POV: Critical Condition

And what about the two million to three million insurance industry employees whose sole job it is to turn down claims? Well, I have a plan for them: It’s called unemployment. What country in its right mind would pay millions of people to deny other people health care?

–Barbara Ehrenreich, “Healthcare Surrender Monkeys” (21 September 2007)

Propose a national health care program to cover everyone, or invest a mere $7 billion per year over five years to expand the children’s health insurance program? Sounds like “each according to need” Marxism. But spend several times that amount to bail out AIG, the nation’s largest insurance company? That’s, um, market stabilization.

–Alex Koppelman, “War Room” (23 September 2008)

Karen Dove started feeling pain “in the lower stomach area” five months before she could see a doctor. “A lot of doctors wouldn’t see me,” says, “because I didn’t have insurance.” At last, she calls the cancer Society in Austin, Texas, sees an oncologist, and learns her fate. She has to have her cancerous ovaries removed — soon. Karen has Stage 3C cancer, her doctor tells her stunned family, then adds, “Most people with this stage of cancer die of their cancer.”

Karen’s story is one of four told in Roger Weisberg’s documentary, Critical Condition, the first film of POV‘s new season, premiering 30 September on PBS. None has health insurance and all are facing catastrophic health concerns. Heart-wrenching and infuriating, their experiences repeat basic themes: for lack of coverage, they are unable to pay for care or medication, and so muddle through pain and difficulties, until their conditions are so acute that they must seek treatment. At this point, their problems shift focus: not only are they dealing with physical trouble, but now they face dire financial straits, owing many thousands of dollars. Following her surgery, Karen works over her bills at the kitchen table, her fingers tapping numbers into a handheld calculator as her husband Ronnie hovers over her shoulder. She confesses that she’s turned off the phone to avoid collecting agencies. Determined and overwhelmed, Karen says, “When you don’t have insurance, you always have to worry, how long is your resources gonna last?”

The movie makes a less aggressive but more affecting argument than Sicko. Where Michael Moore’s film points out differences between national health care systems and the cruelties of the U.S. structure in particular, Weisberg’s offers a devastating critique of systemic health care denial by following his subjects through their daily efforts to find relief, work, or counsel. If the dramatically dissolving graphics and cheesy soundtrack music occasionally recall a Lifetime movie, the film maintains effective focus on the details of each subject’s experience.

Joe Stornaiuolo, a doorman for 15 years now unable to work because of incapacitating cirrhosis of the liver, compounded by diabetes, for years tried to get by without the proper medication because he and his wife Dale couldn’t afford it. When he was let go, he lost his insurance, of course, which has left him with painfully swollen limbs and still, no access to medication. “I don’t want to live like this,” he sighs. “I can’t get social security because I’m too young, I can’t get welfare because I make a little it too much.” And now he’s facing some $50-60,000 in medical bills. (A liver transplant, at $200,000, is out of the question.) “If Joe had insurance,” Dale says, “he would never would have had to skimp on his medication,” making up his own course of treatment, using the same needles eight or nine times. As Joe’s body fills with fluid, the hospital becomes his primary source of treatment. “Hospitals typically charge uninsured patients two and a half times what they charge privately insured patients,” the film reveals.

Patients’ status as insured or uninsured can change without much warning. Hector Cardenas, a warehouse manager in L.A., is suffering from a gangrenous foot and diabetes. Though his doctor thinks he can save his foot, Hector has had to take time off work to get his treatment, and now, if he doesn’t get back to work by the end of the year, he will lose his job and his coverage. He agrees to have the foot removed, but complications in treatment and prosthetics fitting mean he cannot get back to work on time and so he loses his insurance anyway. When an administrator informs him that he has been “retroactively disenrolled” from his plan, despite the fact that he had approval to get the surgery, Hector is furious and frustrated. “I can only imagine,” says the administrator, shaking her head.

Carlos Benitez, a chef at a French restaurant in L.A. with a family and a salary of $45,000 a year, is also uninsured. For years, he’s treated the pain in his spine by taking Tylenol and other over-the-counter medications, so much that he’s suffered internal bleeding (he says he’s been “filling my stomach with flames”). At the start of the film, he has this condition treated, but learns he has ankylosing spondylitis, a progressive inflammation of the spine that leads to fusion of vertebrae. He is increasingly bent over and hunch-backed, having lost seven inches in height during the years he’s gone untreated. The surgery will cost at least $150,000: “If I had insurance,” he says, “I think someone would pay more attention.”

When Carlos does finally get a chance to have the surgery, Dr. Nick Shamie, a Professor of Spine Surgery who oversees his care, observes that he’s uniquely lucky, “because he’s met the right people at the right time.” Shamie and Dr. Patrick Dowling, chair of the UCLA Department of Family Medicine, perform the work for free. “For Carlos,” Shamie confesses, “being part of this documentary, he’s getting more attention than the average patient.” While Carlos’ pregnant wife thanks God for the miracle of his treatment, Carlos thanks “the media.”