Rising healthcare costs a 'bitter pill' to swallow

A brain surgeon isn't required to tell you the healthcare system in the United States is vastly overpriced and inherently unfair.

Vivekanand Palavali, M.D., took the job anyway.

A neurosurgeon trained at the University of Chicago who practices in the gritty environs of Flint, Mich., Palavali has spent the past 13 months single-handedly crafting "Bitter Pill: America & Healthcare In America." It examines the reasons why the nation's healthcare system is so expensive and fails to cover tens of millions of people.

I spoke with Palavali last week, and just finished watching a nearly completed version of "Bitter Pill" Tuesday afternoon. He should be lauded for a remarkable accomplishment. "Bitter Pill" isn't perfect--it focuses a little too much on the nation's economic conditions and falls short of convincingly tying them into his general thesis. Palavali also is too much in thrall with the Occupy movement, which has faded out of public view.

Otherwise, "Bitter Pill" packs into less than two hours a clear-eyed critique of all the ills of healthcare delivery I've been discussing in this space over the past two years.

And from the roughly 20 interviews Palavali conducted-which included physicians, academics and working people trying to obtain healthcare or struggling to pay for it--he extracted two astonishing yet unilaterally opposed revelations.

On one pole is an uninsured patient of Palavali's who broke her neck in a roller skating accident. After receiving more than $100,000 in bills for her care and being rejected by numerous state programs to cover the cost, Palavali asked her opinion of the Affordable Care Act.

"Now that there's ObamaCare, the system definitely needs to be fixed," she said.

On the other pole is someone only identified as "Malibu." She's a hostess at an unidentified "gentleman's club" in Las Vegas who recounted how spinal surgeons and other doctors regularly visit as guests of surgical supply and pharmaceutical companies--and are given everything they ask for. In exchange, those companies get first crack as the physician's suppliers.

That is among the reasons, Palavali concluded, why medical devices such as orthopedic screws are at least five times more expensive in the United States than anywhere else in the world.

"When your spine gets screwed in America, you wallet gets screwed too," said Palavali in the documentary (who served not only as the film's cameraman and director but narrator as well). That's a remarkably courageous statement from someone who practices in a specialty where some of his colleagues earn millions of dollars a year gaming the Medicare program.

Overall, "Bitter Pill" makes a cogent thesis about how the modern U.S. healthcare system evolved from its nonprofit origins in the 1930s to its current corporate, bottom-line culture. All the necessary culprits are discussed, including not-for-profit hospital CEOs who are paid millions of dollars a year, the administrative costs piled on by health plans, corporate lobbyists and the wide array of politicians who use disinformation to scare their constituents into thinking European healthcare systems are not only incompetent but also downright evil. Which, despite the contrary exhortations from my readers, is exactly why someone with a broken neck and no insurance believes the ACA is bad.

By the way, Palavali is no big fan of the ACA himself. He noted that while it is goodhearted, it gives too much away to insurance companies and does virtually nothing to tame soaring costs.

To go the extra mile, Palavali interviewed citizens and healthcare experts in France, Sweden, Denmark, the United Kingdom and the Netherlands. They're all highly satisfied with their healthcare systems (and seemed much healthier-looking as well). By contrast, few Americans he spoke to seemed happy.

One Swede pinpointed the reason why: "Money makes the choice for them," she said.

Palavali also traveled to his native India. He noted healthcare delivery there is segmented between patients who are wealthy and those who are not. He is able to make a strong comparison between a country with huge swathes of poverty and the wealthiest nation on earth. He does this by finding an Indian and an American suffering from cancer. Both are homeless and are unable to obtain proper care. Palavali found the American, Whitney Haynes, sitting on a street near Harvard University. Palavali slyly used an establishing shot for that interview of a rowing team sculling in the nearby Charles River.

I asked Palavali what inspired him to put an obviously staggering amount of work into this project.

"In the past few years, I have seen so many patients who used to have good insurance, who have lost their jobs," he said, noting that the number of uninsured he has treated went from 15 percent of his practice to about 30 percent. Nevertheless, he still kept on treating them.

"I began asking myself, 'isn't anyone ashamed?' America is the richest, powerful nation in the world," he said. "It spends close to $3 trillion a year on healthcare. Where is the money going to?"

Palavali owns two digital cameras, dabbles in oil painting and previously made a documentary about spirituality. To him, focusing on how he earns a living seemed a natural next step.

Palavali concludes that the U.S. healthcare system is motivated primarily by greed. As a result, he advocates for a single-payer system in the documentary. He examines two of them currently operating in the United States: Medicare and the Veterans Administration. Like the Europeans, everyone who is enrolled in them seems satisfied with the care they receive. He also looked briefly into the single-payer system slowly being cobbled together in Vermont.

Inevitably, the comparison to another documentary filmmaker from Flint popped up. "Roger & Me," Michael Moore's first cinematic effort, turned out to be the most important film about the United States made during the 1980s. In some ways it's even more relevant today than when it was released nearly a quarter of a century ago.

"I have a tremendous respect for Michael Moore," Palavali said, but he begged off any direct comparisons--both in the interview and, as it turned out, in the introduction to "Bitter Pill." He also noted Moore has always had the backing of either powerful movie studios or distributors such as Harvey Weinstein.

There's also another difference. "Bitter Pill" is actually a better effort than Moore's investigation of the healthcare system, 2007's "Sicko." It is far more matter-of-fact, lacks its smug self-satisfaction, and isn't silted with propagandistic stunts such as taking Americans to Cuba for checkups.

At the moment, "Bitter Pill's" entire release has been confined to a single preview in the Flint area. There is no distributor as of now, though there definitely should be. It distills the complexity of healthcare delivery and finance down to a mainstream audience, something this country sorely needs.

"Bitter Pill's" creator, however, seems aware of the uncertainty of making a living in the film business. He instead plans to continue fixing brains one at a time rather than en masse.

"I cannot ignore my day job," Palavali said. - Ron (@FierceHealth)