‘John Q.’s’ Public Warning

Hundreds of thousands of Americans watched this weekend as a desperate father held a hospital emergency room at gunpoint and demanded a heart transplant for his dying son.

Fortunately for everyone, it all happened in a movie, “John Q,” which opened Friday. The movie stars Denzel Washington as John Q. Archibauld, an Illinois factory worker who resorts to hostage-taking after learning that the hospital won’t even request an organ for his son without sufficient insurance coverage, which he doesn’t have.

In his scramble to save his son, Archibauld runs into one unbending bureaucrat after another. The hospital won’t help him raise funds. The factory, trying to save money, has downgraded his insurance to an HMO policy that pays only a fraction of the operation’s cost. Even Medicaid, the government assistance program for the poor, turns away the Archibaulds because their meager income is too high to qualify for the program. As his son’s heart winds down, tick by tick, John Q. sells off his possessions and becomes increasingly frantic.

Though medical experts object to some of the details of the story, they say it draws attention to issues worthy of public discussion: the role of employers in determining health coverage, the importance of understanding your insurance policy and, perhaps most important, the huge disparities in our current health-care system.

Strictly as a depiction of transplant medicine, the story is farfetched, experts say. For one thing, most children whose families are in financial need would qualify for state or federal funds to help pay for a heart transplant operation, said Larry Levitt, a vice president of the Kaiser Family Foundation, a Menlo Park health policy organization. There are also private funding groups across the nation, and many hospitals have staff trained to help families tap those resources, said Anne Paschke, a spokeswoman for the United Network for Organ Sharing in Richmond, Va., which coordinates organ procurement throughout the country.

Another issue highlighted in the movie is a type of insurance that places caps on medical benefits. The policy that John Q. has through his employer sets a $20,000 maximum cap on benefits, meaning that any medical expenses above that amount are not paid. But health benefits consultants say that employers rarely stick their workers with a capped policy without including some provision for a catastrophe. “A cap of $20,000 would be very low for an employer plan,” Levitt says. “More commonly, we see caps of $200,000 or $500,000.”

Many people fall through the cracks: 38 million Americans have no health insurance, and many are working adults who couldn’t afford an organ transplant. Some doctors believe that “John Q.” could strike a chord with audiences because it illustrates some of the inequities of the U.S. health system. “There’s a huge public concern about coverage, about how much health-care costs; and here’s a man fighting for his son’s life,” said Dr. Hillel Laks, director of the heart-lung transplant program at UCLA. “I think it’s going to hit a very big audience.”

And HMOs, which come in for a share of the criticism in the movie, apparently still make good villains. A current best-selling novel, “The Oath,” by John Lescroart, centers on an HMO executive who dies in a suspicious accident. And an upcoming made-for-television movie on Showtime is based on the true story of an executive at a health insurance company who blew the whistle on questionable business practices.

Before “John Q.” even premiered, the insurance industry launched an ad campaign framing the movie’s message as a plea to cover the uninsured, not an attack on HMOs.

In fact “John Q.” blasts the entire health-care system, also shedding some light on the role that employers play in deciding which types of health plans their workers will choose from. As the economy remains weak and health costs rise sharply, employers already have begun shifting more cost to workers, insurers say.

In such an environment, Kaiser’s Levitt said, it’s increasingly likely that employers will consider the type of policies that John Q. has, with lower benefit caps. “It’s a natural place to cut down on insurance costs,” Levitt said.

No one expects to need an organ transplant, of course, and few of us can contemplate a medical catastrophe when we’re healthy.

But if “John Q.” succeeds in reaching a large audience, it may well get people with insurance to look closely at what their policy covers and what it doesn’t, health experts said.

“It’s very important for people to know what their insurance pays for, and to know they can do something about it,” said UCLA’s Laks. “John Q. could have gone to the company and said, ‘I don’t like this policy. I want to spend $100 more and get better insurance.’ If he’s willing to go shoot people to save his son, why can’t he pay a little extra a month to make sure he’s covered?”