Educational Media Reviews Online

According to its directors, this feature-length documentary has the ambitious goal of helping to catalyze a paradigm shift in the way our country views health and healing and to empower citizens to push for “escape fire” changes in what these filmmakers view as our almost broken “disease care” system. They also hope the film will motivate viewers to take better control over their personal health. Using extended interviews with nine different healthcare leaders and experts on different aspects of this flawed system and the stories of three patients and a frustrated primary care doctor, the film illustrates a broad range of significant problems that are fueling out-of-control cost increases and escalating rates of poorly controlled chronic disease. These include the entrenched system of very profitable drug, medical device and insurance companies as well as hospitals that resist change with the aid of powerful Washington lobbyists; the overmedication and overtreatment of patients with consequent high costs and often poor outcomes; and fee-for-service payments based strictly on the number of patients providers diagnose and treat rather than how well they understand their patients’ health behaviors and counsel them on strategies to keep well.

The film’s title comes from a speech given by Dr. Donald Berwick when he became director of the Center for Medicaid and Medicare Services in 2010. He compared the situation of our healthcare system to that faced by the team of firefighters who were trying to outrun a wind-fueled wall of flames in the 1949 Montana Man Gulch fire. Their foreman, Wag Dodge, recognized that they would not make it, so he quickly invented a solution: he bent down and set fire to the grass directly in front of him and stepped into the middle of the newly burnt area, calling for his crew to join him. They ignored Dodge, clinging to what they had been taught, and continued to try to outrun the fire and were killed, while Dodge survived, nearly unharmed. Today the “escape fire” strategy Dodge invented is standard practice. As Berwick says in the film, “We’re in a healthcare Mann Gulch; our system is in really bad trouble. The answer is among us. Can we please stop, think, make sense of the situation, and find our way out of it?”

This film has excellent production values drawing on the extensive documentary film expertise of director-producers Matthew Heineman and Susan Froemke and photographer Wolfgang Held, who between them have six Emmy awards or nominations and an Academy Award nomination. The film has also been distributed in theatres and has won many film festival awards (best documentary, audience, human rights, social issues, etc.). Nevertheless, for this viewer, the film suffers somewhat from its very ambitious goals. With so many different fragments of interviews with many different healthcare leaders and experts, interspersed with the patient and physician stories, it can be confusing and a bit overwhelming to keep track of the various complex problems and potential solutions the film presents. For this reason, the film will be most suitable for college or university students or well-educated adults concerned about the future of our healthcare system.