America's sick healthcare system

A compelling PBS documentary explores the mess that Al Gore and George W. Bush refuse to confront.

By Beatrice Motamedi

Oct 16, 2000 | After watching "Critical Condition," journalist Hedrick Smith's damning, exhaustive documentary on America's healthcare crisis, I put down my remote and did two things.

I seriously considered moving to Canada. And then I thought about firing off a memo to Al Gore and George Bush.

See, the only thing that's sadder than Smith's three-hour saga of a healthcare system gone awry is knowing that neither Al nor George has the vision to fix it.

Unfortunately, when it comes right down to it, neither does Hedrick Smith. But at least he's willing to give this patient a thorough exam. Too bad "Critical Condition" wasn't broadcast much earlier in this campaign year -- or at least before the presidential debates -- when it could have given the whole healthcare discussion a giant shot in the arm. But even a day after this week's final chat-fest between the candidates, it's medicine that's well worth taking.

So here's my prescription for Al and George. This Wednesday evening, stop whatever you're doing, tune in to your local PBS station and watch this show. And don't forget the Tylenol. You're going to get a headache -- big-time.

First a note about Smith: Of all the journalists you could name, perhaps no one is better suited to document the sorry state of healthcare in America than he is, and not because he reports regularly on medicine or science (he doesn't).

What qualifies Smith, a two-time Pulitzer Prize winner and former New York Times foreign correspondent, is that he made his mark by pointing out the cracks in a decaying empire, the Soviet Union. His bestselling book, "The Russians," portrayed a people that didn't deserve the political system they got but seemed fatally destined to live with it. So Smith seems like the perfect choice for a documentary on another crumbling monolith -- America's ailing healthcare system.

Fast forward to "Critical Condition." Smith tackles a huge topic by carving it up: First, a look at America's "secret killer," namely the medical errors that plague modern healthcare; second, the plight of the chronically ill under managed care; third, an in-depth look at Kaiser Permanente, a relatively progressive HMO whose good intentions don't always guarantee positive outcomes; and finally, a segment on America's 42.6 million uninsured, whose numbers have dropped during the Clinton administration but whose very existence remains a national outrage.

Smith interviews dozens of patients and experts from New York to California and Tennessee to Texas. And no matter where he trains his lens, he digs up the same kinds of problems, over and over. And even where the system seems to be working, it's only a matter of time before Smith turns over another rock and you find out that things aren't as good as they look.

Take medical mistakes. They've been in the news since an Institute of Medicine report last year estimated medical mistakes cause up to 98,000 deaths a year. Even the usually sober British Medical Journal recently devoted an entire issue to comparing safety procedures in medicine with those in aviation. Statistically speaking, it appears, you're much more likely to get the wrong drug from your doctor than you are to lose your luggage on an airplane.

That's what happened to Claudie Holbrook. A survivor of the Korean War, he died of a blood clot after taking an overdose of Heparin, a blood-thinning drug. Questioned by Smith, his daughter Sandy Reynolds blames the Veterans Affairs Hospital in Lexington, Ky., for giving her father the wrong dosage and causing his death.

Remarkably, the hospital agrees. "I told the Holbrook family that we made the error that we believed contributed solely to his death," says Ginny Hamm, a hospital attorney. "We call it doing the right thing." The apology made a difference and defuses Reynolds' rage. "If they hadn't come forward, I would have wanted millions," she says. "I would have wanted to rip them apart," Reynolds says. Instead, she settled for just $50,000.

So far, so good. There's just one problem: Smith goes next door to the bigger and more prestigious University of Kentucky Chandler Medical Center. There, he finds an administrator who admires the V.A. but thinks its policy of apologizing to patients is nuts; to do that, he insists, would be like throwing his hospital to the malpractice wolves. "Our attorneys would feel that we had no intelligence left," he says.

Chronic illness is another paradox. In this country, as Smith notes, it's not smallpox and syphilis that are killing us; it's chronic illnesses such as cancer, diabetes, stroke and heart disease, which afflict some 100 million Americans. That's a challenge for HMOs, which like to talk about preventive care but cringe when the illness is long-term.

Humana, one of the nation's biggest HMOs, tries to cut costs and improve outcomes through a strategy it calls 'disease management.' Patients who have been diagnosed with a major chronic illness, such as heart disease, are closely monitored before, during and after treatment; nurses call patients at home to check on medications, offer advice and encourage patients to seek help if they have symptoms. Disease management programs have cut hospital visits for patients with congestive heart failure by 60 percent. One in 10 such patients die these days, compared with 1 in 5 before the program began.

But again, there's a twist: To pay for this new program, it turns out, Humana has cut off care to catastrophically ill patients, including Caitlin Chipps, a 12-year-old Florida girl with cerebral palsy.

After Humana refuses to pay for Caitlin's ongoing physical therapy bills, her father sues. Lawyers then discover that not only Caitlin but dozens of other such children have been cut loose by Humana in order to free more money for its disease management program, which apparently does not include kids who need help learning to walk. A Florida jury eventually awarded Caitlin's family $78.5 million -- ironically, notes Smith, "almost exactly the amount that Humana figured it would save" by eliminating care to Caitlin and others like her.

Next Page: Where's the vision thing?

• View blog reactions