Diaz Hendropriyono
Washington, DC
I have just finished watching a movie called John Q, which i rented from NetFlix. I like the movie so much that I have seen it for a few times. This movie reminds me of the problems that I found in the U.S. health care system: Access, Cost, and Quality.
John Q. Archibald, played by my favorite actor Denzel Washington, is a behind-on-bills metal worker who has just been cut to half-time hours due to the recession and who has been out of luck looking for a second job. The income that he makes as a part-time worker and his wife, Denise, as a cashier at a grocery store apparently is not enough to financially support the family that they even need to let their car got reposed by the bank just so that they can pay the house rent.
Their family problem started to get worse when their only son, nine-year-old Michael, collapsed when playing baseball. After being rushed to the hospital, Michael was found to be seriously ill and needed an emergency heart transplant. Should he not get the transplant immediately, he would soon die for heart failure.
After deciding on the high-risk surgery, to their surprise, the hospital told them that John’s insurance will not cover the cost of a procedure the magnitude of this transplant, costing $250,000, an outrageous amount that the family obviously cannot afford. With Denise not receiving any health insurance at all from her employer, the family must race with time to accumulate at least $75,000 as a down payment just to put Michael as a prospective recipient on the donor list.
Then, John went to his employer asking about his health insurance, in which he was told that the company will only pay for the maximum payout limit of $20,000 for the procedure because of the restrictions on his policy as a part-time employee. Desperately seeking for help, he went to the State Service only to find out that those who qualify for financial assistance must be on welfare. Both the Medicaid and the County Medical Assistance, whose offices he visited, were of no help either. The money he receives from selling his low-priced assets, contributions from his neighborhood, and church donation is still not enough, while the hospital is already planning to send Michael home after the $30,000 cost of his treatment left unpaid.
With time and options running out, John unexpectedly made a bold move. Using a gun, he took the emergency room hostage, with several patients and a doctor inside it. John’s request is quite clear: to put Michael’s name on the donor list to avoid a blood bath.
The movie carries a strong argument that the U.S. health care system faces three major problems: access, cost, and quality.
Access to Health Care
First, it fails to serve every American. It only caters to the rich and well-insured middle classes while denying quality care to the uninsured and the poor. The Census Bureau reported that the number of Americans without health insurance had jumped from 39.8 million in 2000 to 45.8 million in 2004. Unfortunately, this trend will likely continue into the foreseeable future.
The Lewin Group, a private health consulting firm, reported that among those uninsured Americans, the African-Americans and Hispanics are less likely to be insured than the Whites. The fact that the Arhcibalds are African-American may coincidentally portray the reality of inequality of access to health care. John’s limited access is shown, for example, when he went to the County Medical Assistance, where he was denied coverage simply because Michael’s condition is congenital: a birth defect which pre-dates existing coverage. This is a problem since many Americans have exclusions in their policy that deny coverage for treatments related to conditions that preexisted initiation of their present coverage. This means that the cost of the care they are most likely to need is not insured.
Cost of Health Care
At $5,000 per person per year, America spends 40 percent more dollars per capita on its health care than the next most expensive nation, and more than twice as much as most. The increase spending for health care is expected to increase continuously. It is even predicted that Americans would be spending about eighty percent of their GDP to health care by the mid-point of the twenty-first century, compared to only 5 percent when contemporary health care began in the 1950s. It is equally embarrassing to know that with the glut of funding, the U.S. is the only developed nation in the world that does not guarantee health care to its people.
The movie touches on the cost subject when the Archibalds were asked to give the down payment just to put Michael’s name on the donor list. Denise asks “our son is upstairs dying and all you can talk about is money?” To the Archibalds, it is shameful that the hospital could not do one operation in good faith after getting nice profits from performing over three hundred surgeries the year before.
Looking at this, it is easy to say that the goal of health care should not be to maximize profits. By focusing on profits for both insurance companies and hospitals, the cost of health care will continue to rise. It is precisely because of the “wrong” thinking adopted in health care that a citizen like John does not receive adequate health care.
The incredibly high cost of health care, or heart transplant in particular, that John faces is exactly what many Americans are facing. In fact, because of this expensive procedure many Americans have decided to go overseas to have a certain operation done for a better price and, often, a better medical treatment. In general, offshore medical procedures can be performed for as little as one-tenth the cost of what would normally be charged domestically.
For example, while Americans pay $55,000 for heart bypass surgery at a U.S. hospital, patients would only pay $6,000 for the same procedure in India. Obviously, this cost-saving has attracted many American patients to go to India. It is, thus, not surprising that the McKinsey Consulting group estimated medical tourism will bring about $2.1 billion revenues for India by 2012, especially after it has established world-class expertise in cardiac care, cosmetic surgery, dentistry, and joint replacements.
Quality of Health Care
Quality of health care has been debated that an increasing number of scholars have expressed concern about the potential for failing standards of care. Indeed, the average American does not reliably receive care of high quality. It is because of the low quality in health care that between 44,000 and 98,000 people die needlessly every year due to medical error.
Although John Q puts emphasis more on cost and access as problems, it also shows that quality is a problem in health care. When the Archibalds were told that the hospital needed the big sum of money to do the surgery, John’s thinking of moving Michael to a county hospital for a cheaper cost was quickly discouraged by the hospital administrative supervisor. She ensured him that Hope Memorial is the better place to do the operation than the low quality county hospital, whose surgeons are not as well-trained as those at Hope Memorial.
Another major problem displaying the deficiency of health care quality that John Q shows is a common disrespect towards patients. For example, John was not even told that his employer switched to a different, less costly, carrier.
What the Movie Shows
John Q perfectly shows several major health care problems that each one represents an actual challenge in the sector. Indeed these problems have existed for years that many scholars have advocated for a fundamental reform in health care but continued to face numerous barriers that prevent it from getting implemented.
John Q shows us the complexity of the health care system during a conversation at the emergency room between male nurse Leo Maguire and the rest of the hostages, in which Leo says:
"You see, here's the problem, on the one hand, you've got your insurance companies who basically want you healthy or dead. That's how they make money. On the other hand, you've got your medical establishment, doctors, pharmaceutical companies, who don't want you healthy. They want you sick. That's the way they make money… and the individual is caught in the middle of this gigantic tug-of-war. It's a game. And the end result is, people don't get the treatment they deserve."
John Q also points out how much bureaucracy is involved in health care policy. So much that it impedes the processes. For example, when John asked Dr. Turner to give recommendations to put Michael’s name on the recipient list, the latter only said, “I am only a physician. I don’t make policy decisions…I make recommendations, all the time. Yet, the final decision rests with the board of trustees.” Additionally, John was upset with the bureaucracy in health care when he met his insurance representative and was told to file an appeal, which would take seven working days—a long process, indeed. He even got more irritated when the hospital administrator told him that he should have filed for another procedure instead, called grievance (since an appeal is only for an already existing claim)—which would take thirty business days. These two examples illustrate that health care policy is full with “red-tape” bureaucracy. Procedures must be followed. None would argue against such statement. Yet, in an emergency, often these procedures slow down the processes that they will produce unfavorable results, including low quality, high cost, inequality, access, and even the loss of life.
John Q has become a reminder to the public as well as policy makers of several major problems in health care that need to be reformed.
