DAMAGED CARE

REVIEWED BY BRETT WILLIS

Our rating: 4 out of 5

Because of: thematic elements, mild language

Rated:  

This is an outstandingly worthwhile docudrama, exposing the failure of the HMO system.

As an intern, Dr. Linda Peeno (Laura Dern) sees firsthand the “weakness” in the traditional fee-for-service practice of medicine. Namely, the greedy side of human nature. While most physicians treat patients conscientiously and often provide free care, there have always been a few who overcharged, over-treated and over-operated. While no administrative system can take greed out of the human heart, it’s possible that an effective method of oversight could curb the abuses. Linda (I’ll call her that, since her husband Doug is also a physician, an OB/GYN) wants to make healthcare better. And that’s just what she intends to do, years later, when she goes to work for an HMO as a “layer of management” between the Primary Care Physician and the patient.

Linda’s dream turns into a nightmare, as the “cure” is clearly worse than the disease. HMOs routinely deny payment for necessary procedures, to inflate their own profits. But when trying to lure a new group of physicians into their net, they’ll at first approve almost anything the physicians ask for, returning to their normal slash-and-burn tactics only when the physicians are safely in the fold. The practice of “capitation”—paying a physician a flat rate per patient, per year, so there’s a financial incentive to provide less care—creates an even more dangerous manifestation of greed than the traditional system did. And when an HMO takes over a company’s traditional health insurance plan, there are assurances that nothing will change, while behind the scenes a policy is in place to get rid of the subscribers with expensive conditions (those who need health insurance most). All of these abuses and more, plus an office culture that’s like a Communist Spy network, add up to a lot of stress and compromise for the well-meaning Linda.

Linda eventually quits jobs at two different HMOs, and then begins speaking out for reform and testifying as an expert witness on behalf of wronged patients. No more compromise on the issue of good patient care. But meanwhile, there’s a parallel compromise brewing. Linda and Doug rarely have time to interact with each other, and they both find interesting opposite-sex people to relate to in the course of their jobs. Doug seems over-friendly to one of the nurses, but we never get to see what they might be doing in private. One day, Doug “catches” Linda at a business lunch with a man, and blatantly accuses her of scr**ing him (other than a rare use of d* or h*, that’s the only foul language in the film). Although Linda is attached to that man in an emotional sense (they’re working together on an anti-HMO case), we suspect that Doug is projecting his own shortcomings onto Linda.

Eventually, Linda’s crusader activities create a backlash of political pressure on Doug’s practice. (He can’t very well hide in anonymity; how many other “Dr. Peeno’s” can there be in one city?) Then there are anonymous phone calls threatening to expose her husband’s indiscretions, or even to kill her entire family. But, she persists. And the jury in one of her cases awards the wronged HMO subscriber a landmark amount of punitive damages. Other than what’s been mentioned, there’s no sexual content and no profanity. Essentially no violence either, although we see some simulated injuries and medical emergencies. This is basically a single-minded drama about a subject of interest to nearly all of us. Well-done, informative, and worth your time.

According to the real-life Linda Peeno, the film is very accurate in detail, and almost every scene is underplayed (that is, things were actually worse than shown), not Hollywoodized. There’s a scene where Linda is pressured by her HMO employer, Humana, into denying a life-saving transplant, and then while leaving work she sees an art sculpture being installed in the building and is told that its cost is about equal to that of the transplant. All of that really happened, and the film doesn’t tell us that the actual cost of the sculpture was about eight times the figure Linda was given.

The film’s producers even allowed references to spiritual and ethical writers (Heschel, Merton, Havel) who influenced Linda to begin her campaign for reform. In discussions about HMO abuse, the only complaint I have is it that seems no one, not even Congress, is directly addressing the fact that HMOs are abusive by nature. The constant interference with the physician-patient relationship is simply wrong. The only “cure” is to wipe them out of existence, return to a fee-for-service system instead of wasting healthcare money on an extra “layer of management,” and create an effective system of reporting and disciplining physicians who misuse their practice for personal profit. And please don’t even think about government-run Socialized Medicine. That’s the only thing that could be worse than the HMO system. That’s my opinion, as a private citizen and a healthcare worker.

Getting back to the film... Rent it. Watch it. Learn from it. It’s worth your time.

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