Health Care Experts React to Themes of Uninsured, Patients’ Rights in ‘John Q.’

"John Q." -- a movie about a father who takes a hospital hostage in an attempt to get a heart transplant for his son -- debuted last weekend as the top film in America, sparking debate in the media over patients' rights, the uninsured and organ transplant policies. The film centers on John Q. Archibald, a factory worker whose son needs a heart transplant. The fictional HMO offered by Archibald's employer has a $20,000 cap on benefits -- far below the $250,000 required for the son's heart transplant. The following is a recap of some recent newspaper articles that examined the health care issues raised by the film.

Dramatic License or Real Life?
The Philadelphia Inquirer examines the realism of "John Q." According to the Inquirer, although the situation is "highly unlikely," some people could encounter a "real-life dilemma similar" to that of the film's main character. The Inquirer reports that "it is possible" for a health plan to "exclude the type of coverage" Archibald needed for his son's heart transplant. However, when interviewed by the Inquirer, officials from Cigna Corp. said all its commercial health insurance policies would cover such a surgery, and officials from Aetna Inc. said "99.9%" of its 18 million customers had coverage that would cover the surgery. Susan Pisano, spokesperson for the American Association of Health Plans, said the "real roadblock" in getting a heart transplant is "the lack of available organs" (Lowe, Philadelphia Inquirer, 2/20). Before the film debuted, AAHP released an ad campaign implying that the managed care industry is not to blame for the 40 million people without health insurance in America (American Health Line, 2/14). The New York Times also questions whether the "John Q." plot "square[s] with real life." The Times reports that the film's director, Nick Cassavetes, employed consultants to ensure accuracy in the film, including transplant expert Dr. Mehmet Oz, director of the Columbia Presbyterian Center's Cardiovascular Institute, and health management expert Eric Price. However, according to organ transplant officials, the plot "went too far" when it denied a healthy child a heart transplant because of a lack of funds. According to the Times, health care experts say that "a real life John Q. would not have run out of options so quickly." The Times reports that all transplant centers have "full-time financial coordinators" to assist patients with their "financial options." In addition, blaming managed care "might have been a bit of a diversion," according to Oz. "They were creating an evil person. But there is no bad guy in the system. Insurers have defensible reasons for what they do," Oz said. Oz added that because of the "scarcity" of hearts, they often have to be rationed (Stryker, New York Times, 2/19).

Director's Personal Interest
The Washington Post last week profiled Cassavetes, reporting that "it's no leap" for the director to "imagine" the possibility of having a child in need of a transplant. Cassavetes' 14-year-old daughter, Sasha, has conjunctive heart disease and has undergone four heart operations and two back surgeries and still needs a heart transplant. Although Cassavetes "has been able to get good health care" for his daughter, the Post reports that he knows that's "not the case for a lot of people." Cassavetes said, "I have no gripe with the medical establishment. It's not their fault. We are not set up well as a system. There's a crack in the system. And it just happens to be 50 million people and getting wider" (Waxman, Washington Post, 2/16).

Translation into Policy?
CongressDaily last week questioned whether the film would have an effect on the patients' rights issue. When told of the movie, Rep. John Dingell (D-Mich.), said, "Anybody who has these matters exposed to them comes to support the patients' bill of rights" (Fulton, CongressDaily, 2/15). Addressing the issue of the uninsured, syndicated columnist Clarence Page writes that while "John Q." may be an "exaggerated ... melodrama," it does portray a "familiar nightmare: health plan anxiety." In a Newsday opinion piece, Page notes that President Bush unveiled his plan for a 10-year, $300 billion health care reform days before the opening of the film. Page said that the president's proposal "contains the seeds of an achievable compromise," and concludes, "The real question is whether Bush, who came somewhat reluctantly to the health care debate, can cut taxes, fight a war, raise defense spending and fix the cracks in our national health insurance system at the same time. Miracles like that don't even happen in the movies" (Page, Newsday, 2/19).