Le prix de la santé

Damaged Care is an excellent, must see movie which centers around the state of ethics in medical care and what happens when corporations get involved in medical decision making and make the bottom line take precedence over sound medical care. It delivers it's message both intelligently and poignantly, and without any over-dramatization; showing the dilemmas faced by the doctors, as well as, the plight of their patients. The script, acting, and direction were all realistic and superbly done. Laura Dern's performance as Dr. Linda Peeno is totally engrossing and believable. You'll stay riveted to the screen. Go see this movie, but be forewarned: even though most people are aware from the media or their own experience of what's going on today, watching this movie may make you become motivated enough to go out and help change things, if even in some small, personal way.

A pivotal point of this movie which raised my ire was when a self-righteous transplant surgeon accused the HMO of committing "murder" by its refusal to bankroll a one-million dollar heart transplant procedure. Suppose the HMO officer had countered by saying: "O.K., we'll put up half the money if your team at the hospital hospital agrees to do the procedure for half price"; hopefully that would have given the doctor pause for thought - I suspect in most cases the outraged retort might have been something like "no way! we're running a hospital not a charity!" The crux of the matter is that the progress of medical science has made it technically possible to treat more and more formerly fatal conditions, but it has not made it affordable in most cases. Is any health care provider morally obligated to treat a patient regardless of cost or patient circumstances - even if it deprives other patients of the care they need? Some years ago, the British National Heath Service was excoriated by the tabloid press for refusing to finance a second bone marrow transplant for a young cancer patient whose first transplant had failed. The NHS management team replied that there was about zero chance of another transplant saving the girl's life and what right did they have to spend another million pounds on just one patient and deprive thousands of other patients the care they needed. Utilitarianism is a theory of ethics based on quantitative maximization of good for society or humanity - sometimes summarized as "The greatest good for the greatest number." All health care professionals should remember this principle; there isn't ever going to be enough cash available to do everything you would wish to do. Medical ethics become comparatively simpler in an emergency situation, e.g. a war zone or terrorism situation - doctors use the triage system, i.e. separate the wounded into three groups: (a) the seriously wounded who can be helped with the resources available (b) those with slight wounds who will survive anyway without treatment (c) those so badly injured they will inevitably die even if treated. Start with group (a), continue with group (b) if resources permit, leave group (c) to die.

"Damaged Care" is an often-poignant, always compelling look at the true story of HMO whistle-blower Dr. Linda Peeno.

Laura Dern's portrayal of a somewhat naive and vulnerable Linda Peeno is outstanding, with excellent supporting work from a solid cast. (One odd bit of miscasting is James LeGros as her husband, Doug. Inches shorter -- and looking ten years younger -- LeGros' character seems no match for Laura Dern's Linda. It might have worked better for LeGros and to switch roles with Adam Arkin, who did a fine, if thankless, turn as a health-claims lawyer.) Michelle Clunie gave a good performance in the interesting minor role of Linda's antagonistic secretary, Gemma, along with Suki Kaiser's underplayed (how could it be otherwise?) Dawn Dubose.

The lovely, haunting musical score and poetic narration cleanly underline and enhance this well-written, well-acted drama. Beyond that, the clear and present dangers of HMO practices that "Damaged Care" warns about are all too real. That alone would make this a must-see movie of 2002, though it offers much more.

Look for this one in the Emmy nominations.

In 1980, Linda Peeno (Laura Dern) is a student doctor who witnesses excessive procedures for the insurance money. In 1987, she joins Humana as a medical reviewer. She and her husband have a blended family. She believes in filtering out the excessive medical work, but she soon discovers that managed care is less about medicine and more about business. She is forced to deny a man a life saving heart transplant. She is congratulated for saving the company half a million dollar which is about the cost of their new sculpture. She would eventually become a whistleblower against the industry.

This is an advocacy movie on Showtime. While it is informative, it is not necessarily dramatic. It is also about timing. By 2002, the subject matter is well considered and HMOs are already the uber-villains. It is interesting to see the business priorities that permeates the environment.

This movie wasn't a blockbuster though it did make an important point about US health care with its rising cost and declining quality. This made for TV movie portrays an honorable doc called to be the hatchet - woman for the dishonorable insurer out to save its Yankee green. Theee is much feel good liberal predictability in the denouement. To an extent the movie does show how doctors are willing conspirators or accomplices in the process. The acting flagged in places but overall the film did portray the essential ethical conflict between being a doctor and being the hatchet person kaboshing medical procedures treating doctors thought necessary. Too much feel - good liberalism enters the picture. In real life, insurers have little trouble finding replacements for such as the honest doc portrayed here and few docs if any ever become whistle blowers.