HEALTH CARE/Joan Retsinas

Health Policy at the Movies

Although Oscar mania has passed, Americans’ enthusiasm for movies remains high. No wonder: the cinematic world is a glorified respite from real-life America.

Indeed, the hits cast a grim light on Health Care USA — an almost subliminal light, but discernible to a discerning eye.

Avatar and the Underinsured

Everybody older than age 6 has thrilled to the tale of Jake Scully, a wounded marine who goes undercover to infiltrate the Na’vi on Pandora, a planet rich in Unobtainium, which earthlings on our dying planet need. For Jake, the end is predictable: he becomes one of the “them.” We’ve seen that ending before. But the question to ponder: Why does Jake go undercover? Adventure? Patriotism? Greed? No. The reason is medical. Jake is a paraplegic, and his insurance won’t pay for new legs. To get those legs, he turns into a green-tailed creature.

Many Americans face the same dilemma as Jake. Medical science can help them (OK, it can’t cure paraplegia — that’s only in the movies), but they can’t pay for it. Either they have no insurance, or their insurance falls short. Unlike Jake, they don’t have the option of morphing into avatars.

Crazy Heart and Substance Abuse

Country music-lovers warmed to Bad Blake, a down-at-the-heels singer reduced to bartering songs for drinks in a bowling alley. The plot tracked his alcohol-fueled descent to the bottom. An axiom is that an addict must reach “bottom,” before embracing help. In the movie, once Bad asked for help, he got it. The ending is happy: Bad is sober, back on stage — a real one, not a bowling alley.

Outside the silver screen, substance abuse treatment is available — provided the addict, or an insurer, can pay. Publicly funded programs (they are not the plush residential facilities in Crazy Heart) have waiting lists. The movie doesn’t explain how Bad paid for treatment. Did his long-time friend put him on a group policy? Did his agent? At the start of the film Bad was broke — a true-to-life portrait of a man nearing bottom. The flesh-and-blood Bads don’t have as easy a time as the cinematic one climbing up from their bottoms.

It’s Complicated and Elective Procedures

The robustly healthy characters in It’s Complicated want medicine to give them more of the good life. Jake (Alec Baldwin) is a corporate attorney married to a trophy wife who wants a sibling for her 5-year old son. Long ago, in marriage #1 to Jane (Meryl Streep), he sired three children, so once upon a younger time he produced enough sperm. But now he wants — and can pay for — physicians to make him fertile once again. So, in one scene, he waits with other aging couples in a fertility clinic.

Meryl Streep, on the other hand, looks beautiful to her millions of fans. She wants to erase wrinkles. A dermatologist, who sees a patient-load of similar women, advises Meryl of the months of uncomfortable recuperation. Meryl demurs, not at the price tag, but at the recuperation. In the rarefied world of the cinematic Santa Barbara, people can pay for their heart’s desires, whether it is an addition to an already glorious house, sperm-enhancement, or wrinkle-reduction.

Even in real-life Santa Barbara, though, many people cannot have their medical hearts’ desires. Maids, waiters, construction workers are struggling to get the care that they desperately need. (In fact, the Wall Street Journal recently reported a drop in demand for cosmetic procedures: the recession has hit even the real-life Janes and Jakes.)

Julie and Julia and Obesity

It is Meryl Streep again, this time as Julia Child, paired with an adoring acolyte who blogged a year-long trek. Julie made all those succulently rich recipes that Julia introduced to American kitchens. In this movie everybody is eating, cooking, or talking about food. And nobody is obese.

Obesity in real-life America, however, is epidemic. We eat lots, a lot of the time; but unlike the movies’ protagonists, we are eating lots of non-nutritious fare, while staring at television. Julia Child shopped, chopped, and stirred. She savored meals, often as a prelude to some romantic time with her husband. As for Julie, she lived in a third-floor walk-up, and between working, cooking, and blogging, she filled her days (alas, she enjoyed far less romantic time with her mate). The duo ate fresh produce, seafood, meat, dairy (lots of butter). They didn’t gobble deep-fried snacks or processed food-stuff. Eating was the occasion for sharing not just food, but friendship and love.

In the movies we glimpse a world with no health care constraints, no pre-existing condition exclusions, no caps, no “no’s,” indeed, a world where nobody is obese. How wonderful if real-life rated five stars.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, April 15, 2010