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Death by Pink Slip

A film on a health care system that impoverishes and kills people, just because they lose their jobs.
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The four forlorn figures Roger Weisberg follows in his new documentary, Critical Condition, spend a fair amount of screen time in stunned disbelief. Hard-working, rule-abiding and utterly devoid of self-pity, they find themselves in an increasingly common predicament: They have serious medical problems but no health insurance. As the fragility of their situation gradually becomes clear, they are filled with fear and frustration, which they express in muted, almost apologetic tones.

But where is the outrage? One woman laments that her dying husband deserved better, but she seems to be speaking out of grief more than anger — and she is by far the most outspoken person we meet. The default setting of several others seems to be shame; one senses an unspoken assumption that they have somehow failed the ones they love.

That’s one of several important insights found in Weisberg’s film, which premieres Sept. 30 on most PBS stations as part of the P.O.V. series. Its unstated subtext: Self-reliance is such a fundamental facet of American mythology that when stricken citizens are denied desperately needed help, they feel dumbfounded rather than demanding, bewildered rather than betrayed.

“Many of them are embarrassed by their predicament,” the filmmaker said in an interview from his New York office. “I also saw this in my previous documentary (Waging a Living, a 2006 PBS film about the struggles of the working poor) — that pervasive sense that you deserve what you get and you get what you deserve.”

Perhaps, as Weisberg notes, they are too depressed — too emotionally spent — to get indignant. Perhaps that is our job. Certainly the film points us in that direction, not through any agitprop tricks a la Michael Moore but by telling their stories in a straightforward way. We come away convinced the current system, under which 47 million Americans go uninsured, is indefensible from an economic, public-policy or moral standpoint.

A veteran documentary producer/director and two-time Academy Award nominee, Weisberg has studied the problems of the uninsured for a couple of decades; it was a peripheral subject in several of his previous films. Sensing access to health care would be a major issue in the 2008 presidential campaign, he approached PBS and some private funders with a proposal to focus on the topic. After securing the film’s $900,000 budget, he began contacting labor unions, advocacy organizations and safety-net health providers in a search for subjects.

After interviewing 100 uninsured people with significant medical problems, Weisberg and his staff narrowed their focus to 15 individuals, filming their often-frustrating interactions with the health care system for more than a year. Ultimately, four of them were chosen for inclusion in the documentary. (Two others had their stories turned into short documentaries; they will be included on the DVD of the film, which goes on sale around the time it is aired.)

To sketch them quickly: Joe Stornaiuolo spends 15 years as a hotel doorman. But when he is laid off, he loses his health insurance and is unable to afford the medication or doctor visits needed to manage his chronic liver disease (which, the film notes, was not caused by alcohol abuse). He is hospitalized four times in the course of a year as his condition steadily deteriorates.

Karen Dove has to leave her job as an apartment manager due to her weakening physical condition, but this renders her uninsured and without access to a doctor. Her recurrent abdominal pains go untreated for a year before she finally finds a physician willing to see her for free. She is diagnosed with stage-three ovarian cancer, which is almost always fatal.

Carlos Benitez is a full-time chef who makes a decent living, but given the expenses of raising a family, he decides he can’t afford the costly insurance plan offered by his restaurant. So his extremely painful chronic back condition goes untreated for years, until the director of family medicine at the University of California, Los Angeles spots him at a local community health fair and comes to his rescue.

Hector Cardenas, a laid-off warehouse manager and a diabetic, is told by his doctor that his badly infected foot can probably be saved with six more months of treatment. But since his insurance runs out before that, he opts to have it amputated. The operation is a success, but his troubles continue when his temporary prosthesis snaps in two. Without a permanent prosthesis to make him presentable, he has little chance of landing a decent job. But, of course, he needs the insurance such a job would provide to obtain an artificial foot.

Their stories meld the maxims of Joseph Heller and Roseanne Roseannadanna: If it’s not one Catch-22, it’s another. “Everybody in our film started off working,” Weisberg notes. “Several of them lost their jobs because they got ill. In our employer-based system, when you lose your job, you generally lose your health insurance” — which, of course, makes it far less likely you will return to health and find a new job.

Joe’s story clearly illustrates the system’s senseless circularity. Without insurance, he couldn’t afford the drugs he needed to manage his liver problems, which cost a few hundred dollars a month. But as his condition inevitably got worse, the government did pay for the resultant hospital stays, which cost tens of thousands of dollars. Critical care is a priority, but chronic care is not — until the patient deteriorates into critical condition.

Critical Condition compellingly makes the case that the lack of universal coverage is not only morally abhorrent but economically absurd. (Think of the lost productivity of these people.) “Every other country (in the industrialized world) has figured out how to guarantee some basic health care for all of its citizens,” Weisberg notes. “Why are we such an anomaly?”

The families Weisberg chronicles are all from the working class, and while this illustrates the truism that it is easy to fall off the edge when you are living close to it, a more inclusive approach might have helped the film hit closer to home for educated, upper-middle-class PBS subscribers. As it turns out, he had a story of misfortune among the well-to-do (or formerly well-to-do) but ultimately thought it didn’t quite fit.

“An affluent couple had twins who were born prematurely and spent three months in the ICU,” he says. “The insurance company decided they could rescind their coverage because the woman hadn’t disclosed she had a miscarriage five years earlier. So this family was left with over $1 million in medical bills. They had to sell their quite lovely house in Los Angeles.”
Weisberg decided this illustrated a different, if similarly troubling, problem: Even those who can afford individual insurance have no guarantee their coverage won’t be canceled on a pretext. Just the same, it illustrates a different aspect of a dysfunctional health care system and deserved to be included.

Even without it, Critical Condition is a frightening addition to a long-overdue national dialogue. Statistics (including the harrowing figures Weisberg periodically flashes onto the screen in lieu of voice-over narration) are one thing. Watching a man slowly die in front of your eyes, in the full knowledge it didn’t have to happen this way or this soon, is something else.

“I hope by presenting sympathetic, honest, decent Americans who play by the rules, get sick through no fault of their own and find themselves without health care coverage, people will be moved,” Weisberg says. “I think people can grasp the fact they may be a pink slip or a divorce away from being in their shoes.”

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