Does the fact that The Diving Bell and The Butterfly won the Golden Globe award for the best foreign movie tell us anything about French health care? Or does it tell us more about movies about health care, the artistic French vs. “The Ugly American”?
For the upcoming Academy Awards, Michael Moore’s health care movie, SiCKO, has been nominated for Best Documentary Feature and The Diving Bell and the Butterfly, which was not eligible for best foreign movie under the Academy rules, was nominated for four Oscars: best director, best cinematography, best film editing, and best adapted screenplay. That cluster of nominations should tell you something about the quality of the film. But since this is a health policy blog and not a movie site, we should move past the awards shows and ask what the two movies can tell us about perceptions of health care, or health policy in the United States and in France.
Actually, very little of The Diving Bell and The Butterfly is set in environment allowing direct comparisons to SiCKO. The movie, and book on which it is based, are set in an old nineteenth-century naval hospital facing the English Channel, transformed into what in the U.S. would be a long-term care or rehab facility for people with traumatic brain and spinal injuries. To use a local reference, it would be as if the Kennedy Krieger Institute in Baltimore were actually an antebellum mansion on Maryland’s Eastern Shore, presided over by the ghost of a nineteenth-century patroness, perhaps someone like Fanny Kemble, since the U.S. did not have empresses like Eugénie, the patroness of The Diving Bell’s hospital at Berck in France.
If this story were taking place in the American health care system, the patient and family would have already navigated a complex and fragmented system trying to figure out what kind of insurance would pay for which facility and which treatments. SiCKO never gets that far into the chronic care continuum; it highlights the problems Americans with insurance have in accessing health care at the first point of contact. SiCKO asks such questions as: Can you be admitted to this hospital? Will your insurance pay for this procedure? How much of the procedure and ensuing treatment is covered? Michael Moore’s movie never gets to the problems of long-term care.
The Diving Bell and the Butterfly, by contrast, skips over the debate surrounding access to the health care system. Instead, its hero, Jean-Dominique Bauby, is in a coma during the entire period of his primary hospitalization, and he only wakes up at the long-term care facility. Perhaps this is the point. Never once, in the book or in the movie, does anyone mention cost. No one seems to be worried about how to pay for Bauby’s care. t’s not that Bauby is a particularly religious person, thinking “don’t worry, God will provide,” or an incurable optimist. Rather, cost and access to care were simply never an issue. Yes, Bauby is an important person with connections, a well-known editor of a fashion magazine, but even in the U.S. that would not exempt him entirely from worries about health care cost.
In an amusing blog on The Huffington Post, Barry Levinson mused on how good the French health care system looked based on the movie. He extolled the fresh air and open windows of the hospital, the food, and the availability of attractive nurses. The book, however, is somewhat different. Bauby, in the book, writes about how many staff members seem unaware of both his needs and abilities, forget to make him comfortable, shut off a light, turn on a TV, or respond to alarms from the machine that regulates his feeding tube. Fortunately for him, it seems that a majority of the staff at Berck meet his needs, and a few extraordinary individuals unlock his ability to communicate.
Perhaps the one universal experience that many could share with Bauby is his encounter with an unfeeling ophthalmologist who sews up his right eye. The movie shows a doctor who never addresses his patient and assumes his patient has no opinions or feelings about the matter. In the book Bauby characterizes him as: “the very model of the couldn’t-care-less doctor: arrogant, brusque, sarcastic—the kind who summons his patients for 8:00 a.m., arrives at 9:00, and departs at 9:05 after giving each of them 45 seconds of his precious time.” The difference between Bauby and his American reader is that at least Bauby was not left fuming over the bill that arrived after those precious 45 seconds.