Arthur “Tim” Garson Jr., M.D., MPH, who leads the Texas Medical Center Health Policy Institute, is co-author of the book Health Care Half-Truths: Too Many Myths, Not Enough Reality. A physician and former medical school dean, Garson challenges commonly-held notions about the U.S. health care system. He spoke with Pulse about health care “myths.” This interview has been edited for clarity.
PULSE | Does the U.S. really have the best health care in the world?
TG | When you ask people whether the U.S. has the best health care in the world, the vast majority say “yes,” but when you ask how you measure that, you get blank stares. Two major measures are infant mortality and life expectancy. Depending upon the year, the U.S. ranks about 50th in each, which shocks people.
Medical care, on the other hand, is what doctors and nurses and patients do together. How many breast cancer screenings do we perform? What’s the mortality rate for coronary bypass? We are good at a few things—for example the U.S. ranks first in breast cancer mortality. But in the overall index of the rate of preventable deaths, we’re at the bottom of wealthy countries, ranked 18 out of 18.
There’s a frequently cited paper that says 10 percent of life expectancy is due to medical care, and 90 percent is the other things, including 40 percent that is due to people’s own behavior. If we want to improve health care, we can do a lot more by helping people quit smoking, overeating, doing drugs and committing murders.
PULSE | We hear all the time about how preventive care can save money, but you argue that’s not really the case. Could you elaborate?
TG | Let’s be really clear: prevention is important and must be done. But it rarely saves money. There are a lot of things that we do that are good for all kinds of reasons but don’t save money. In the case of prevention, saving money isn’t the point. The point is to keep people healthy.
For example, do immunizations save money? Measles immunizations do, because measles can result in a person becoming brain damaged, living a long time and requiring lots of expensive care. Preventing measles saves money. Some of the other immunizations are important to keeping people healthy, but they just don’t save money.
Here’s a real paradox: In a really well-done study, it was shown that over a very long time frame, smoking actually saves money. Why? If you smoke, you die earlier, and you don’t spend money over the course of a longer life.
PULSE | One of the things we’ve heard during the debates about health reform is that people can get insurance if they just go to work. Should we believe that?
TG | No. Uninsured people work. Data show that more than 70 percent of uninsured people come from working families. The real problem is that many of these people work for employers who aren’t offering insurance to their workers. Fewer than half of small businesses offer health insurance to their workers, according to the Kaiser Family Foundation.
As we discuss and debate the future of health care in this country, it’s important to understand that today, having a job doesn’t necessarily equate to having insurance.
PULSE | You published your book 10 years ago. How have your attitudes about the health care system changed?
TG | I’m more pessimistic now. In 2017, we were just one vote away from taking health insurance away from 20 million people, instead of giving health insurance to more people. I hope that’s a short-term aberration, rather than a view from our leaders who’ve decided the best thing we can do as a country is take health care away from 20 million people.
I was more optimistic in 2007. The last chapter of the book predicted that we would get a better health care system, but it would take a major disaster of some sort. I was wrong. We had the financial collapse in 2008, and despite the Affordable Care Act, there was no fundamental change to health policy. At some point, we’ll have a real safety net system, like just about every other country. We’re the only outlier. What I don’t know is what it will take for us to get there. But we have to keep trying.
Want to learn about more health care myths? Attend the TMC Health Policy Institute’s event: “True or False? A discussion challenging everything you think you know about health care.” 5:30–7 p.m. on Jan. 9, 2018, at the TMC Health Policy Institute, 6550 Bertner Ave., 6th floor. Free; registration required.
Baylor College of Medicine will be closed Monday, May 28 in observance of Memorial Day. https://t.co/6CNQMhyJ92
Baylor College of MedicineBaylorCollegeOfMedicine
Baylor College of Medicine will be closed Monday, May 28 in observance of Memorial Day.
TAMU Health Sciences@TAMHSC
#TAMHSC researchers are working to solve #diabetes-related blindness: https://t.co/D1Pi8CaD0H #Health
#Melanoma survivor explains how #immunotherapy #clinicaltrial and @DrSapnaPatel gave her hope. #CancerMoonShot #endcancer https://t.co/gxr9MaYsHi
MD Anderson Cancer CenterMDAnderson
Leticia Rousseve found comfort whenever she verbalized her frustrations and feelings to others who understood what she was going through as a caregiver for her husband, James, during his soft tissue sarcoma treatment. “This taught me an important lesson that I now share with others going through cancer: you are not alone.” Now, she pays it forward by volunteering with myCancerConnection, MD Anderson’s one-on-one cancer support community of patients, survivors and caregivers who have been there. #endcancer
At sprawling VA hospital in southern Dallas, a righteous battle to keep the promise to care for America's Veterans https://t.co/yBX7Jqyn6X via @dallasnews
6.1, 11:30 a.m.-1 p.m.: Join @MethodistHosp Cancer Center at St. John for a celebration and luncheon as we honor those living with a history of cancer. Register today: https://t.co/epZbgu9fA0 https://t.co/FLv19JSQs0
Today’s #VeteranOfTheDay is @USArmy Veteran M. Ross Kirk. https://t.co/Z1oqPWmWig
U.S. Department of Veterans AffairsVeteransAffairs
Today’s #VeteranOfTheDay is Army Veteran M. Ross Kirk. Ross served for 28 years and retired in 1988. He attained the rank of lieutenant colonel. Ross served two tours in Vietnam with the 4/39th Infantry Battalion, the 9th Infantry Division and the 5th Special Forces Group with the Chaplain Corps. He was also a member of the 101st Airborne Division, the 18th Airborne Corps 1st Division, and the Green Beret Parachute Demonstration Team. He wore the Green Beret on active duty for nine years and is nicknamed the “Leapin’ Deacon” due to his 225 military jumps, including 50 HALO (high altitude, low opening) jumps and 450 sport parachute jumps. Ross’ positions in the Army included Command Chaplain for the Special Operations Command (Airborne) and Senior Chaplain of the Combined Peacekeeping Forces in the liberation of Grenada. He retired at Fort Riley, Kansas in 1988 and has lived with his wife Judy in Wakefield, Kansas for 27 years. They have four children, eight grandchildren and one great-grandchild. Ross was awarded four Bronze Stars, five Air Medals, the Meritorious Service Medal with three Oak Leaf Clusters, the Joint Service Commendation Medal, the Army Commendation Medal with two Oak Leaf Clusters, the Army Achievement Medal and the Good Conduct Medal. He also earned the Ranger Tab, the Special Forces Tab and Master Parachutist and Air Assault Badges. Thank you for your service, Ross!
New @USDOT program provides free pilot training for Veterans https://t.co/z6mIJVPMlU via @Militarydotcom
New research funded by Department of Defense grants will look into why some women with estrogen receptor-positive breast cancer develop resistance to endocrine therapies. https://t.co/TMhNyXWZ8Y
Baylor College of MedicineBaylorCollegeOfMedicine
Congratulations to M.D/Ph.D. student Muhammad Saad Shamim on becoming a 2018 fellow of the Paul & Daisy Soros Fellowships for New Americans program.
#Chemobrain is real. Learn more about this common #cancer treatment side effect: https://t.co/86Kcj2AzFy #endcancer https://t.co/iH7IP2dIUv
What you need to know about #prostatecancer screening: https://t.co/Sbt5pA5B0J @oncolognews #endcancer
Dr. Elizabeth McIngvale talks about her journey with obsessive compulsive disorder. https://t.co/SxpIBc1gyA #MentalHealthAwarenessMonth