take away from that.

MH: The narrative of Dr. Martin, as she searches to practice the medicine and  to have the time she wants for patients...I think its a sad story because there isn’t a lot of hope there. Because primary care doctors are really marginalized; it’s a really hard career path for medical students to follow. It’s much sexier with the amount of debt you’re in to go into some specialty care. That’s one of the problems we don’t have a solution for right now. But I hope we were able to highlight the problem. The flip-side of a problem is going to be a solution.

SK: The second narrative you follow is one of a veteran who is trying to reduce his dependence on narcotics. Why did you decide to include a large narrative on veteran’s health care?

MH: Then we also had a military strand, which was really powerful for us. We were able to use that as a microcosm. It was a powerful story because it showed this huge institution recognizing the problem but trying to think about the solutions. It not only provided the window, but big institutions can change. We’re really at a tipping point.

Just a few days ago, we screened the film at the Pentagon, where we were hosted by the army surgeon general. We had a room full of leaders at the military watching "Escape Fire." It showed not only that they're acknowledging the problem but also trying to fix it. 

SK: Without giving too much away, I think it’s fair to say that the narrative about the veteran ends up pretty optimistic, while the one on Dr. Martin is much less so. So I was curious to know how you came away from the project, whether you’re optimistic about the direction our health-care system is heading.

MH: I am optimistic because it can’t get any worse. I think there’s a problem here and a really powerful energy for wanting to change this. It doesn’t have to come from Washington. A lot of this is going to be doctor by doctor and patient by patient. As we learned from the experts in the film, we’re all in this together. To create a sustainable change, it’s not just change from Washington that we need. It’s all Americans. We need to be smarter consumers as patients.

SK: One area your film doesn’t touch is end-of-life health-care, which tends to be an large area of spending. Did you think about including that as an issue?

MH: Our goal was to create a conversation around health care and create not a one-sided conversation. So many of these films are so partisan and so hyperbolic that you just preach to the choir. We wanted to create a conversation amongst all the stakeholders. We tried to address the systemic issues. There are so many things we could have covered but can’t cover in a 90 minute. End-of-life care, that’s really a whole other film and such a hot-button topic.

SK: What surprised you the most in making this film?

MH: There were two things. The first was the military story. I would never think the military would be giving acupuncture to soldiers. That story was just a very pleasant surprise to us.

The other [surprise] was this idea of over-treatment  We have this fascination that more is better, and we what we learned was more isn’t better, that more care can actually hurt you. That fascination with the quick fix is often hurting us. One-third of health-care spending doesn’t even improve health care. So it was really surprising to us that was happening.

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