‘InHospitable’ Director Sandra Alvarez Reveals Why Pittsburgh’s Healthcare Situation is Not So Different Than Other Cities

Awards Daily’s Megan McLachlan talks to director Sandra Alvarez about her documentary InHospitable, which screened at the 2022 Miami Film Festival.

While watching the 2019 presidential primary debates, director Sandra Alvarez was struck by the way the candidates on both sides of the aisle tackled questions around healthcare.

“It was seeing them list out all the problems in the United States,” says Alvarez. “We have insurance, we have pharma, but you don’t hear about hospitals in Republican or Democratic debates. It’s something I had this question about, of looking at healthcare and trying to figure out the role of hospitals.”

So while Alvarez started doing research for what would become her documentary InHospitable, physician and author Elisabeth Rosenthal (An American Sickness) pointed her in the direction of what was going on in Pennsylvania, where the state Attorney General had filed a lawsuit against healthcare and insurance provider UPMC (University of Pittsburgh Medical Center). In 2019, UPMC was trying to create a monopoly where they would take patients with UPMC insurance and other providers, but not Highmark, the largest insurance provider in the region.

“That is a very, very rare thing, for an attorney general to take on such a powerful institution, especially in Pennsylvania where [UPMC is] the largest nongovernmental employer.”

Soon Alvarez reached out to some of the local organizations in the region and discovered they were developing this movement around the 2019 deadline for when the current UPMC-Highmark contract would expire. So she went to Pittsburgh to cover this unprecedented time.

“The Perfect Storm”: UPMC vs. Highmark

Now Alvarez was faced with a new question.

“How do you make a documentary about hospital consolidation that’s appealing and compelling to people who are not healthcare experts?”

She knew she wanted to tackle the topic in a way that humanized and personalized it for audiences, so she connected with the Pennsylvania Health Access Network (PHAN), a patient health advocacy group that had been collecting stories from patients to present to the public with political muscle from the Allegheny County Controller’s Office behind them.

Describing the situation as a “perfect storm,” when Alvarez reached out, PHAN gave her 20 videos of patients that they had filmed and edited together.

“So I basically had casting videos in front of me and I was able to pick [who to talk to],” she says.

Just Another Brick in the Wall

But as an outsider of the region, Alvarez’s understanding of the complex UPMC-versus-Highmark relationship was another hurdle she had to overcome.

“Explaining that whole relationship is so complex. It took me months to figure it out,” she says with a laugh. “Poor [TribLive reporter] Natasha Lindstrom—I was on the phone with her for hours trying to get it straight.”

In trying to figure out the complex legal situation, Alvarez realized she would also need to explain this relationship in the film, and how she would do it would be through an intricate animated sequence.

“The idea for the animation itself came from my husband because he loves Pink Floyd’s The Wall. It had an interesting way of depicting an institution pushing down on the man. We need to really understand the ways these large institutions affect each individual person. It was kind of perfect. I gave that to my animator [Simon Wilches] as a reference. He does a lot of beautiful work.”

What Makes Pittsburgh a Good City to Put Under a Microscope

Today, Pittsburgh has become a city known for technology, but at one time it was the epicenter of steel production. When that industry collapsed, healthcare institutions came in to fill the gaps and boost the economy with jobs. While Pittsburgh’s situation is put under a microscope in this doc, Alvarez says that sadly it’s not that unique.

“I think it’s not so different than a lot of other regions we’re looking at across the U.S. Sutter [Health] is doing the same thing in Northern California. Partners in Boston. These healthcare organizations are buying out all the doctors’ offices and hospitals around the area and essentially creating these monopolies. The only difference in Pennsylvania is that UPMC also has its own insurance arm as well. When other health organizations have tried to add the insurance arm, they just have not been able to be successful in terms of their outward claim of bringing down prices and lowering costs.”

As Alvarez and her crew documented the time leading up to the 2019 deadline, they realized they were also documenting a grassroots movement from the ground up, as the film demonstrates the power of protest.

“For me, what it really has showed is that mostly when it comes to healthcare, we’re all in these bubbles and silos. We get these huge bills and it feels like this lonely place. I think because of what happened in Pittsburgh with the deadline, it was an impetus to motivate people to all get together and speak out. What it taught me was the power of these patient advocacy organizations and how the ability to work as a collective can make you so much stronger.”

The film was screened for the Antitrust Subcommittee for the House and the Senate, with a couple of contributors from the film speaking at the hearing.

“We were told Amy Klobuchar watched the film and really learned from it and appreciated it.”

This is just the first step in spurring change, as Alvarez describes healthcare’s obstacles as being twofold.

“A lot of the issue is the lack of education, even on the politician’s side. Now that they know, they’re not going to do anything or act unless they know it’s an issue for their constituents. So it comes to educating them on what’s happening and motivating [the constituents] to act.”

InHospitable will be screening at the Cleveland Film Festival and the Phoenix Film Festival.