Star Wars fans wait outside the TCL Chinese Theater one week before the release of “Star Wars: The Rise of Skywalker” movie in Hollywood,
The final film in the epic Star Wars saga, Star Wars: The Rise of Skywalker hit theaters this weekend and many of those fans are either yawning with disinterest or speculating on YouTube about just how bad the last installment in the 40-year-old series might be. The critics have panned the film in early reviews, with Rotten Tomatoes pegging the critical score at a meager 57%. What happened to Star Wars?
As a doctor, movie-lover and proud tech geek, I often see parallels between work and my other hobbies. In my last movie-themed article, Which Avengers Character Are You? I compared roles in the healthcare industry with the characters from this year’s biggest box office hit.
When I consider Star Wars, especially what has happened to the franchise after the Disney acquisition of Lucasfilm in 2013, some stark comparisons to the U.S. healthcare system come to mind. The system is in many ways fragmented, bloated with administrative expenses and if we’re candid, mismanaged at the macro-level. Star Wars has followed a similar path since the new Disney trilogy was launched in 2015 that, in my view, accounts for many of the problems that the franchise is currently suffering from.
Star Wars vs. the Medical System
If we rewind back to the first Star Wars, Episode IV: A New Hope, you’ll find a far different production than the $200 million extravaganzas produced by Disney. A New Hope debuted in the summer of 1977 and went on to become one of the highest-grossing films of all time. It featured a clear plot that pitted good against evil, realistic special effects and, most importantly, substantial character development inspired by timeless mythological storytelling. Moviegoers were thrilled, and many of them went back to the theaters to see Star Wars again and again. A New Hope was followed up by two excellent sequels that continued the saga in 1980 and ’83, both of which adhered closely to the formula established in the first film.
Fast forward 42 years, and you have a far different Star Wars. The basic elements of an action-adventure set in space are the same. Unfortunately, the iconic film series is now packed with a multitude of characters (some important, many that are not), and bloated storylines that ping-pongs viewers between concrete plot development and over-the-top action sequences. Some moviegoers are satisfied on the surface with the glitz and fancy CGI, but true fans of the series complain that their underlying expectations remain unmet by the fragmented stories and lackluster character development. Moreover, the new films now also incorporate current era political elements, that feel out of place in a story that is meant to transcend time.
The healthcare of the 1970s was, in many ways, the starting point for the system that we have today and I find that it has followed a similar course to Star Wars. The bill that laid the groundwork for what we now know as Medicare and Medicaid was being implemented, and President Richard Nixon unveiled his plan to require employers to offer health insurance to employees while providing subsidies to those who had trouble affording medical care. The U.S. healthcare system made sense. It was becoming clear, affordable for most people, and was set to provide the best medical care in the world. With these legislative imperatives, it appeared everyone’s healthcare needs were now going to be met.
However, like the current unraveling of Star Wars, the bloat of the healthcare system began to seep in. A subsequent bevy of new laws required more governance and more administrative staff to ensure compliance and reimbursement for medical services. One can chart the growth in how expensive US healthcare has become by simply looking at the growth of the ratio of administrators to doctors since the 1970s. According to HBR, there are now 10 administrators for every one doctor in the United States today. And 95 percent of new hires in healthcare aren’t doctors or nurses, they are administrative hires that have little to do with caring for patients. This represents a growth rate of over 3,200 percent from where we were in 1975:
By the late 1990s, national healthcare spending in the United States had skyrocketed and accounted for 12.1 percent of total GDP – the highest thus far in the history of the country. Fast forward to the 2010s and the introduction of the Patient Protection and Affordable Care Act, commonly known as the ACA. This law had the potential to dramatically improve the system. Unfortunately, this potential came along with new ACA requirements for Electronic Medical Records dramatically increasing workloads on physicians, with little discernible patient benefit. Moreover, expanded regulation and insurance benefits mandated by the ACA resulted in even more administrative expenses. While the ACA did successfully increase insurance coverage, the additional costs were often borne by patients in the private insurance market in the form of sky-rocketing insurance premiums and higher out-of-pocket deductibles. Today, the healthcare system now consumes an eye-popping 17.8 percent of GDP.
As was the case with the growth in Star Wars film budgets under Disney – bigger and more expensive didn’t necessarily translate into better. Bigger in healthcare has led to a reality in which my fellow doctors have their attention diverted into EMRs and away from patients, a situation that has contributed to an epidemic of physician job dissatisfaction and burn out.
The proceeding decade was one in which political divisions and competing reimbursement models created an ever more convoluted and fragmented approach. The system is again poised to be a political football in the 2020 presidential election. Recent polling suggests that healthcare is the number one concern among U.S. voters. It is tragic that the U.S. now ranks amongst the lowest among developed nations for healthcare, despite spending the most. This reality is shocking, given that the U.S. is widely acknowledged as having some of the best doctors in the world, along with the most advanced medical technologies and therapies.
As in the new Star Wars, which due to bad management decisions from the top of Lucasfilm, has had a rotating cast of directors and writers; there are too many competing stakeholders in the healthcare system for the average patient to even keep track. Even major tech companies are moving deeper into the industry, and have inadvertently ignited controversies over patient privacy. High drugs costs are another pain point, that many Americans simply can’t afford. Against this backdrop, it’s easy to see why the system leaves so many feeling insecure and vulnerable.
In the movie business, the focus should always be on the audience. Giving the audience a thrilling film that transported them to a galaxy “far, far away” is what made Star Wars successful in the first place. The analog in healthcare is a laser-focus on the patient. Delivering the best care possible is what made the U.S. healthcare system the envy of the world. With the potential re-thinking of the healthcare system in 2020, my hope is that we can regain that patient-focus by simply letting doctors do the work they love. And as for Star Wars, The Rise of Skywalker….smaller might be the future. After all, who doesn’t love the internet’s latest TV star — Baby Yoda?
Photo: Mark Ralston, Getty Images
