What does "Jurassic Park" have to do with managed care?
Well, both are filled with monsters that scare the daylights out of viewing audiences.
Laura Dern, the blond, lanky actress whose character couldn't get enough of dinosaurs, has now turned to the high-tech jungle of modern medicine in the Showtime movie "Damaged Care," which airs tomorrow and June 4 at 8 p.m. on Showtime.
It is a devastating portrait of a health-care system run amok. From shots of lavish corporate headquarters to touching scenes at the bedside, the movie conveys a simple message: Health care in the United States is all about money. The system is skewed toward limiting and denying care to patients to enhance the health plan's bottom line.
Even scarier is that while "Damaged Care" is dramatic fiction, the story is about a real physician: Linda Peeno of Louisville. The former medical reviewer for several managed care plans is now a celebrity critic. She has twice testified before Congress on the flaws of managed care. She lectures on medical ethics and has been an expert witness on behalf of patients who have sued their managed-care plan.
"I'm not a wild-eyed anti-managed-care activist," says Peeno, who understands "the necessity of some management of care."
But as she told Congress: "The health-care industry systematically causes patient harm. What we call 'managed care' is an organized system of limitation and denial -- an unprecedented, market-driven system of rationing medical resources."
The managed-care industry, naturally, is appalled by the movie. It disputes the way cases are portrayed and decries the greedy Godzilla stereotype of those who work in health plans.
"Our view is that this fits into the old kind of health debate that relied on blame-gaming, finger-pointing and the hatchet job at a time when people are looking for real solutions," says Susan Pisano, director of communications for the American Association of Health Plans.
Can this country's marriage with managed care be saved?
The risk is that "Damaged Care" will merely intensify the slugfest between pro- and anti-managed-care forces. The movie already is being championed by advocates for a single-payer universal health care system. Certainly the big-bully view of managed care will appeal to anyone who has been put on hold by an insurance company.
The hope is that it can help prod the public into confronting the current meltdown in the health-care system.
All medical care in the United States is "managed care," whether it is administered through an HMO, a PPO or a more traditional plan. Bottom-line behavior is found in both profit and nonprofit plans. Many of the problems dramatized in "Damaged Care" are issues that the industry is also raising, namely:
Costs. Economics matters. Medical costs are rising. Insurance premiums are soaring nearly 15 percent a year. The temporary solution has been to shift costs to the consumer in the form of co-pays, deductibles and out-of-pocket expenses for uncovered services and drugs. The burden falls on individuals who get sick and have to pay an increasing share of the bill. Meanwhile, nearly 40 million Americans have no insurance. The public is about to cry foul. There has to be a new debate on ways to tame inflation without compromising the welfare of patients.
Coverage. In "Damaged Care," a man dies after his request for payment of a heart transplant is denied. (The industry says the man didn't die on the operating table waiting for a transplant, but lived another 2 1/2 years.) Peeno believes she is responsible for his death because she denied the claim. As she told Congress in 1996: "I am haunted by the thousands of pieces of paper on which I have written that deadly word: DENIED." Still, the movie makes clear that the patient's benefit package excluded heart transplants. Who's really to blame here -- the managed care company or the employer that chose this specific policy with the exclusions, presumably for a lower premium? There needs to be some consensus on a standard benefit package to protect consumers from fine-print surprises when it comes to lifesaving treatments.
Accountability. The trend in many states is to establish independent panels to review disputed decisions denying payment for treatment. The alternative is litigation. The movie portrays a Florida family that sues its plan for dropping services for a son with special needs. After much heartbreak and expense, the case is settled out of court. There needs to be a system other than litigation for consumers to appeal decisions and monitor quality in their plan.
Flexibility. "Damaged Care" shows how Peeno fights her colleagues to approve a voice-assist machine for a nurse, age 31, who suffered a massive stroke and could not speak. The request probably could have been denied on grounds that it wasn't "medically necessary" or that the machine wasn't covered. But Peeno argues that this device would not only improve quality of life, but would save dollars in the long run.
This scene captures what consumers want: decisions based on good medicine and concern for the patient. What they fear are arbitrary decisions made primarily on short-term economic grounds.
Watching the first part of the movie makes Peeno very sad. In the beginning, she is surrounded by a proud husband and laughing children. She is excited about starting a new job in managed care. Then both her marriage and her career unravel. "Medicine was not what I had thought. Marriage was not what I was led to believe," she says now.
"It's a deep kind of sadness. It's a loss of innocence."
Perhaps that's what all of us are experiencing with health care these days. A decade ago, we rejected the Clinton initiative to overhaul medicine and put our hopes in the marketplace and this thing called managed care.
Now we're realizing that the system still needs fixing.
Abigail Trafford is a columnist and writer for The Washington Post.
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